Quality in primary care最新文献

{"title":"A Profile of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Provider Network: Results from the Year 1 NBCCEDP Survey of Program Implementation.","authors":"Zachary Myles, Ketra Rice, Amy Degroff, Jackie Miller","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"23 6","pages":"315-317"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912227/pdf/nihms793025.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34599776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual practice and how to improve it.","authors":"A. Siriwardena, S. Gillam","doi":"10.1201/9780429084041-16","DOIUrl":"https://doi.org/10.1201/9780429084041-16","url":null,"abstract":"Individual practice needs to be developed to improve effectiveness, safety and patient experience. Although good systems can support better individual performance, without personal development, individual practice can be a source of error. This, the final article in our series on the science of quality improvement, describes models of competence and practice and the causes of good or poor practice. We show how quality improvement techniques can be used to improve individual practice and how this can be incorporated into the appraisal process for doctors, nurses and other healthcare professionals.","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"12 1","pages":"133-8"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82562176","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":"Factors associated with patient satisfaction with primary care in Europe: results from the EUprimecare project.","authors":"Carlos Alberto Sánchez-Piedra,&nbsp;Francisco Javier Prado-Galbarro,&nbsp;Sonia García-Pérez,&nbsp;Antonio Sarría Santamera","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>EUprimecare is a study funded by the Seventh Framework Programme of the European Union, aimed at analysing the quality of the different models of primary care in Europe. The objective of this study was to describe and analyse the determinants associated with patient satisfaction in primary care in Europe.</p><p><strong>Methods: </strong>We conducted telephone population surveys among primary care users in each EUprimecare consortium country (Germany, Spain, Estonia, Finland, Hungary, Italy and Lithuania). The survey was conducted with 3020 patients and the questionnaire included sociodemographic variables, health status, and use and satisfaction with primary care services. We undertook descriptive analyses, bivariate correlations and an ordinal regression model to study the direct relationship between levels of satisfaction and the explanatory variables for demographics, health status and health services for patients. We present the regression coefficients (β) with 95% confidence intervals and associated tests of statistical significance.</p><p><strong>Results: </strong>The mean age of the respondents was 51 years (SD 14.1). We found significant associations between the level of satisfaction and age (β = 0.008), specialist visits (β = -0.030), not having a general practitioner (β = 0.70), not measuring weight, cholesterol and blood pressure (β = 0.52), country (β1 Germany = -1.08 and β2 Lithuania = -0.60; β3 Hungary = 0.50 and β4 Italy = 0.53) and a better perception of health status (β = 0.33). Specialist visits had a negative association with satisfaction.</p><p><strong>Conclusions: </strong>Overall, the results indicate factors that may be related to greater satisfaction with primary care services: age, visits to a specialist, having a doctor assigned to primary care and measurement of control parameters are associated with a better perception of the care received.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 3","pages":"147-55"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32371046","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":"What is it about homeopathy that patients value? and what can family medicine learn from this?","authors":"Norbert Schmacke,&nbsp;Veronika Müller,&nbsp;Maren Stamer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Homeopathy is one of the most frequently used areas of complementary and alternative medicine (CAM). Previous research has focused in particular on the pharmacological effectiveness of homeopathy. There is intense discussion among German family medical practitioners as to whether family medicine should adopt elements of homeopathy because of the popularity of this treatment method.</p><p><strong>Aim: </strong>For the first time in Germany, patients with chronic conditions were asked about their views on the medical care provided by homeopathic medical practitioners.</p><p><strong>Methods: </strong>The survey used questionnaire-based, semi-structured expert interviews, the contents of which were then analysed and summarised.</p><p><strong>Results: </strong>A total of 21 women and five men aged from 29 to 75 years were surveyed. The 'fit' between therapist and patient proved to be particularly important. Both the initial homeopathic consultation and the process of searching for the appropriate medication were seen by patients as confidence-inspiring confirmations of the validity of homeopathic therapy which they considered desirable in this personalised form.</p><p><strong>Conclusion: </strong>The possible adoption by family medicine of elements of homeopathy may be seen as controversial, but this study again indicates the vital importance of successful communication to ensure a sustainable doctor-patient relationship. Advances in this sector not only require continuous efforts in the areas of medical training and professional development, but also touch on basic questions relating to the development of effective medical care, such as those currently being discussed in the context of the 'patient-centred medical home'.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 1","pages":"17-24"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32169587","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":"Expanding capacity for supervision in general practice through student-engaged clinical audit.","authors":"Emily Mauldon,&nbsp;Jan Radford,&nbsp;Anne Todd","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Expanding clinical teaching opportunities is essential for securing a sustainable health workforce. Although Tasmanian general practitioners (GPs) are keen to provide learning opportunities for medical students, they have identified time pressures due to a need to meet patient service demand and a need for more guidance on effective clinical teaching, as factors impacting their ability to increase clinical supervision. By developing a clinical audit activity, we delivered an educational resource that did not require direct GP supervision yet provided meaningful learning outcomes for students. Through systematically reviewing patient records it was hoped that students would strengthen practice based quality improvement activities, thus 'giving back' to their placement practice.</p><p><strong>Methods: </strong>A clinical audit curriculum was developed for fourth-year medical students at the Launceston Clinical School (n = 46) and implemented during their general practice rotation. This included a lecture and tutorial, and structured activities based on an audit of diabetes care. Preparation and support was provided to GP supervisors and practice staff through ongoing practice visits conducted by school academics. Implementation of the curriculum within general practice was evaluated through focus groups conducted with staff from five training practices (n = 29). Evaluation of student experiences is ongoing.</p><p><strong>Results: </strong>This paper reports on the experiences of general practice supervisors and other practice staff. GPs and practice staff responded positively, indicating that the syllabus provided novel teaching opportunities and a modest contribution to improving patient records and patient care. Major learning opportunities identified included the development of skills working with patient records and practice software, and understanding the importance of accurate and reliable medical records for the optimal delivery of patient care.</p><p><strong>Conclusions: </strong>Conducting clinical audit provides students with novel learning opportunities while also strengthening the capacity of teaching general practices to provide clinical placements. Students learnt about the importance of monitoring professional practice using systematic clinical audit, and the complexities of managing patients within primary care. In so doing, they enhanced the robustness and rigor of patient records within their placement practice.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 1","pages":"35-41"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32169589","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":"Do local enhanced services in primary care improve outcomes? Results from a literature review.","authors":"G Kumar,&nbsp;J Quigley,&nbsp;M Singh,&nbsp;S Keeping,&nbsp;R Pitman,&nbsp;S Carroll","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>This paper aims to examine the role of local enhanced services (LES) as a financial incentive in improving clinical and process outcomes in primary care with a view to discussing their future in light of the Health and Social Care Act.</p><p><strong>Methods: </strong>A literature review was conducted to identify LES commissioned in the UK in any disease area and to evaluate common themes relating to their impact on outcomes. The literature review consisted of two stages: an initial reference database search (MEDLINE, MEDLINE IN-PROCESS and EMBASE) and a more general internet search. The internet search used free text augmented by a targeted search of key health organisations' websites. Data were extracted from the LES to provide information on the background and context of the LES before going on to describe the incentive structure, health and economic outcomes and limitations of the LES.</p><p><strong>Results: </strong>Although a number of LES were identified in the online search, only 14 reported any data on outcomes. These LES programmes related to 10 different disease areas, with cancer, alcohol dependence and chronic obstructive pulmonary disease (COPD) being the most common health needs. Three common factors between the selected LES emerged that appear to influence the extent of the impact on local health or economic outcomes: (1) a national framework supporting the LES, (2) existing service provision, and (3) the size of the financial incentives.</p><p><strong>Conclusion: </strong>The common themes emerging from the literature review suggest that, following the Health and Social Care Act 2012 and newly established national standards, given sufficient attention to planning service specifications, LES could continue to be important in reducing health inequalities and preparing poorly performing general practices for longer term changes directed at improving outcomes and standards in healthcare.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 3","pages":"157-69"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32371047","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":"Considerations for using the 'brown bag' strategy to reconcile medications during routine outpatient office visits.","authors":"Erin M Sarzynski,&nbsp;Clare C Luz,&nbsp;Carlos F Rios-Bedoya,&nbsp;Shiwei Zhou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Among medication reconciliation studies, varying methods are used to determine which medications patients are actually taking. One recommended approach is to ask patients to \"brown bag\" their medications for routine office visits.</p><p><strong>Aims: </strong>To determine if 'brown bag' practices performed during routine office visits improve the accuracy of provider-documented medication lists.</p><p><strong>Methods: </strong>This cross-sectional pilot study was conducted in a university affiliated community geriatric clinic. Forty-six cognitively intact elders who managed their own medications enrolled. Participants self-selected into two groups: 'brown-baggers' (BBs) and 'non-brown-baggers' (NBBs). Three medication lists were compared for each patient: provider-documented in patient's chart (chart list); researcher-generated by post-appointment semistructured interview (point-of-care [POC] list); post-appointment semi-structured telephone interview (telephone list, reference standard). Accuracy of chart and POC lists were compared with reference lists among BBs and NBBs.</p><p><strong>Results: </strong>Thirty-three (72%) patients brought some of their medications to scheduled appointments (BBs); of these, 39% bagged all of their medications. Excluding route as a variable, 35% of provider-documented chart lists were complete; only 6.5% were accurate. Some 76% of chart-documented medication lists contained inclusion, omission and/or dosing instruction discrepancies, with no differences between BBs and NBBs. However, POC lists obtained using a semi-structured interview included fewer inclusion and omission discrepancies among BBs than NBBs (42% v 77%, P = 0.05). In subset analyses by medication type, over-the-counter (OTC) medication documentation was more accurate among BBs than NBBs. Overall, chart lists contained two to three times more discrepancies than lists generated at POC.</p><p><strong>Conclusion: </strong>Most BBs do not bag all their medications for office visits. Chart list accuracy is no better among BBs than NBBs, although patients who 'brown bag' their medications for office visits may prompt providers to conduct a more thorough medication history. Lists generated by semistructured interviewing, regardless of BB status, are more accurate than chart lists. Findings challenge benefits of the 'brown bag' unless coupled with in-depth questioning and processes for transferring information to chart lists.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 4","pages":"177-87"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33066921","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":"Exploring consumer values of comparative performance information for hospital choice.","authors":"Nicole A B M Ketelaar,&nbsp;Marjan J Faber,&nbsp;Gert P Westert,&nbsp;Glyn Elwyn,&nbsp;Jozé C Braspenning","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In many countries, market orientation in healthcare has resulted in the publication of comparative performance information (CPI). Most of the research in this field is oriented towards the content and the presentation format of CPI while little is known about how consumers value CPI and the use of this information.</p><p><strong>Aim: </strong>The aim of this study was to clarify the perceived value that CPI brings for consumers of healthcare. Methods Qualitative research using six focus group interviews. Twenty-seven healthcare consumers were recruited using a mailing list and by personal invitation. Data from focus group interviews were transcribed and thematic analysis undertaken.</p><p><strong>Results: </strong>Most participants were unaware of CPI, and valued alternative sources of information more than CPI. Through discussion with other consumers and by means of examples of CPI, respondents were able to express the values and perceived effects of CPI. Numerous underlying values hindered consumers' use of CPI, and therefore clarification of consumer values gave insights into the current non-usage of CPI.</p><p><strong>Conclusions: </strong>CPI is marginally valued, partly because of conflicting values expressed by consumers and, as such, it does not yet provide a useful information source on hospital choice beyond consumers' current selection routines in healthcare. Future research should be more focused on the values of consumers and their impact on the use of CPI.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 2","pages":"81-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32288050","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":"Key activities used by community based primary care practices to improve the quality of diabetes care in response to practice facilitation.","authors":"Polly Hitchcock Noël,&nbsp;Raquel Lozano Romero,&nbsp;Michaela Robertson,&nbsp;Michael L Parchman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A recent systematic review suggests that practice facilitation (PF) is a robust intervention for implementing evidence-based preventive care guidelines in primary care, but the ability of PF to improve chronic illness care remains unclear.</p><p><strong>Aims: </strong>To examine the specific activities and Chronic Care model (CCM) components that primary care practices implemented and sustained in response to a 12-month PF intervention.</p><p><strong>Methods: </strong>The ABC trial tested the effectiveness of PF to improve care for diabetes in 40 small community-based primary care practices that were randomized to \"initial\" or \"delayed\" intervention arms. A trained facilitator met with each practice over 12-months. Facilitators used interactive consensus building to help practices implement one or more of quality improvement activities based on the CCM. Facilitators prospectively recorded implementation activities reported by practice teams during monthly meetings and confirmed which of these were sustained at the end of the intervention.</p><p><strong>Results: </strong>37 practices implemented and sustained a total of 43 unique activities [range 1-15, average 6.5 (SD=2.9)]. The number (%) of practices that implemented 1 or more key activities in each CCM component varied: Patient Self-Management Support: 37 (100%); Clinical Information Systems: 24 (64.9%), Delivery System Design: 14 (37.8%), Decision Support: 13 (35.1%), Community Linkages: 2 (5.4%); Healthcare System Support: 2 (2.7%). The majority of practices (59%) only implemented activities from 1 or 2 CCM components. The number of sustained activities was associated with the number of PF visits, but not with practice characteristics.</p><p><strong>Conclusions: </strong>In spite of the PF intervention, it was difficult for these small practices to implement comprehensive CCM changes. Although practices implemented and sustained a remarkable number and variety of key activities, the majority of these focused on patient self-management support, as opposed to other components of the CCM, such as clinical information systems, decision support, delivery system redesign, and community linkages.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 4","pages":"211-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326068/pdf/nihms614606.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33057957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intervention fidelity in primary care complex intervention trials: qualitative study using telephone interviews of patients and practitioners.","authors":"Jane V Dyas,&nbsp;Fiona Togher,&nbsp;A Niroshan Siriwardena","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Treatment fidelity has previously been defined as the degree to which a treatment or intervention is delivered to participants as intended. Underreporting of fidelity in primary care randomised controlled trials (RCTs) of complex interventions reduces our confidence that findings are due to the treatment or intervention being investigated, rather than unknown confounders.</p><p><strong>Aim: </strong>We aimed to investigate treatment fidelity (for the purpose of this paper, hereafter referred to as intervention fidelity), of an educational intervention delivered to general practice teams and designed to improve the primary care management of insomnia.</p><p><strong>Method: </strong>We conducted telephone interviews with patients and practitioners participating in the intervention arm of the trial to explore trial fidelity. Qualitative analysis was undertaken using constant comparison and a priori themes (categories): 'adherence to the delivery of the intervention', 'patients received and understood intervention' and 'patient enactment'.</p><p><strong>Results: </strong>If the intervention protocol was not adhered to by the practitioner then patient receipt, understanding and enactment levels were reduced. Recruitment difficulties in terms of the gap between initially being recruited into the study and attending an intervention consultation also reduced the effectiveness of the intervention. Patient attributes such as motivation to learn and engage contributed to the success of the uptake of the intervention.</p><p><strong>Conclusion: </strong>Qualitative methods using brief telephone interviews are an effective way of collecting the depth of data required to assess intervention fidelity. Intervention fidelity monitoring should be an important element of definitive trial design.</p><p><strong>Trial registration: </strong>ClinicalTrials. gov id isrctn 55001433 - www.controlled-trials.com/isrctn55001433.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 1","pages":"25-34"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32169588","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}