Chronic-Care-Management Programs for Multimorbid Patients with Diabetes in Europe: A Scoping Review with the Aim to Identify the Best Practice

Aim. This scoping review is aimed at providing a current descriptive overview of care programs based on the chronic care model (CCM) according to E. H. Wagner. The evaluation is carried out within Europe and assesses the methodology and comparability of the studies. Methods. A systematic search in the databases PubMed, Embase, and MEDLINE via OVID was conducted. In the beginning, 2309 articles were found and 48 full texts were examined, 19 of which were incorporated. Included were CCM-based programs from Belgium, Cyprus, Germany, Italy, Switzerland, and the Netherlands. All 19 articles were presented descriptively whereof 11 articles were finally evaluated in a checklist by Rothe et al. (2020). In this paper, the studies were tabulated and evaluated conforming to the same criteria. Results. Due to the complexity of the CCM and the heterogeneity of the studies in terms of setting and implementation, a direct comparison proved difficult. Nevertheless, the review shows that CCM was successfully implemented in various care situations and also can be useful in single practices, which often dominate the primary care sector in many European health systems. The present review was able to provide a comprehensive overview of the current care situation of chronically ill patients with multimorbidities. Conclusions. A unified nomenclature concerning the distinction between disease management programs and CCM-based programs should be aimed for. Similarly, homogeneous quality standards and a Europe-wide evaluation strategy would be necessary to identify best practice models and to provide better care for the steadily growing number of chronically multimorbid patients.

Prevalence and risk factors of upper gastrointestinal cancers missed during endoscopy: a nationwide registry-based study

Background and aims A significant proportion of upper gastrointestinal cancers (UGICs) remain undetected during esophagogastroduodenoscopy (EGD). We investigated the characteristics and risk factors of UGICs missed during endoscopy. Methods In this nationwide registry-based study, we analyzed two large Polish datasets: the National Health Fund and the National Cancer Registry, to identify individuals who underwent EGD and were subsequently diagnosed with UGICs. Cancers diagnosed <6 months after EGD were defined as “prevalent” and those within ≥6 and <36 months as “missed.” We compared the characteristics of missed and prevalent cancers and analyzed the risk factors for missed UGICs in a multivariable regression model. Results We included 4,105,399 patients (mean age 56.0 [±17.4] years; 57.5% female) who underwent 5,877,674 EGDs between 2012-2018. Within this cohort, 33,241 UGICs were diagnosed, of which 1,993 (6.0%) were missed. Within esophageal neoplasms, adenocarcinomas were more commonly missed than squamous-cell cancers (6.1% vs. 4.2%) with a relative risk of 1.4 (95% confidence interval [CI]:1.2–1.5, P=0.011). In the stomach, missed adenocarcinomas constituted 5.7%. Overall, missed UGICs presented more often at an advanced stage than prevalent cancers (42.2% vs. 36.2%, P<.001). Risk factors for missed UGICs included: initial EGD performed within primary (vs. secondary) care (odds ratio[OR] 1.3, 95%CI:1.2–1.5), female gender (OR 1.3; 95%CI:1.2–1.4), and higher comorbidity (Charlson comorbidity index ≥5 vs. 0; OR 6.0; 95%CI:4.7–7.5). Conclusions Esophageal adenocarcinomas are most commonly missed among UGICs. Overlooked cancers occur more frequently within the primary care sector and are found more often in women and individuals with multiple comorbidities.

Consumption of Antibacterials for Systemic Use in Slovakia: A National Study and the Quality Indicators for Outpatient Antibiotic Use

This paper aims to analyse the consumption of antibiotics in the Slovak health care system from 2011 to 2020. The data source on the consumption of antibiotics is sales data from SUKL and NCZI. The study employed the ATC/DDD Index and focused on the consumption of antibiotics in the primary care sector. Total antibiotic consumption decreased from 19.21 DID in 2011 to 13.16 DID in 2020. Consumption of beta-lactamase-sensitive penicillins, expressed as a percentage of the total consumption of antibiotics, decreased from 8.4% in 2011 to 4.2% in 2020. Consumption of the combination of penicillins, including beta-lactamase inhibitor, expressed as a percentage of the total consumption of antibiotics, increased from 16.2% in 2011 to 17.9% in 2020. Consumption of third- and fourth-generation cephalosporins, expressed as the percentage of the total consumption of antibiotics, increased from 2.0% in 2011 to 4.6% in 2020. Consumption of fluoroquinolones, expressed as the percentage of the total consumption of antibiotics, decreased from 10.7% in 2011 to 8.6% in 2020. Overall, antibiotic consumption significantly changed in Slovakia from 2011 to 2020. The ratio of the consumption of broad-spectrum to the consumption of narrow-spectrum penicillins, cephalosporins and macrolides decreased from 14.98 in 2011 to 13.38 in 2020.

The Association Between Admission to A Tertiary Children’s Hospital and Future Unplanned Dental Presentation

Objective: Dentistry should aim to prevent rather than focus on end-stage treatment which is more costly and less effective. This study investigated the association between unplanned dental presentations and any previous admissions at a tertiary hospital for children. Design: A retrospective analysis of 351 unplanned dental presentations at PCH was performed. Setting: A tertiary children’s hospital, the Perth Children’s Hospital (PCH). Main outcome measures: Reasons for unplanned presentations (infection, trauma, others) and the history of any previous admissions at PCH were analysed. Results: Dental infection and trauma were the main reasons for the unplanned dental presentations. More than half of those who presented due to dental infection had at least once previous admission at PCH due to other reasons. Patients who presented with dental infection were more likely to have previous visits by community nurse or social worker, while those who presented due to trauma, were more likely to have had previous visits at orthopaedic or fracture wards of the same hospital. Conclusions: Community nurses and social workers can possibly play a role in informing patients about dental care options in the primary care sector.

Giving patients a voice within healthcare reform: the qualitative VOICE study

Background: Inclusion of patients in healthcare service and system planning is an increasingly important tool to improve healthcare systems worldwide. In 2012, a focused healthcare reform was initiated in Austria to strengthen the primary care sector. Objectives: The aim of this study was to assess the perceptions, desires and needs of patients in terms of primary care as a necessary building block of the Austrian healthcare reform. Methods: This study was designed as an exploratory qualitative study using semi-structured interviews between the years 2013 and 2018. Research questions focused on patients positive and negative experiences with regard to GP consultations and the overall primary care system, as well as desires for improvement. Qualitative content analysis by Mayring was used to analyze the material. Results: Altogether, 41 interviews were conducted with seven main-categories identified. These categories include coordination and time management around consultation, human and professional aspects of consultation including coordination of care, access and availability including opening hours, infrastructure and hygiene of the waiting room, personnel, and overarching healthcare system factors. Conclusion: This study demonstrates the importance of bringing the patients voice into ongoing healthcare reform. Without appreciating and responding to patients perceptions and needs, healthcare reform in Austria might be challenged to improve in areas such as time, coordination and navigation. Successful health care reform necessitates the inclusion of the patient voice.

Developing a Patient Safety Culture in Primary Dental Care

Patient safety should be at the heart of any healthcare service. Systems, teams, individuals and environments must work in tandem to strive for safety and quality. Research into patient safety in dentistry is still in the early stages. The vast majority of the research in this area has originated from the secondary care and academic fields. Approximately 95% of dental care is provided in the primary care sector. In this paper, we provide an overview of the evidence base for patient safety in dentistry and discuss the following aspects of patient safety: human factors; best practice; the second victim concept; potential for over-regulation and creating a patient safety culture. Through discussion of these concepts, we hope to provide the reader with the necessary tools to develop a patient safety culture in their practice.

My Throat ”Tickles”

This article investigates the multiple ways in which bodies present themselves in email consultations (econs) between patients and general practitioners (GPs). The data stem from a larger qualitative research project on digital consultation in Denmark, focusing on the 65+ age group. Our analysis departs from a sociotechnical perspective by considering the introduction of the technology in question – the econ between the patient and GP – as creating new challenges and opportunities for participation in and the exchange of communication within this relationship. Our analysis leads to a six-category typology of bodies in affective discourse in econs: sensations, emotions, countings, medication, visuals and movements. The analysis brings together a theoretical perspective, the mutual shapings of the social and technological, with an affective practice-based approach. The econ produces what we call an “unruly data vitality”, as the data are accessed and recombined in the larger digital ecosystem of the Danish primary care sector.

Blockchain for Strengthening the Privacy of Healthcare Data

The desire for eHealth systems is ever-growing as public institutions, healthcare providers, and its users see the positive gains from having systems of patient health information held in a single place; a decentralized connected architecture called blockchain. This concept can solve the interoperability issues and integrate the fragmented way healthcare records are held and present a more transparent, secure method to share data and protect patient privacy. The aim of this article is to provide a supportive environment for the health and social care workplace with special reference in the Primary Care sector in England on the impact and changes to the information governance toolkit (IGTK) as a result of the new European General Data Protection Regulation (GDPR) coming into force from May 2018. These challenges will also include the implementation of the National Data Guardian (NDG) review of data security and opt-outs amongst others.

Cardiovascular Disease Patient Prevention Experience with Nurses in the Primary Care Sector

Introduction: Cardiovascular disease (CVD) is a common term used to refer to disorders affecting the blood vessels or the heart that have led to the majority of deaths worldwide. Aim: The aim of the present study was to explore nurse's perception of their role and their experiences in relation to engaging with cardiovascular disease prevention in the primary care setting. Methods: In the selection of clinical nurses who were interested in primary care to participate, qualitative describing design and impracticable sampling were used. The data collection methods include semi-structured and one-on-one interviews. The results were analyzed by the methodology for qualitative content analysis. Results: In this study, 10 nurses were participated and their role in CVD prevention plays a part in health education, diagnosis and consultation, reassurance, monitoring of vital signs, and collecting blood samples. The challenges include cultural obstacles and vocabulary, negative attitudes, contradictory regulations, a lack of equipment, a shortage of nursing staff and the lack of knowledge and information. Electronic information, patient education, nurse training, and communication workshops are the facilitators for nurses that prevent heart disease. Conclusion: Cardiovascular disease is lethal, but adequate preventive programs can accommodate it. In addition, nurses play an important role in preventing CVD in primary healthcare and should therefore concentrate efforts on the enhancement of their capacity. The aim of future research should be to understand how patients interpret and incorporate data on the prevention of CVD provided by nurses.

Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London

BackgroundMissed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector.AimTo evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions.Design and settingPractices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population.MethodStudy practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis.ResultsIn total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%.ConclusionForward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.