scholarly journals The Over 75 Service: Continuity of Integrated Care for Older People in a United Kingdom Primary Care Setting

2020 ◽  
Vol 20 (3) ◽  
Author(s):  
Julie MacInnes ◽  
Julia Baldwin ◽  
Jenny Billings
Keyword(s):  
Primary Care ◽  
United Kingdom ◽  
Older People ◽  
Integrated Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Service Continuity ◽  
Care For Older People

FRI0512 INTEGRATED CARE NETWORK AS A BUILDING STONE FOR SUSTAINABLE AND COMPREHENSIVE CARE FOR PATIENTS WITH ARTHRALGIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 855.1-855
Author(s):  
E. Van Delft ◽  
K. H. Han ◽  
J. Hazes ◽  
D. Lopes Barreto ◽  
A. Weel
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Integrated Care ◽  
Usual Care Group ◽  
Inflammatory Arthritis ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Group ◽  
Care Network ◽  
The Right

Background:Western countries experience an increasing demand for care, particularly for inflammatory arthritis (IA), while the healthcare budget decreases1. The innovative value-based primary care strategy2includes integrated care networks, where primary and secondary care bundle their expertise to improve patient value by providing the right care at the right place.General practitioners (GPs) have difficulties recognising IA, leading up to only 20% IA diagnoses of all newly referred arthralgia patients. However, since IA needs to be treated as early as possible to overcome progression, it is worthwhile to analyse whether integrated care networks have an impact on patient outcomes and cost-effectiveness. Triage by a rheumatologist in a primary care setting is one of the most promising integrated care networks for efficient referrals3.Objectives:To assess the effect of triage by a rheumatologist in a primary care setting in patients suspect for inflammatory arthritis.Methods:The present study follows a cluster randomized controlled trial design. The intervention, triage by a rheumatologist in a local primary care centre, will be compared to usual care. Usual care means that patients are referred to a rheumatology outpatient clinic based on the opinion of the general practitioner.The primary outcome is the frequency of IA diagnoses assessed by a rheumatologist. Patient reported outcome measures (PROMs (EQ-5D)) and costs (work productivity (iPCQ) and healthcare utilization (iMCQ)) were determined at baseline, after three, six and twelve months. The target was to include 267 patients for each study group (power level 0.8). Since this study is still ongoing we can only show first results on the efficiency of referrals.Results:In the period between February 2017 and December 2019 a total of 543 participants were included; 275 in the usual care group and 268 in the triage group. Mean age (51.3 ± 14.6 years) and percentage of men (23.6%) were comparable between groups (page=0.139; psex=0.330).The preliminary data show that the number of referred patients in the triage group is n=28 (10.5%) (Fig. 1). 32 patients (11.9%) were not referred directly but advice was given for additional diagnostics. Since all patients in the usual care group were referred there is a decrease of at least 77.6% in referrals when rheumatologists are participating in the integrated practice units.Preliminary data on diagnosis are available for all referred patients in the triage group and for n=137 (49.8%) in the usual care group at this point. In the triage group n=18 (64.2%) of referred patients were diagnosed with IA (6.7% of the total study population). In the usual care group this was n=52 (38.0%) of the patients yet diagnosed.Conclusion:These preliminary results of an integrated care network are promising. Approximately three-quarters of all patients can be withheld from expensive outpatient care. PROMs data and cost-effectiveness analysis will give clear answers in order to provide evidence whether this integrated care network can be implemented as a standard of care.References:[1] Rijksoverheid. (2018). Bestuurlijk akkoord medisch-specialistische zorg 2019 t/m 2022.https://www.rijksoverheid.nl/.[2] Porter ME, Pabo EA, Lee TH. (2013). Redesigning Primary Care: a strategic vision to improve value by organizing around patients’ needs. Health affairs, 32(3);516-525[3] Akbari A, et al. (2008). Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database Syst Rev, 4,CD005471.Disclosure of Interests:None declared

Crisis Intervention in Integrated Care

2017 ◽  
Author(s):  
Scott A. Simpson ◽  
Robert E. Feinstein
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Crisis Intervention ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Environment ◽  
Intervention Treatment ◽  
Response To Stress ◽  
Life Stressor ◽  
Integrated Team

A crisis occurs when a life stressor overwhelms a person’s ability to cope with a problematic life situation. Crises often become evident in the primary care setting. People in crisis feel distressed and alone; they experience a psychological disorganization that affects their mood and functioning. Most patients can benefit from a brief crisis intervention treatment delivered in an integrated care environment. Behavioral health specialists can lead crisis intervention therapy with the support of the primary care provider, nurses, staff, and a consulting psychiatrist. Crisis intervention treatment includes identifying the life stressor, understanding the patient’s response to stress, assessing the patient’s social system, listing possible solutions to the crisis, and working to implement those solutions. As the crisis resolves, the integrated team provides anticipatory guidance for the patient and primary provider.

scholarly journals Practical and validated tool to assess falls risk in the primary care setting: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e045431
Author(s):  
Wytske MA Meekes ◽  
Joke C Korevaar ◽  
Chantal J Leemrijse ◽  
Ien AM van de Goor
Keyword(s):  
Systematic Review ◽  
Risk Assessment ◽  
Primary Care ◽  
Older People ◽  
Care Setting ◽  
Primary Care Setting ◽  
Predictive Performance ◽  
Assessment Tools ◽  
Falls Risk ◽  
Risk Assessment Tools

ObjectiveAlthough several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently.DesignA systematic review based on prospective studies.MethodsAn extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included.ResultsSix falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%–83.3%, specificity:28.4%–96.6%).ConclusionsGiven that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history.Trial registraion numberThe Netherlands Trial Register, NL7917; Pre-results.

Treating Substance Use Disorders in Integrated Care Settings

2017 ◽  
Author(s):  
Patricia Pade ◽  
Laura Martin ◽  
Sophie Collins
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Integrated Care ◽  
Substance Use Disorders ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Assessment Process ◽  
Care Providers ◽  
Care Environment

Addiction and substance use disorders (SUDs) are extremely prevalent and are commonly encountered in the primary care setting. The traditional separation of SUD treatment from mainstream medicine has not been an optimal model of effective patient care. Primary care providers can play a crucial role in the recognition, intervention, and treatment of SUDs. This chapter provides an overview of the assessment process, intervention strategies, and pharmacologic and nonpharmacologic treatments that can be effectively implemented in an integrated care environment or primary care setting for a variety of SUDs. The integration of SUD treatment into integrated care environments holds the promise of improving acceptability to patients, decreasing the stigmatization of SUDs, enhancing satisfaction for providers, and improving outcomes for patients.

scholarly journals Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting

2016 ◽  
Vol 6 (6) ◽  
pp. 380-388 ◽  
Author(s):  
A. Fleischman ◽  
S. E. Hourigan ◽  
H. N. Lyon ◽  
M. G. Landry ◽  
J. Reynolds ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Pilot Study ◽  
Integrated Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Model
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