Quality in primary care最新文献

{"title":"Evaluating improvement.","authors":"A Niroshan Siriwardena,&nbsp;Steve Gillam","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Evaluating quality improvement interventions requires a variety of methods. These range from quantitative methods, such as randomised controlled trials, to quasi-experimental (controlled before-and-after and interrupted time series) and uncontrolled before-and-after studies, including clinical audits, to determine whether improvement interventions have had an effect. Qualitative methods are often also used to understand how or why an intervention was successful and which components of a complex or multifaceted intervention were most effective. Finally, mixed methods designs such as action research or case study methods are widely used to design and evaluate improvement interventions. </p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 2","pages":"63-70"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32288047","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":"Immunisation errors reported to a vaccine advice service: intelligence to improve practice.","authors":"Sarah Lang,&nbsp;Karen J Ford,&nbsp;Tessa John,&nbsp;Andrew J Pollard,&nbsp;Noel D McCarthy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The success of immunisation programmes depends on the quality with which they are administered. The Vaccine Advice for CliniCians Service (VACCSline) is an advice service to support immunisers and promote excellence in immunisation practice, through specialist guidance and local education, covering a catchment population of two million people. All enquiries are recorded onto a database and categorised. Vaccine error is selected when a vaccine has not been prepared or administered according to national recommendations or relevant expert guidance.</p><p><strong>Method: </strong>All enquiries from 2009 to 2011, categorised on the VACCSline database as 'vaccine error' were analysed and subjected to a detailed free-text review.</p><p><strong>Results: </strong>Of 4301 enquiries, 158 (3.7%) concerned vaccine errors. The greatest frequency of errors, 145 (92.9%) concerned immunisations delivered in primary care services; 92% of all errors occurred during either vaccine selection and preparation or history checking and scheduling. Administration of the wrong vaccine was the most frequent error recorded in 33.3% of reports. A shared first letter of the vaccine name was noted to occur in 13 error reports in which the incorrect vaccine was inadvertently administered. Consultations involving pairs of siblings were associated with various errors in seven enquiries. Failure to revaccinate after spillage (seven reports) showed a widespread knowledge gap in this area.</p><p><strong>Conclusion: </strong>Advice line enquiries provide intelligence to alert immunisers to the errors that are commonly reported and may serve to highlight processes that predispose to errors, thus informing immuniser training and updating.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 3","pages":"139-46"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32371045","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":"Colorectal cancer--applying a gender lens.","authors":"Devesh V Oberoi,&nbsp;Moyez Jiwa,&nbsp;Alexandra McManus,&nbsp;Rupert Hodder","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is a major global health problem with survival varying according to stage at diagnosis. The incidence of CRC is much higher in patients with lower bowel symptoms. The symptoms are non-specific and are commonly experienced in the general population. Biological and environmental factors account for the high incidence and poor prognosis of CRC in men.</p><p><strong>Objective: </strong>To review the behavioural factors influencing patient delay in seeking help for lower bowel symptoms using a gender lens.</p><p><strong>Methods: </strong>An extensive literature search was performed using various databases including Medline, PubMed, CINAHL Plus, EMBASE and PsycINFO (1993-2013). Various search terms including rectal bleeding, prevalence, colorectal cancer, consultation, help-seeking, gender differences and men were used. A systematic methodology including systematic data extraction and narrative synthesis was applied.</p><p><strong>Results: </strong>Thirty-two studies were included in the review. All studies except four were quantitative. Although there is some evidence that men delay more compared with women, there has not been any major improvement in the help-seeking behaviour for such symptoms over the past two decades. Several behavioural and demographic factors were associated with low rates of help-seeking.</p><p><strong>Conclusion: </strong>There are limited studies focusing on men's help-seeking behaviour for lower bowel symptoms. To facilitate timely help-seeking in men, it is important to understand their patterns of helpseeking for such symptoms. Further research to understand men's help-seeking behaviour is warranted.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 2","pages":"71-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32288049","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":"Disease prevention guidelines put interprofessional collaboration to support healthy eating on the agenda.","authors":"Sophie Rodebjer Cairns,&nbsp;Karin Kauppi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 4","pages":"173-5"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33066920","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":"A qualitative exploration of the motives behind the decision to order a liver function test in primary care.","authors":"I J Litchfield,&nbsp;R J Lilford,&nbsp;L M Bentham,&nbsp;S M Greenfield","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The number of tests ordered in primary care continues to increase influenced by a number of factors not all of which are concerned with diagnosis and management of disease. Liver function tests (LFTs) are a good example of inexpensive tests that are frequently ordered in patients with non-specific symptoms. They remain among the most frequently ordered tests despite their lack of specificity yet the full range of motives behind the decision to order an LFT remains unexplored.</p><p><strong>Aims: </strong>To gain an understanding of the family practitioner's (FP) medical and non-medical motives for ordering an LFT and the influence of various social and technical factors on this decision.</p><p><strong>Methods: </strong>We interviewed FPs across six practices who were participating in a prospective study of the efficacy of an abnormal LFT to indicate the development of a serious liver disease. Following content analysis of the data from the semi-structured interviews we used the 'attitude-social influence-efficacy' model to categorise the determinants of test ordering behaviour.</p><p><strong>Results: </strong>Factors influencing an FP's decision to order a test were grouped into two broad categories; the first is 'internal' including expectation of efficacy and general attitude towards LFTs. The second group is 'external' and consists of themes of social influence, tests characteristics and defensive medicine.</p><p><strong>Conclusions: </strong>Whilst our sample acknowledged the clinical use of LFTs such as the routine monitoring of medication and liver-specific diagnostic purposes we also found that social and behavioural reasons are strong motivators to order an LFT and may take precedence over clinical factors.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 4","pages":"201-10"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33066923","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 relationship between quality of care and self-management in patients with type 2 diabetes: a cross-sectional survey in primary care in Mexico.","authors":"Yolanda Martinez,&nbsp;Stephen M Campbell,&nbsp;Mark Hann,&nbsp;Peter Bower","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Achieving glycaemic control in diabetes reduces complications and improves outcomes. Glycaemic control requires both good quality clinical care and effective self-management support. However, the relationship between these factors in routine clinical practice is unclear.</p><p><strong>Aims: </strong>To evaluate baseline levels of self-management and clinical quality of care in patients with type 2 diabetes in primary care in Mexico and to explore relationships between measures of self-management and clinical quality of care.</p><p><strong>Methods: </strong>The sample consisted of adults (N=205) diagnosed with type 2 diabetes for over a year and registered at one of five practices in the Mexican Institute of Social Security in Aguascalientes. Self-management and quality of care were measured using medical record review and interviews, including validated measures of diabetes knowledge, self-care behaviours, self-efficacy, treatment intensification, continuity of care, doctor-patient communication, and patient satisfaction with diabetes care. HbA1c and cholesterol tests were taken.</p><p><strong>Results: </strong>There were few associations between measures of self-management, and between measures of the quality of clinical care. 'Strong' knowledge about medical prescription was associated with higher diabetes knowledge (OR = 1.2, 95% CI 1.08 to 1.32). Diabetes self-efficacy was associated with self-care behaviours (OR = 1.51, 95% CI 1.26 to 1.81). Patient-doctor communication was associated with continuity of care (Chi-squared = 11.03, P <0.05), with patient satisfaction (β = 6.17, 95% CI 4.47 to 7.93) and with diabetes self-efficacy (β = 0.70, 95% CI 0.19 to 1.20, P <0.01). Patient satisfaction was associated with continuity of care (F = 7.82, P <0.001).</p><p><strong>Conclusion: </strong>The associations between measures of self-management and quality of care were modest. Patients who were achieving high levels of one aspect of care were not necessarily receiving high levels of the other. This indicates that different factors are likely to be driving each aspect of care and highlights the importance of measuring their relative importance.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 6","pages":"262-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33230718","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":"Development of a patient-administered self-assessment tool (SATp) for follow-up of colorectal cancer patients in general practice.","authors":"Irene Ngune,&nbsp;Moyez Jiwa,&nbsp;Alexandra McManus,&nbsp;Jeff Hughes,&nbsp;Richard Parsons,&nbsp;Rupert Hodder,&nbsp;Fiona Entriken","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Treatment for colorectal cancer (CRC) may result in physical, social, and psychological needs that affect patients' quality of life post-treatment. A comprehensive assessment should be conducted to identify these needs in CRC patients post treatment, however, there is a lack of tools and processes available in general practice.</p><p><strong>Aims: </strong>This study aimed to develop a patient-completed needs screening tool that identifies potentially unmet physical, psychological, and social needs in CRC and facilitates consultation with a general practitioner (GP) to address these needs.</p><p><strong>Methods: </strong>The development of the self-assessment tool for patients (SATp) included a review of the literature; face and content validity with reference to an expert panel; psychometric testing including readability, internal consistency, and test-retest reliability; and usability in clinical practice.</p><p><strong>Results: </strong>The SATp contains 25 questions. The tool had internal consistency (Cronbach's alpha 0.70-0.97), readability (reading ease 82.5%), and test-retest reliability (kappa 0.689-1.000). A total of 66 patients piloted the SATp. Participants were on average 69.2 (SD 9.9) years old and had a median follow-up period of 26.7 months. The SATp identified a total of 547 needs (median 7 needs/per patient; IQR [3-12.25]). Needs were categorised into social (175[32%]), psychological (175[32%]), and physical (197[36%]) domains.</p><p><strong>Conclusion: </strong>SATp is a reliable self-assessment tool useful for identifying CRC patient needs. Further testing of this tool for validity and usability is underway.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 6","pages":"270-7"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33230719","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":"Systems and spread.","authors":"A Niroshan Siriwardena,&nbsp;Steve Gillam","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This is the fifth in a series of papers about the science of quality improvement. In this paper, we explore the issue of healthcare as a system and how this contributes to our understanding of how to spread improvement. </p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 1","pages":"7-10"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32169585","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":"Multimorbidity: what's the problem?","authors":"Alice Shiner,&nbsp;Nicholas Steel,&nbsp;Amanda Howe","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 3","pages":"115-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32373291","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":"Regulation in primary care.","authors":"Steve Gillam,&nbsp;A Niroshan Siriwardena","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Professional bodies have long overseen the maintenance of standards of training and practice within the different healthcare professions. Organisational regulation of healthcare in England comprises two main elements: regulation of the quality and safety of care offered by healthcare providers, currently undertaken by the Care Quality Commission (CQC); and regulation of the market in healthcare services, currently the responsibility of Monitor and the Department of Health. The eighth in the series, this article considers the expanding roles of newer bodies, particularly in relation to primary care. The cost-effectiveness of these new arrangements is unknown - and possibly unknowable. </p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"22 2","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32287113","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}