scholarly journals Care plan use among older people with functional impairment: analysis of the English General Practice Patient Survey

2018 ◽  
Vol 6 (4) ◽  
pp. 571
Author(s):  
Alice Shiner ◽  
John A Ford ◽  
Nicholas Steel
Keyword(s):  
General Practice ◽  
Older People ◽  
Functional Impairment ◽  
Planning Process ◽  
Interpersonal Relationship ◽  
Patient Survey ◽  
Care Plan ◽  
Care Planning ◽  
Care Plans ◽  
Practice Patient

Objectives: Care plans may improve health when patients are involved in the care planning process. They are recommended for primary care.  This study aimed to identify characteristics of older patients with functional impairment (age ≥75 years with problems completing daily activities) who report having a care plan and who are involved in care planning.Methods: The General Practice Patient Survey (individual-level dataset) 2015-16 in England was analysed. Logistic regression was used to estimate associations between having a care plan and being involved with care planning and age, gender, ethnicity, deprivation, multimorbidity, interpersonal relationship with general practitioner (GP) and other variables, clustered at practice level.Results: Three point five percent of GPPS respondents and 14.4% of older people with functional impairment reported having a care plan; however, only a quarter of the latter were involved with the care planning process. Involvement with care planning was associated with seeing own GP (odds ratio (OR) 1.88, 95% confidence interval (CI)1.48 to 2.38) and factors reflecting a positive interpersonal relationship with the GP, including having confidence in the GP (OR 5.92, CI 2.38 to 14.77). Respondents involved with care planning reported greater confidence in managing their own health.Conclusions: Few older people with functional impairment report having a care plan and fewer report involvement in the care planning process. This may reduce the ability of care plans to deliver health benefits and person-centered care.

Care planning and adherence to diabetes process guidelines: Medicare data analysis

2013 ◽  
Vol 37 (1) ◽  
pp. 83 ◽  
Author(s):  
Akuh Adaji ◽  
Peter Schattner ◽  
Kay Margaret Jones ◽  
Bronwyn Beovich ◽  
Leon Piterman
Keyword(s):  
General Practice ◽  
Strong Association ◽  
Hdl Cholesterol ◽  
Practice Management ◽  
Care Plan ◽  
Care Planning ◽  
Process Measures ◽  
Care Plans ◽  
Management Plans ◽  
Chi Square Analysis

Objective. To test the association, in patients with a diagnosis of diabetes I and II, between having or not having a care plan, (i.e. General Practice Management Plans (GPMPs),Team Care Arrangements (TCAs)), and having the recommended number of biochemical checks according to the diabetes Annual Cycle of Care guideline. The checks comprised HbA1c, HDL cholesterol and urinary microalbumin. Methods. Chi-square analysis of retrospective group data obtained from the Medicare database (from ‘billing’ patterns only). Results. The creation of GPMPs was associated with general practitioners (GPs) requesting checks for HbA1c (59.7%), HDL cholesterol (36.9%) and microalbumin (50.8%) for diabetes patients in accordance with guideline recommendations. Although the introduction of multidisciplinary care via a TCA was associated with an increase in the frequency of HbA1c checks (61.3%) in accordance with the guidelines, there was a reduction in the number of HDL cholesterol (23.7%) and microalbumin (36.8%) checks. The group with no care plans had the lowest association with HbA1c (47.8%), HDL cholesterol (19.7%) and microalbumin (29.3%) checks that met guideline requirements for diabetes. Conclusions. The use of GPMPs showed strong association with increased testing of process measures that met guideline requirements for diabetes. Further research is needed to understand the value and benefits of TCAs in promoting adherence to diabetes guidelines. What is known about the topic? Research suggests that care planning is associated with increased adherence by GPs to some of the processes of care stipulated in diabetes guidelines. What does the paper add? This study examines Australia-wide data obtained from Medicare. The findings demonstrated strong association between care planning and the process measures examined in this study. In contrast to previous studies, multidisciplinary team involvement via a TCA appeared to be less important than a GPMP in promoting adherence to process measures. What are the implications for practitioners? GPs should continue to provide structure care to patients via General Practice Management Plans.

Prevalence and Benefits of Care Plans and Care Planning for People with Long-Term Conditions in England

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 64-71 ◽  
Author(s):  
Jenni Burt ◽  
Martin Roland ◽  
Charlotte Paddison ◽  
David Reeves ◽  
John Campbell ◽  
...  
Keyword(s):  
Patient Survey ◽  
Care Plan ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Long Term Conditions ◽  
Patient Reports ◽  
Care Plans ◽  
Interpersonal Care

Objectives Among patients with long-term conditions, to determine the prevalence and benefits of care planning discussions and of care plans. Methods Data from the 2009/10 General Practice Patient Survey, a cross sectional survey of 5.5 million patients in England. Outcomes were patient reports of: care planning discussions; perceived benefit from care planning discussions and resultant care plans. Patient and practice variables were included in multilevel logistic regression to investigate predictors of each outcome. Results Half the respondents (49%) reported a long-term condition and were eligible to answer the care planning questions. Of these, 84% reported having a care planning discussion during the last 12 months and most reported some benefit. Only 12% who reported a care planning discussion also reported being told they had a care plan. Patients who reported having a care plan were more likely to report benefits from care planning discussions. Several factors predicted the reporting of care planning and care plans of which the most important was patients' reports of the quality of interpersonal care. Conclusions There is a gap between policy and current practice which might reflect uncertainty as to the benefits of care plans. There is, therefore, a need for rigorous evaluation of care plans.

Do our current approaches to care planning and the CPA enhance the experience and outcomes of a person's recovery?

2014 ◽  
Vol 9 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Miles Rinaldi ◽  
Flippa Watkeys
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Planning Process ◽  
Action Plan ◽  
Care Plan ◽  
Care Planning ◽  
Care Programme ◽  
Content Type ◽  
Care Plans

Purpose – Increasingly mental health services are attempting to become recovery focused which demands changing the nature of day-to-day interactions and the quality of the experience in services. Care planning is the daily work of mental health services and within this context, care planning that enhances both the experience and the outcomes of a person's recovery is a key element for effective services. However, care plans, the care planning process and the Care Programme Approach (CPA) continue to pose a challenge for services. The purpose of this paper is to discuss these issues. Design/methodology/approach – Conceptual paper. Findings – Within recovery focused services a care plan becomes the driving force, or action plan, behind a person's recovery journey and is focused on their individual needs, strengths, aspirations and personal goals. If involving people directly in the development of their care plan is critical to creating better outcomes then supporting self-management, shared decision making and coproduction all underpin the care planning process. Based on the evidence of people's experience of care plans and the care planning process it is time to seriously debate our current conceptualisation and approach to care planning and the future of the CPA. Originality/value – The paper describes aspects of the current situation with regard to the effectiveness of care planning in supporting a person's recovery. The paper raises some important questions.

Using a multi-disciplinary process-mapping approach for care plan program design.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18203-e18203
Author(s):  
Meredith Jones
Keyword(s):  
Planning Process ◽  
Clinical Information ◽  
Care Plan ◽  
Successful Implementation ◽  
Care Planning ◽  
Process Mapping ◽  
Care Coordinator ◽  
Care Plans ◽  
Care Coordinators ◽  
The Impact

e18203 Background: The Center for Medicare and Medicaid Innovation has challenged oncology practices to engage in practice transformation activities through participation in the Oncology Care Model (OCM). One difficult requirement of OCM is the creation of care plans inclusive of the 13 IOM components. Though OCM does not require that care plans be given to patients, true practice transformation exists not only with care plan creation, but with delivery and education to patients and caregivers. Many challenges to care plan implementation exist, starting with the lack of staff dedicated to the care planning process. Methods: Two multi-disciplinary teams representing the Medical Oncology Clinic were formed to simulate and process-map current workflow, incorporating care plan generation and delivery. First, teams process-mapped current workflows utilizing existing staff to establish a baseline. Second, teams added care planning to the baseline and determined whether existing or new staff would be needed to accomplish the OCM care plan requirements. Both teams received the same 6 care planning steps: 1. Enter patient demographics into software, 2. Give patient survey, 3. Enter clinical information in software, 4. Generate plan, 5. Print/deliver plan, and 6. Scan into EMR. Results: Both teams completed process mapping with minimal variation at baseline. However, the teams disagreed on responsible staff for each care planning step. Both teams agreed, though, that 4 out of 6 steps must be completed by RNs, NPs or Physicians. Both teams also indicated that current RN staffing levels would not accommodate capacity to add care planning responsibilities to existing positions, due to the time-consuming nature of the care planning process. Conclusions: Multi-Disciplinary teams recommended addition of RN Care Coordinator positions to oversee the care planning process. Successful implementation requires hiring adequate numbers of RN Care Coordinators that, with a reasonable caseload each, will manage the process, track patients and evaluate outcomes. Future opportunities exist to research the impact that the addition of both care plan delivery and RN Care Coordinators have on patient satisfaction and outcomes.

scholarly journals Exploring shared care plans for older people regarding fulfillment of policy requirements and shared decision making - A qualitative study

2021 ◽  
Vol 9 (2) ◽  
pp. 154-183
Author(s):  
Anna Condelius ◽  
Magdalena Andersson
Keyword(s):  
Decision Making ◽  
Older People ◽  
Shared Decision Making ◽  
Social Services ◽  
Planning Process ◽  
Shared Care ◽  
Care Planning ◽  
Shared Decision ◽  
Next Of Kin ◽  
Care Plans

The aim was to explore the documentation in shared care plans regarding the fulfilment of policy requirements and shared decision-making. The sample consists of 15 shared care plans established for older people in Sweden. The analysis was performed using directed content analysis. The requirements in the Swedish law and the 15 indicators of shared decision making (SDM) in the Multifocal Approach to the Sharing in SDM inventory was used to define the main categories. The policy requirements were fulfilled to a varied extent. All the care plans were established in collaboration between the municipality and the county council, but social services were not represented in six of them. The older person and next of kin were present at 14 of the care planning meetings. The individual’s agreement to the establishment was documented in ten of the plans but how and what the person had agreed to was not specified further. The headings focused at the policy requirements and did not support a care planning process, or a documentation based on SDM. Six out of 15 indicators of SDM were reflected. The decision-making process needs to be acknowledged more in the process of establishing shared care plans for older people.

scholarly journals Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041569
Author(s):  
Lucina Rolewicz ◽  
Eilís Keeble ◽  
Charlotte Paddison ◽  
Sarah Scobie
Keyword(s):  
General Practice ◽  
Unmet Need ◽  
Patient Survey ◽  
Secondary Outcome ◽  
Community Based ◽  
Long Term Conditions ◽  
Local Services ◽  
Community Based Services ◽  
Practice Patient

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

scholarly journals A decline in patient disclosure of heterosexuality in the English General Practice Patient Survey: a longitudinal analysis of cross-sectional data

2020 ◽  
Vol 37 (5) ◽  
pp. 661-667
Author(s):  
Harry Cross ◽  
Carrie D Llewellyn
Keyword(s):  
Health Care ◽  
General Practice ◽  
Sexual Orientation ◽  
Descriptive Analysis ◽  
Patient Survey ◽  
Cross Sectional ◽  
Orientation Data ◽  
Heterosexual Identity ◽  
Health Care Experiences ◽  
Practice Patient

Abstract Background Persistent health inequalities in relation to both health care experiences and health outcomes continue to exist among patients identifying with a marginalized sexual orientation (MSO). Objective To compare the patterns of sexual orientation disclosure within primary care in England over a 5-year period. Methods Descriptive analysis of cross-sectional, repeat measure, fully anonymized survey data of adults responding to the General Practice Patient Survey (GPPS) January 2012 to 2017. Participants from each year varied between 808 332 (2017) and 1 037 946 (2011/2012). Results The analysis samples comprised between 396 963 and 770 091 individuals with valid sexual orientation data depending on the year. For males, heterosexual disclosure decreased consistently from 92.3% to 91.2% from 2012 to 2017. Male patients reporting gay, bisexual and/or ‘other’ sexual orientations increased from 3.1% to 3.9%. For females, a larger reduction in heterosexual disclosure was recorded from 94% to 92.5%. Those reporting as lesbian, bisexual and/or ‘other’ increased from 1.82% to 2.68%, with the largest increase seen in the reporting of bisexuality, which nearly doubled from 2012 until 2017 (0.56–0.99%). Conclusion We found a year-on-year decline in patients reporting a heterosexual identity and an increase in the proportions of people reporting being either gay, bisexual, ‘other sexual orientation’ or preferring not to say. Heteronormative environments extend to health care settings, which may put increased stress on MSO individuals attending a GP practice. The introduction of environmental signs/symbols to show that a practice is inclusive of MSOs could reduce the potential stress experienced by patients.

scholarly journals What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018690 ◽  
Author(s):  
Charlotte A M Paddison ◽  
Gary A Abel ◽  
Jenni Burt ◽  
John L Campbell ◽  
Marc N Elliott ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Experience ◽  
Secondary Analysis ◽  
Patient Survey ◽  
Models Of Care ◽  
Unintended Consequences ◽  
Multidisciplinary Teams ◽  
Face To Face ◽  
Patient Reported ◽  
Practice Patient

ObjectivesTo examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse).DesignSecondary analysis of data from the 2013 to 2014 General Practice Patient Survey.Setting and participants870 085 patients from 8005 English general practices.OutcomesPatient ratings of communication and ‘trust and confidence’ with the clinician they saw.Results77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse the last time they tried to make an appointment (weighted percentages). Being unable to see or speak to the practitioner type of the patients’ choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead. The greatest difference was for patients who asked to see a GP and instead spoke to a nurse for whom the adjusted mean difference in confidence and trust compared with those who wanted to see a nurse and did see a nurse was −15.8 points (95% CI −17.6 to −14.0) for confidence and trust in the practitioner and −10.5 points (95% CI −11.7 to −9.3) for net communication score, both on a 0–100 scale.ConclusionsPatients’ evaluation of their care is worse if they do not receive the type of consultation they expect, especially if they prefer a doctor but are unable to see one. New models of care should consider the potential unintended consequences for patient experience of the widespread introduction of multidisciplinary teams in general practice.

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