Quality in primary care最新文献

{"title":"Should healthy populations be screened for breast cancer? A perspective from someone with previously diagnosed breast cancer.","authors":"Mitzi Blennerhassett","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 3","pages":"187-8"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31676538","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":"Breast cancer screening: an ethical dilemma, or an opportunity for openness?","authors":"Mitzi Blennerhassett","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The NHS Breast Screening Programme was hailed as a life-saver when it was set up, but research has raised concerns about efficacy and levels of harm. The honesty and adequacy of screening information was challenged: proof of the '1400 lives a year saved' claim was not offered and some serious harms were not mentioned. The report of the independent review of breast screening exposed grave concerns, but brought more controversy. Doctors, patients and the doctor/patient relationship may be adversely affected.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 1","pages":"39-42"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31481711","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":"Gender differences in cardiovascular disease risk management for Pacific Islanders in primary care.","authors":"Yulong Gu, Jim Warren, Natalie Walker, John Kennelly","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To assess gender differences in cardiovascular disease risk (CVR) assessment and management for Pacific people in New Zealand.</p><p><strong>Methods: </strong>New Zealand guidelines indicate CVR assessment from age 35 years for Pacific men and from age 45 years for Pacific women. Using general practice electronic medical records from 16 practices in New Zealand, the rate of CVR screening, treatment patterns and physiological measures for high-CVR (≥15% five-year) patients were assessed for Pacific patients ≥20 years of age by gender.</p><p><strong>Results: </strong>Records for 10 863 Pacific patients showed a higher proportion of indicated women screened for CVR (65 vs 56%), but a lower proportion of assessed women with high CVR (28% for Pacific women vs 40% for Pacific men). Many of these high-CVR patients had physiological measures well above desirable levels based on their most recent readings. In the high-CVR group, women had similar CVR levels to men, but higher systolic blood pressure and HbA1c level, and a higher proportion of women were treated with antihypertensive and oral antidiabetic medication. There were substantial levels of poor medication adherence, particularly for cholesterol-lowering medication. Women and men were equally likely to adhere to treatment. Those adhering to relevant medications had lower blood pressure, total-to-HDL cholesterol ratio and HbA1c than non-adherers.</p><p><strong>Conclusions: </strong>Pacific men were less likely than Pacific women to have their CVR assessed when indicated, more likely once assessed to have high CVR and equally likely to adhere to treatment. Medication adherence was associated with better control of risk factors and should be further promoted in this population.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 5","pages":"275-85"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31802206","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":"Should healthy populations be screened for breast cancer? A consultant surgeon's perspective.","authors":"Jayant S Vaidya","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 3","pages":"189-92"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31676539","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 future for primary care for the Greek population.","authors":"Peter P Groenewegen,&nbsp;Arnoldas Jurgutis","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare.</p><p><strong>Approach: </strong>Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders.</p><p><strong>Results: </strong>The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care.</p><p><strong>Conclusions: </strong>The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 6","pages":"369-78"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32103147","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":"Harnessing information technology to innovate in primary care.","authors":"Moyez Jiwa,&nbsp;Alexander McManus,&nbsp;Ann Dadich,&nbsp;James White,&nbsp;Alison Rieck,&nbsp;Shohreh Razmi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The health sector's capacity to meet the changing needs of patients is being questioned. This has significant implications for patients, carers, health services and those who hold the public purse. It is therefore important to bolster its capacity to serve a greater proportion of people in need of health care, opportunities for which might be facilitated by information technology (IT).</p><p><strong>Aim: </strong>To identify strategies to bolster the capacity of the primary care sector to deploy and innovate with IT.</p><p><strong>Methods: </strong>Three discussion groups comprising clinicians, regulatory agents, innovators and academics from each Australian state. Themes discussed included: (1) health problems that can be readily solved by IT, (2) clinician engagement with IT, (3) experiences with IT implementation, (4) engagement with hard-to-reach groups, and (5) social media use.</p><p><strong>Results: </strong>Although participants were aware of the issues surrounding the use of IT, including limited evidence and reduced data integrity, they were equally aware of the opportunities afforded by IT. With appropriate support, they indicated that IT could help to innovate and reinvigorate the primary care sector. This could be demonstrated via research, initiatives that improve governance arrangements (within and beyond the primary care sector), programmes that enhance care delivery and consumer empowerment initiatives.</p><p><strong>Conclusion: </strong>Clinicians are rarely included as part of teams developing innovations, and technology is not always tailored for clinical practice or tested on clinical outcomes. Technical and access issues continue to hamper dissemination of innovation. The need for leadership in developing IT healthcare solutions remains paramount, with the organisation best able to negotiate with the key stakeholders at the helm.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 1","pages":"43-9"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31481712","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":"Convergence of HbA1c values towards target in 272 primary care patients following nine years of target-driven care.","authors":"E L Clarke,&nbsp;J R Richardson,&nbsp;M Bhartia,&nbsp;D M Kennedy,&nbsp;J J Milles,&nbsp;S Ramachandran","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>We wished to determine the effect of a target-driven incentivised programme on haemoglobin A1c (HbA1c ) values in a UK diabetic population.</p><p><strong>Methods: </strong>An audit was carried out in 1999-2000, which included an estimation of glycaemic control in a randomly selected diabetic cohort from ten primary care practices in Sutton Coldfield, serving a population of 90 000 patients. Each practice was given a randomised list of patients and asked to complete detailed questionnaires on patients with confirmed diabetes. We collected data on 516 patients, 425 of whom had their HbA1c measured in 1999-2000 (Audit 2000). A re-audit of HbA1c was carried out in 2007-08 (Audit 2008) determining the changes in HbA1c since the original audit. Of the original cohort, 272 patients had an audit of HbA1c carried out in Audit 2008.</p><p><strong>Results: </strong>Overall, a small increase in median and mean HbA1c values was observed. We estimated that the proportion of patients with HbA1c achieving the lower Quality and Outcomes Framework HbA1c target of < 7.5%; 173 of the 272 patients met this target in Audit 2000, whereas the number was 162 in Audit 2008. To understand the changes observed, patients were stratified as quintiles based on the HbA1c in Audit 2000 and changes in HbA1c after 8 years for each quintile were estimated. The mean changes for the different quintiles are: quintile 1 (HbA1c < 6.1%), +1.49%; quintile 2 (HbA1c 6.1- 6.6%), +0.8%; quintile 3 (HbA1c 6.7-7.3%), +0.3%; quintile 4 (HbA1c 7.4-8.5%), -0.18%; and quintile 5 (HbA1c > 8.5%), -1.55%.</p><p><strong>Conclusion: </strong>Our results suggest that, eight years on, patients with poor glycaemic control in 2000 saw an overall decrease in HbA1c by 2008, with the reverse seen in patients with good control.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 5","pages":"287-92"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31802207","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":"Commissioning for quality improvement.","authors":"Steve Gillam,&nbsp;A Niroshan Siriwardena","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This is the fifth in a series of articles about the science of quality improvement. We examine the nature of healthcare commissioning and its role as a driver for quality improvement. We draw on evidence from previous forms of primary-care-led commissioning (PCLC) and consider how the quality of care might be improved through the processes of commissioning. </p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 6","pages":"339-43"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32103144","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":"Use of automated reminder letters to improve diabetes management in primary care: outcomes of a quality improvement initiative.","authors":"Sally H Berryman,&nbsp;Brian T Sick,&nbsp;Qi Wang,&nbsp;Paul J Swan,&nbsp;Anne Marie Weber-Main","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Effective management of patients with diabetes mellitus (DM) can be time-consuming and costly. One patient-centred quality improvement strategy is to generate reminder letters to prompt patient action(s), but this strategy's effect on DM outcomes is uncertain.</p><p><strong>Aim: </strong>To determine whether using the electronic medical record to automatically generate reminder letters for patients not meeting recommended DM targets is associated with improvement in practice level quality metrics for DM management.</p><p><strong>Methods: </strong>Over 15 months, letters were sent monthly to all patients with DM in a large, urban, primary care teaching practice whose records for haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) or blood pressure (BP) indicated non-compliance with recommended levels and testing intervals. Logistic regression was used to analyse cross-sectional, practice-level differences in the proportion of patients meeting DM quality metrics (HbA1c < 7%, LDL < 100 mg/dl and BP < 130/80 mmHg; rates of checking each value within the last 12 months; and a composite of these five measures) across four time points: six months before the intervention, start of the intervention, end of the 15-month intervention period and six months after the intervention.</p><p><strong>Results: </strong>The number of letters sent per month ranged from 284 to 392, representing 28-38% of all patients with DM. At the end of the intervention, patients' odds of being at goal were higher than before the intervention began for LDL < 100 mg/dl, and for HbA1c and LDL tested once within the last 12 months (or 1.24, P = 0.005; or 1.35, P = 0.03; or 1.48, P < 0.001, respectively). Post intervention, declines were seen in LDL checked within the last 12 months (or 0.76, P = 0.003) and in the composite endpoint (or 0.78, P = 0.005).</p><p><strong>Conclusions: </strong>The automated patient-reminder letter intervention was associated with modest improvements in several, but not all DM measures. This approach may be an effective tool for improving quality of care for patients with DM.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 6","pages":"359-68"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32103146","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 representations and experiences of case-management users: towards difficulties and solutions to leading qualitative interviews with older people with complex living conditions.","authors":"Frédéric Balard,&nbsp;Stéphanie Pin Le Corre,&nbsp;Hélène Trouvé,&nbsp;Olivier Saint-Jean,&nbsp;Dominique Somme","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible.</p><p><strong>Aim: </strong>This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services.</p><p><strong>Methods: </strong>Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance.</p><p><strong>Results: </strong>Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis.</p><p><strong>Conclusion: </strong>Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.</p>","PeriodicalId":88096,"journal":{"name":"Quality in primary care","volume":"21 4","pages":"229-35"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31737188","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}