Quality in primary care最新文献

{"title":"Quality of thyroid referrals in Saskatchewan.","authors":"Kerollos Wanis,&nbsp;Jennifer Oucharek,&nbsp;Gary Groot","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A thyroid nodule is a common presentation for thyroid pathology. A low proportion of thyroid nodules harbour malignancy and the investigation of these nodules should be performed in a cost-effective manner. The American Thyroid Association (ATA) has published guidelines which should aid physicians in performing the appropriate investigations.</p><p><strong>Aim: </strong>To determine the proportion of patients referred to thyroid surgeons in Saskatchewan with appropriate pre-referral work-up.</p><p><strong>Methods: </strong>Data were retrospectively collected from the charts of all new thyroid referrals seen between 8 June 2011 and 8 June 2012 by two thyroid surgeons in the Saskatoon Health Region, Saskatchewan, Canada. Main outcome measures were the presence of thyroid stimulating hormone (TSH) and ultrasound results, and the appropriateness of ultrasound report recommendations in referrals to thyroid surgeons.</p><p><strong>Results: </strong>Recent TSH results were done and sent to the thyroid surgeon in 55.1% of referrals. A recent ultrasound was performed in 92.3% of referrals. Of patients with a high or normal TSH, a radionuclide scan was inappropriately recommended in 11.5% of cases.</p><p><strong>Conclusion: </strong>There is room for improvement in pre-referral work-up of patients with thyroid nodules in Saskatchewan, in order to facilitate appropriate clinical decision making in a cost-effective manner.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 4","pages":"247-52"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31737190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Francis inquiry: a lost opportunity?","authors":"Steve Gillam","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 4","pages":"205-6"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31737263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Dutch government: strong primary care close to the people.","authors":"Peter P Groenewegen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 1","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31480200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are prescribing initiatives readily transferable across classes: the case of generic losartan in Scotland?","authors":"Marion Bennie,&nbsp;Iain Bishop,&nbsp;Brian Godman,&nbsp;Stephen Campbell,&nbsp;Jamilette Miranda,&nbsp;Alexander E Finlayson,&nbsp;Lars L Gustafsson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>There are on-going initiatives in Scotland to improve the quality and efficiency of prescribing in primary care. Activities to enhance prescribing of angiotensin-converting enzyme inhibitors (ACEIs) versus angiotensin receptor blockers (ARBs) include prescribing guidance, guidelines, benchmarking, prescribing targets and financial incentives. These measures stabilised reimbursed expenditure for renin-angiotensin inhibitor drugs between 2001 and 2007 despite a 159% increase in volumes. Generic losartan was included in the Drug Tariff from July 2010. As there is no appreciable difference between ARBs, and the prices of generic losartan are falling, health boards should be actively encouraging its prescribing.</p><p><strong>Aim: </strong>To primarily assess changes in utilisation patterns of losartan versus other ARBs after July 2010. Second, to assess the utilisation of generic versus originator losartan.</p><p><strong>Method: </strong>We used an interrupted time series analysis of ARB utilisation, measured in defined daily doses (DDDs) before and after July 2010. Utilisation data were obtained from the NHS National Services Scotland Corporate Warehouse.</p><p><strong>Results: </strong>There was no significant change in the utilisation pattern of losartan or other ARBs combined before or after the introduction of generic losartan. Losartan accounted for 32% of total ARBs 12 months after listing. Between 98 and 99% of losartan was prescribed generically. In March 2012, the price of losartan was 88% below prepatent prices with potential savings of ?8m per year.</p><p><strong>Conclusion: </strong>Specific measures are needed to change prescribing habits especially with complex messages. The cost of deriving savings must be weighed against other quality initiatives and other ARBs losing or shortly losing their patents.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 1","pages":"7-15"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31480202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership, organisational culture and the continuing cultural divide in UK health services.","authors":"A Niroshan Siriwardena","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 2","pages":"61-2"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31480207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NICE and the Quality and Outcomes Framework (QOF) 2009-2011.","authors":"Daniel Sutcliffe,&nbsp;Helen Lester,&nbsp;John Hutton,&nbsp;Tim Stokes","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The National Institute for Health and Clinical Excellence (NICE) has been responsible for managing the process of developing new clinical and health improvement indicators for the United Kingdom (UK) Quality and Outcomes Framework (QOF) and reviewing the current QOF clinical indicator set since April 2009. This paper sets out in detail the NICE-led process for QOF indicator development and describes experience to date (2009-2011) in four key areas: prioritisation of clinical guideline recommendations by the QOF advisory committee, development and piloting of quality indicators, cost-effectiveness analysis and retirement of QOF indicators. It concludes by reflecting on potential future developments of the QOF.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"20 1","pages":"47-55"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30616501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalfoodie: an interprofessional case study of the redesign of the nutritional management and monitoring system for vulnerable older hospital patients.","authors":"Alastair S Macdonald, Gemma Teal, Claire Bamford, Paula J Moynihan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>To date, a solution to the problem of hospital malnutrition in older patients in the UK has not been found through previous approaches using isolated interventions.</p><p><strong>Aims: </strong>To identify opportunities for, and to develop and prototype a new food and nutritional management system able to meet individual patients' daily requirements.</p><p><strong>Methods: </strong>Using an interprofessional team approach, design researchers worked alongside food scientists, dieticians, medical sociologists, ergonomists, computer scientists, technologists, key stakeholders and a 'food family' (those concerned with nutrition management, and food supply and delivery in hospital, i.e. food producers, caterers, ward staff, nurses dieticians, physicians, speech and occupational therapists), as well as with older people representatives. Through ethnography and workshop-based methods, major opportunities for service improvement were identified. An iterative design and development process was deployed using mixed methods including ethnography, mapping, personas, storyboarding, role-playing, enactment and narratives. Prototypes of interactive interfaces were developed to test the workability of an electronic nutritional management and monitoring system linked to a nutrition composition database. In parallel, new food products were developed, led by food scientists, and a catering supply and delivery system for ward-based food provision was also developed. The methods used to facilitate interprofessional collaboration, the engagement of the food family, and to develop the food and nutrition service concept are described.</p><p><strong>Results: </strong>A demonstration prototype was displayed in exhibition format at a series of conferences to gather further feedback.</p><p><strong>Conclusion: </strong>Early responses to the 'hospitalfoodie' demonstration prototype were favourable and indicate that, with further development, the prototype may offer the means for improving nutritional care standards in hospitals and be adaptable for use across other patient groups.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"20 3","pages":"169-77"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30786093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recruiting children onto research studies by the Scottish Primary Care Research Network: a real team effort.","authors":"Amanda Cardy, Sam Holden, David Watson, Donna Nelson, Steve Turner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Recruiting for research studies is always a challenge, particularly in paediatric studies. Here we report on experiences recruiting children to five studies through primary care.</p><p><strong>Methods: </strong>The Scottish Primary Care Research Network (SPCRN) has approval to identify for research studies eligible participants on primary care practice lists. The number of potential participants and the proportion recruited onto five paediatric studies are provided along with factors involved in recruiting practices and patients.</p><p><strong>Results: </strong>A total of 4910 individuals were recruited, of whom 367 (7%) participated. Recruitment of practices varied between 7 and 44% for different studies. There was evidence that practices who had participated in previous studies were more likely to participate again. Patient participation was positively related to affluence and there was evidence that adults were more likely to participate than children.</p><p><strong>Discussion: </strong>Despite the pressing clinical workload in primary care, many general practices are still able to make accommodation for research activity. What is required is effective communication between colleagues in primary care, researchers, the SPCRN and patients. Given that the majority of medicine is practiced in primary care, there is a desire for evidence-based medicine to be generated from primary care and the SPCRN and other networks can help to provide this.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"20 3","pages":"199-206"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30787511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targets and prioritization: the case of cancer in the English NHS.","authors":"Anthony J Harrison,&nbsp;Catherine S Foot","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>From 1999 onwards, patients judged by their general practitioners (GPs) to require urgent access to care for suspected cancer have been referred under the so-called two-week wait rule, or fast track, which guaranteed that they would be seen in a hospital clinic within that period. The two-week wait was introduced in the belief that England's relatively poor cancer outcomes were due, at least in part, to delays in accessing care. This paper assesses the impact of the two-week wait against a number of criteria. Although the NHS has largely succeeded in meeting this target, there is little evidence that it has improved outcomes.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"20 2","pages":"125-9"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30782880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare in Asia: a perspective from primary care at the gateway to a continent.","authors":"Moyez Jiwa,&nbsp;Sajaratulnisah Othman,&nbsp;Nik Sherina Hanafi,&nbsp;Chirk Jenn Ng,&nbsp;Ee Ming Khoo,&nbsp;Yook Chin Chia","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"20 5","pages":"317-20"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31015239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}