System Redesign: The Value of a Primary Care Liaison Model to Address Unmet Social Needs among Older Primary Care Patients

Assessing and addressing social determinants of health can improve health outcomes of older adults. The Nebraska Geriatrics Workforce Enhancement Program implemented a primary care liaison (PCL) model of care, including training primary care staff to assess and address unmet social needs, patient counseling to identify unmet needs, and mapping referral services through cross-sectoral partnerships. A PCL worked with three patient-centered medical homes (PCMHs) that are part of a large integrative health system. A mixed-methods approach using a post-training survey and a patient tracking tool, was used to understand the reach, adoption, and implementation of the PCL model. From June 2020 to May 2021, the PCL trained 61 primary care staff to assess and address unmet social needs of older patients. A total of 327 patients, aged 65 years and older and within 3–5 days of acute-care hospital discharges, were counseled by the PCL. For patients with unmet needs, support services were arranged through community agencies: transportation (37%), in-home care (33%), food (16%), caregiver support (2%), legal (16%), and other (16%). Our preliminary results suggest that the PCL model is feasible and implementable within PCMH settings to address unmet social needs of older patients to improve their health outcomes.

Team and personal coaching in general practice

NHS primary care staff can now access coaching for themselves and for managing a team. Dave Hancock explores some of the available options

Development and Preliminary Evaluation of an Education Program for Primary Care Teams on Discussing Firearms Storage Safety with Veterans

Background Reducing access to lethal means is one of the few empirically supported approaches for lowering suicide rates, and safe firearms storage practices have been associated with reduced risk of death by suicide. Although there is substantial opportunity for primary care to assist in addressing lethal means with veterans, approaches to intervention and educating staff are not well documented. We sought to 1) describe development of an education program for primary care teams to help them discuss firearms storage safety (FSS) with veterans during primary care visits; and 2) conduct a preliminary evaluation of the pilot education program. Methods We used an iterative process involving veterans and primary care staff stakeholders to develop program content, format, and supplemental materials. A grounded theory approach was used to analyze data from focus groups and individual interviews. Following piloting of the program with 71 staff members in two primary care clinics, we analyzed pre- and post-training participant surveys of program satisfaction and attitudes and behaviors related to firearms safety. Results During the development phase, 68 veterans and 107 staff members participated in four veteran focus groups and four primary care focus groups, respectively, and/or individual interviews. The program that was developed, “’Just in Case’: Discussing means safety with veterans at elevated risk for suicide,” addresses knowledge and skills learning objectives, and includes video demonstrations and skills practice. Survey data obtained just prior to the two pilot training sessions showed low self-reported rates of discussing firearms safety with veterans who may be at elevated risk for suicide. Immediate post-training data showed generally high satisfaction with the program and significant improvements in participant self-reported ratings of the importance of, and comfort with FSS. Conclusions The program shows promise as a means for educating primary care staff to deliver messaging about firearms safety to veterans. Additional research is needed to refine and evaluate impacts of this or similar training programs on clinician and veteran behaviors over time.

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

COVID-19 is disproportionately impacting people in low-income communities. Primary care staff in deprived areas have unique insights into the challenges posed by the pandemic. This study explores the impact of COVID-19 from the perspective of primary care practitioners in the most deprived region of England. Deep End general practices serve communities in the region’s most socioeconomically disadvantaged areas. This study used semi-structured interviews followed by thematic analysis. In total, 15 participants were interviewed (11 General Practitioners (GPs), 2 social prescribing link workers and 2 nurses) with Deep End careers ranging from 3 months to 31 years. Participants were recruited via purposive and snowball sampling. Interviews were conducted using video-conferencing software. Data were analysed using thematic content analysis through a social determinants of health lens. Our results are categorised into four themes: the immediate health risks of COVID-19 on patients and practices; factors likely to exacerbate existing deprivation; the role of social prescribing during COVID-19; wider implications for remote consulting. We add qualitative understanding to existing quantitative data, showing patients from low socioeconomic backgrounds have worse outcomes from COVID-19. Deep End practitioners have valuable insights into the impact of social distancing restrictions and remote consulting on patients’ health and wellbeing. Their experiences should guide future pandemic response measures and any move to “digital first” primary care to ensure that existing inequalities are not worsened.

Exploring the Effect of the COVID-19 Pandemic on the Dental Team: Preparedness, Psychological Impacts and Emotional Reactions

Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems.Aim: To investigate features of health and well-being as an outcome of the uncertainties surrounding COVID-19 for dentists and dental health professionals in primary dental care and for those in training. In addition, the study examined the well-being indices with reference to normative values. Finally a theoretical model was explored to explain depressive symptoms and investigate its generalisability across dentists and dental health professionals in primary dental care and those in postgraduate training.Methods: A cross-sectional survey of dental trainees and primary dental care staff in Scotland was conducted in June to October 2020. Assessment was through “Portal,” an online tool used for course bookings/management administered by NHS Education for Scotland. A non-probability convenience sample was employed to recruit participants. The questionnaire consisted of four multi-item scales including: preparedness (14 items of the DPPPS), burnout (the 9 item emotional exhaustion subscale and 5 items of the depersonalisation subscale of the MBI), the 22 item Impact of Event Scale-Revised, and depressive symptomatology using the Patient Health Questionnaire-2. Analysis was performed to compare the levels of these assessments between trainees and primary dental care staff and a theoretically based path model to explain depressive symptomology, utilising structural equation modelling.Results: Approximately, 27% of all 329 respondents reported significant depressive symptomology and 55% of primary care staff rated themselves as emotionally exhausted. Primary care staff (n = 218) felt less prepared for managing their health, coping with uncertainty and financial insecurity compared with their trainee (n = 111) counterparts (all p's < 0.05). Depressive symptomology was rated higher than reported community samples (p < 0.05) The overall fit of the raw data applied to the theoretical model confirmed that preparedness (negative association) and trauma associated with COVID-19 (positive association) were significant factors predicting lowered mood (chi-square = 46.7, df = 21, p = 0.001; CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). Burnout was indirectly implicated and a major path from trauma to burnout was found to be significant in primary care staff but absent in trainees (p < 0.002).Conclusion: These initial findings demonstrate the possible benefit of resourcing staff support and interventions to assist dental staff to prepare during periods of high uncertainty resulting from the recent COVID-19 pandemic.

PERCEPTIONS PERTAINING TO STIGMA AND DISCRIMINATION ABOUT DEPRESSION: A FOCUS GROUP STUDY OF PRIMARY CARE STAFF

"The present study was conducted to explore the perception and views of primary care staff about Depression related Stigma and Discrimination. The Basic Qualitative Research Design was employed and an In-Depth Semi-Structured Discussion Guide consisted of 7 question was developed on the domains of Pryor and Reeder Model of Stigma and Discrimination such as Self-Stigma, Stigma by Association, Structural Stigma and Institutional Stigma, to investigate the phenomenon. Initially, Field Test and Pilot study were conducted to evaluate the relevance and effectiveness of Focus Group Discussion Guide in relation to phenomena under investigation. The suggestions were incorporated in the final Discussion Guide and Focus Group was employed as a data collection measure for the conduction of the main study. A purposive sampling was employed to selected a sample of Primary Care Staff (Psychiatrists, Medical Officers, Clinical Psychologists and Psychiatric Nurses) to elicit the meaningful information. The participants were recruited from the Department of Psychiatry of Pakistan Medical and Dental Council (PMDC) recognized Private and Public Sector hospitals of Lahore, having experience of 3 years or more in dealing with patients diagnosed with Depression. However, for Medical Officers, the experience was restricted to less than one year based on their rotation. To maintain equal voices in the Focus Group, 12 participants were approached (3 Psychiatrist, 3 Clinical Psychologists, 3 Medical Officers and 3 Psychiatric Nurses) but total 8 participants (2 Psychiatrists, 2 Medical Officers, 3 Clinical Psychologists And 1 Psychiatric Nurse) participated in the Focus Group. The Focus Group was conducted with the help of Assistant Moderator, for an approximate duration of 90 minutes at the setting according to the ease of the participants. Further, it was audio recorded and transcribed for the analysis. The Braun and Clarke Reflexive Thematic Analysis was diligently followed through a series of six steps such as Familiarization with the Data, Coding, Generating Initial Themes, Reviewing Themes, Defining and Naming Themes. The findings highlighted two main themes i.e., Determining Factors of Mental Health Disparity and Improving Treatment Regimen: Making Consultancy Meaningful. The first theme was centered upon three subthemes such as Lack of Mental Health Literacy, Detached Attachment and Components of Stigma and Discrimination. The second theme included Establishing Contact and Providing Psychoeducation as a subtheme. The results manifested the need for awareness-based Stigma reduction intervention for Primary Care Staff aims to provide training in Psychoeducation and normalization to reduce Depression related Stigma and Discrimination among patients diagnosed with Depression."