Pub Date : 2017-02-22DOI: 10.1017/S1463423617000068
Devoshree Chatterjee, S. Iliffe, K. Kharicha, D. Harari, C. Swift, Gerhard Gillman, A. Stuck
Aim To investigate whether the use of long-acting benzodiazepines, in individuals aged 65 and over is mediated by physical or psychological factors. Background Long-acting benzodiazepine consumption among older people has implications for mortality, morbidity and cost-effective prescribing. Two models explain benzodiazepine use in this age group, one linked to physical illness and disability and one to psychological factors. Methods Secondary analysis of baseline data from a study of 1059 community-dwelling non-disabled people aged 65 years and over recruited from three general practices in London. For this analysis, use of long-acting benzodiazepines was defined as any self-reported use of diazepam or nitrazepam in the last four weeks. Associations between demographic factors, health service use, and physical and psychological characteristics and benzodiazepine use were investigated. Findings The prevalence of benzodiazepine use in this sample was 3.3% (35/1059). In univariate analyses, benzodiazepine use was associated with female gender, low income, high consultation rates, physical factors (medication for arthritis or joint pain, polypharmacy, difficulties in instrumental activities of daily living, recent pain) and psychological factors (poor self-perceived health, social isolation, and symptoms of anxiety or agitation). In a multivariate logistic regression analysis only two factors retained statistically significant independent associations with benzodiazepine use: receiving only the state pension (OR=4.0, 95% CI: 1.70, 9.80) and pain in the past four weeks (OR=3.79, 95% CI: 1.36, 10.54).
{"title":"Health risk appraisal in older people 7: long-acting benzodiazepine use in community-dwelling older adults in London: is it related to physical or psychological factors?","authors":"Devoshree Chatterjee, S. Iliffe, K. Kharicha, D. Harari, C. Swift, Gerhard Gillman, A. Stuck","doi":"10.1017/S1463423617000068","DOIUrl":"https://doi.org/10.1017/S1463423617000068","url":null,"abstract":"Aim To investigate whether the use of long-acting benzodiazepines, in individuals aged 65 and over is mediated by physical or psychological factors. Background Long-acting benzodiazepine consumption among older people has implications for mortality, morbidity and cost-effective prescribing. Two models explain benzodiazepine use in this age group, one linked to physical illness and disability and one to psychological factors. Methods Secondary analysis of baseline data from a study of 1059 community-dwelling non-disabled people aged 65 years and over recruited from three general practices in London. For this analysis, use of long-acting benzodiazepines was defined as any self-reported use of diazepam or nitrazepam in the last four weeks. Associations between demographic factors, health service use, and physical and psychological characteristics and benzodiazepine use were investigated. Findings The prevalence of benzodiazepine use in this sample was 3.3% (35/1059). In univariate analyses, benzodiazepine use was associated with female gender, low income, high consultation rates, physical factors (medication for arthritis or joint pain, polypharmacy, difficulties in instrumental activities of daily living, recent pain) and psychological factors (poor self-perceived health, social isolation, and symptoms of anxiety or agitation). In a multivariate logistic regression analysis only two factors retained statistically significant independent associations with benzodiazepine use: receiving only the state pension (OR=4.0, 95% CI: 1.70, 9.80) and pain in the past four weeks (OR=3.79, 95% CI: 1.36, 10.54).","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74520721","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}
Pub Date : 2017-02-21DOI: 10.1017/S1463423617000032
Valerio Villamil-Salcedo, B. E. Vargas-Terréz, A. Díaz-Anzaldúa
Aim The aim of this study was to evaluate the experience of the Collaborative Care model with general practitioners (GPs) for diagnosis and treatment of depression and anxiety disorders in primary care centers (PCC). Background For many years, different ways to address mental health problems in primary care settings have been evaluated. However, there is still debate over how to treat psychiatric conditions in such a context. Method A cross-sectional design was used. The study was conducted in two consecutive studies in six PCC that serve marginalized population in Mexico City. In the first study, cases were interviewed, diagnosed, and treated by a psychiatrist. In the second study, Collaborative Care model was used and GPs were trained; psychiatrists diagnosed and treated patients but GPs discussed the symptoms and treatment of the patients with the psychiatrist. Findings First study: 18 patients with depressive and/or anxiety disorders were interviewed; these cases were not discussed between the GPs and the psychiatrist. Second study: psychiatrists and GPs conducted joint interviews and cases were discussed. From the 399 evaluated individuals, 38.94% were diagnosed with a depressive disorder. After the Collaborative Care model was applied, GPs were more aware about mental health problems and they were more interested in the identification of these conditions in PCC. Replication studies will help confirm the effectiveness of this model.
{"title":"Collaborative Care model in mental health. Scope and experiences after three years of activity in Mexico City","authors":"Valerio Villamil-Salcedo, B. E. Vargas-Terréz, A. Díaz-Anzaldúa","doi":"10.1017/S1463423617000032","DOIUrl":"https://doi.org/10.1017/S1463423617000032","url":null,"abstract":"Aim The aim of this study was to evaluate the experience of the Collaborative Care model with general practitioners (GPs) for diagnosis and treatment of depression and anxiety disorders in primary care centers (PCC). Background For many years, different ways to address mental health problems in primary care settings have been evaluated. However, there is still debate over how to treat psychiatric conditions in such a context. Method A cross-sectional design was used. The study was conducted in two consecutive studies in six PCC that serve marginalized population in Mexico City. In the first study, cases were interviewed, diagnosed, and treated by a psychiatrist. In the second study, Collaborative Care model was used and GPs were trained; psychiatrists diagnosed and treated patients but GPs discussed the symptoms and treatment of the patients with the psychiatrist. Findings First study: 18 patients with depressive and/or anxiety disorders were interviewed; these cases were not discussed between the GPs and the psychiatrist. Second study: psychiatrists and GPs conducted joint interviews and cases were discussed. From the 399 evaluated individuals, 38.94% were diagnosed with a depressive disorder. After the Collaborative Care model was applied, GPs were more aware about mental health problems and they were more interested in the identification of these conditions in PCC. Replication studies will help confirm the effectiveness of this model.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81571227","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}
Pub Date : 2017-02-20DOI: 10.1017/S1463423617000019
Berit Seiger Cronfalk, Astrid Fjell, Nina Carstens, Lars Malvin Kvinge Rosseland, A. Rongve, Dag-Helge Rönnevik, Å. Seiger, K. Skaug, Karen Johanne Ugland Vae, Marianne Hauge Wennersberg, A. Boström
The aim was to describe the development, utilization and feasibility of a model of preventive home visits, in an urban and a rural municipality in Norway. Background Older people >65 years will rise significantly in coming years. Increased age is associated with risk of disability, illness and need for public health services. Preventive home visits is assumed to help older people to maintain their functional level longer, delaying disease and thus delaying the need for health care. Method Descriptive explorative design describing the development, utilization and feasibility of preventive home visits in two different settings. All 77-year-old persons living at home in an urban municipality and all 75 years and older in a rural municipality were invited to participate. A questionnaire including a substantial number of tests concerning; fall, nutrition, polypharmacy and cognitive impairment was used by Health Team Nurses as base for a risk assessment. Pilot studies were conducted to validate the questionnaire including an inter-rater reliability study of the risk assessment tool. A multiprofessional team, Health Team for the Elderly met each week to evaluate risk assessments and make recommendations to be sent to each respective general practitioner. Data were analysed using descriptive and inferential statistics. In total, 167 persons (109 from the urban municipality and 58 from the rural municipality) participated, corresponding to 60% of the approached individuals. The mean time for the visits was 108 minutes (SD 20). Missing data were identified for; Do you feel safe in your municipality (17.5%) and Are you looking forward to ageing (11.4%). In total, 36 persons (21.7%) were identified with increased risk for developing illness. We suggest that a structured model of preventive home visits and collaboration between highly specialized health care professionals are important factors for reliable health promoting risk assessments of elderly home dwellers.
{"title":"Health team for the elderly: a feasibility study for preventive home visits","authors":"Berit Seiger Cronfalk, Astrid Fjell, Nina Carstens, Lars Malvin Kvinge Rosseland, A. Rongve, Dag-Helge Rönnevik, Å. Seiger, K. Skaug, Karen Johanne Ugland Vae, Marianne Hauge Wennersberg, A. Boström","doi":"10.1017/S1463423617000019","DOIUrl":"https://doi.org/10.1017/S1463423617000019","url":null,"abstract":"The aim was to describe the development, utilization and feasibility of a model of preventive home visits, in an urban and a rural municipality in Norway. Background Older people >65 years will rise significantly in coming years. Increased age is associated with risk of disability, illness and need for public health services. Preventive home visits is assumed to help older people to maintain their functional level longer, delaying disease and thus delaying the need for health care. Method Descriptive explorative design describing the development, utilization and feasibility of preventive home visits in two different settings. All 77-year-old persons living at home in an urban municipality and all 75 years and older in a rural municipality were invited to participate. A questionnaire including a substantial number of tests concerning; fall, nutrition, polypharmacy and cognitive impairment was used by Health Team Nurses as base for a risk assessment. Pilot studies were conducted to validate the questionnaire including an inter-rater reliability study of the risk assessment tool. A multiprofessional team, Health Team for the Elderly met each week to evaluate risk assessments and make recommendations to be sent to each respective general practitioner. Data were analysed using descriptive and inferential statistics. In total, 167 persons (109 from the urban municipality and 58 from the rural municipality) participated, corresponding to 60% of the approached individuals. The mean time for the visits was 108 minutes (SD 20). Missing data were identified for; Do you feel safe in your municipality (17.5%) and Are you looking forward to ageing (11.4%). In total, 36 persons (21.7%) were identified with increased risk for developing illness. We suggest that a structured model of preventive home visits and collaboration between highly specialized health care professionals are important factors for reliable health promoting risk assessments of elderly home dwellers.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80710084","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}
Pub Date : 2017-02-02DOI: 10.1017/S1463423617000020
R. Bryar
The development of primary health care (PHC) has been a central concern of this Journal since it was launched in 2000: ‘Implementation of research and evaluation into PHC practice is also an area of significance to the journal and studies that directly address the challenges and successes of implementation arewelcomed by the editors. In all papers, authors should demonstrate how their research or development study relates to primary care both in the context of their own country and internationally’ (https://www.cambridge.org/core/journals/primaryhealth-care-research-and-development). In recognition of this concern, the papers in this issue of the journal focus on development and, in this editorial, an overview of the contribution of these papers to the development of PHC will be discussed. The papers included explore two main themes relevant to development: how PHC can best respond to the need to promote health through a recognition of the wider determinants of health and secondly how primary care is best organised to deliver a service which is acceptable and accessible to the population. The papers included in this issue are drawn from studies in Canada, the USA, Nigeria and the UK reflecting the international interest in questions of application and testing of evidence in practice. The papers by van Weel et al. (2017) and DeSantis et al. (2017) argue for the use of wider frameworks to be used in implementation and evaluation of PHC interventions. van Weel et al. (2017) suggest a focus on the context within which PHC is delivered and identify four dimensions which they advocate should be reported on in studies of PHC: the health system; the social welfare system; the population and society characteristics; and details of the objectives of an intervention. These authors note that most care is delivered in the community and the dimensions identified reflect the reality of the impact of multiple factors, apart from direct care, on people’s health. Awareness of these factors suggests the importance of the relationship between PHC, with its access to individuals, and public health, with its focus on the wider determinants (Laverack, 2015). DeSantis et al. (2017) explore a framework drawn from the behavioural sciences in a study testing the application of the Outcomes Rating Scale to adults attending primary care services. The scale asks people to rate themselves in terms of their individual personal wellbeing, their family and close relationships, their social and wider interpersonal relationships, and their overall sense of wellbeing. In this exploratory study, comparing findings with other scales used in primary care to measure depression, they argue that use of this framework has the potential to identify a larger group of people with situational and relationship distress than scales more specifically focussed on disease symptoms. The growing evidence concerning the impact of personal relationships on health supports the use of such a scale in PHC
{"title":"Primary care and the public’s health: evidence from service development initiatives","authors":"R. Bryar","doi":"10.1017/S1463423617000020","DOIUrl":"https://doi.org/10.1017/S1463423617000020","url":null,"abstract":"The development of primary health care (PHC) has been a central concern of this Journal since it was launched in 2000: ‘Implementation of research and evaluation into PHC practice is also an area of significance to the journal and studies that directly address the challenges and successes of implementation arewelcomed by the editors. In all papers, authors should demonstrate how their research or development study relates to primary care both in the context of their own country and internationally’ (https://www.cambridge.org/core/journals/primaryhealth-care-research-and-development). In recognition of this concern, the papers in this issue of the journal focus on development and, in this editorial, an overview of the contribution of these papers to the development of PHC will be discussed. The papers included explore two main themes relevant to development: how PHC can best respond to the need to promote health through a recognition of the wider determinants of health and secondly how primary care is best organised to deliver a service which is acceptable and accessible to the population. The papers included in this issue are drawn from studies in Canada, the USA, Nigeria and the UK reflecting the international interest in questions of application and testing of evidence in practice. The papers by van Weel et al. (2017) and DeSantis et al. (2017) argue for the use of wider frameworks to be used in implementation and evaluation of PHC interventions. van Weel et al. (2017) suggest a focus on the context within which PHC is delivered and identify four dimensions which they advocate should be reported on in studies of PHC: the health system; the social welfare system; the population and society characteristics; and details of the objectives of an intervention. These authors note that most care is delivered in the community and the dimensions identified reflect the reality of the impact of multiple factors, apart from direct care, on people’s health. Awareness of these factors suggests the importance of the relationship between PHC, with its access to individuals, and public health, with its focus on the wider determinants (Laverack, 2015). DeSantis et al. (2017) explore a framework drawn from the behavioural sciences in a study testing the application of the Outcomes Rating Scale to adults attending primary care services. The scale asks people to rate themselves in terms of their individual personal wellbeing, their family and close relationships, their social and wider interpersonal relationships, and their overall sense of wellbeing. In this exploratory study, comparing findings with other scales used in primary care to measure depression, they argue that use of this framework has the potential to identify a larger group of people with situational and relationship distress than scales more specifically focussed on disease symptoms. The growing evidence concerning the impact of personal relationships on health supports the use of such a scale in PHC","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77090627","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}
Pub Date : 2016-12-28DOI: 10.1017/S146342361600044X
C. Roca Saumell, Anna Aguilar Margalejo, S. Barro Lugo, Dolors Sànchez Collado
Background: An epidemic of Ebola virus disease (EVD) occurred in West Africa in 2014. In Catalonia, primary care is the first level of healthcare so it has a key role in the detection and initial management of possible cases of EVD and in identifying contacts. Aim: This study aimed to find out how the staff of primary care centers perceived the measures for dealing with EVD. Method: An online questionnaire was distributed to all primary care workers in Catalonia during the period February–March 2015. Findings: The estimated response rate was 10.1%. They reported having received training/information, that a specific circuit had been organized and that the necessary equipment was available. They considered it unlikely that a patient with suspected EVD would present at the center and were aware of the action to take but were worried about this possibility. Rigorous scientific training in international health is essential to take on new global health challenges.
{"title":"Perception of measures for dealing with Ebola disease in primary care","authors":"C. Roca Saumell, Anna Aguilar Margalejo, S. Barro Lugo, Dolors Sànchez Collado","doi":"10.1017/S146342361600044X","DOIUrl":"https://doi.org/10.1017/S146342361600044X","url":null,"abstract":"Background: An epidemic of Ebola virus disease (EVD) occurred in West Africa in 2014. In Catalonia, primary care is the first level of healthcare so it has a key role in the detection and initial management of possible cases of EVD and in identifying contacts. Aim: This study aimed to find out how the staff of primary care centers perceived the measures for dealing with EVD. Method: An online questionnaire was distributed to all primary care workers in Catalonia during the period February–March 2015. Findings: The estimated response rate was 10.1%. They reported having received training/information, that a specific circuit had been organized and that the necessary equipment was available. They considered it unlikely that a patient with suspected EVD would present at the center and were aware of the action to take but were worried about this possibility. Rigorous scientific training in international health is essential to take on new global health challenges.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76719358","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}
Pub Date : 2016-12-22DOI: 10.1017/S1463423616000438
C. van Weel, R. Tamblyn, D. Turnbull
Background Health care is provided under the conditions in which people live and under the rules and regulations of a prevailing health system. As a consequence, ‘local’ circumstances are an important determinant of the actual care that can be provided and its effects on the health of individuals and populations. This plays in particular, but not exclusively, a role in community-based primary health care. Although this is generally accepted, there is little insight in the impact of the setting and context in which health care is provided on the outcome of care. Aim This paper argues the case to use this natural variation within and between countries as an opportunity to be used as a form of natural experiment in health research. Arguments We argue that analysing and comparing outcomes across settings, that is comparative outcomes of interventions that have been performed under different health care conditions will improve the understanding of how the real-life setting in which health care is provided – including the health system, the socio-economic circumstances and prevailing cultural values – do determine outcome of care. Recommendations To facilitate comparison of research findings across health systems and different socio-economic and cultural contexts, we recommend a more detailed reporting of the conditions and circumstances under which health research has been performed. A set of core variables is proposed for studies in primary health care.
{"title":"Variation matters and should be included in health care research for comparison of outcomes","authors":"C. van Weel, R. Tamblyn, D. Turnbull","doi":"10.1017/S1463423616000438","DOIUrl":"https://doi.org/10.1017/S1463423616000438","url":null,"abstract":"Background Health care is provided under the conditions in which people live and under the rules and regulations of a prevailing health system. As a consequence, ‘local’ circumstances are an important determinant of the actual care that can be provided and its effects on the health of individuals and populations. This plays in particular, but not exclusively, a role in community-based primary health care. Although this is generally accepted, there is little insight in the impact of the setting and context in which health care is provided on the outcome of care. Aim This paper argues the case to use this natural variation within and between countries as an opportunity to be used as a form of natural experiment in health research. Arguments We argue that analysing and comparing outcomes across settings, that is comparative outcomes of interventions that have been performed under different health care conditions will improve the understanding of how the real-life setting in which health care is provided – including the health system, the socio-economic circumstances and prevailing cultural values – do determine outcome of care. Recommendations To facilitate comparison of research findings across health systems and different socio-economic and cultural contexts, we recommend a more detailed reporting of the conditions and circumstances under which health research has been performed. A set of core variables is proposed for studies in primary health care.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86432454","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}
Pub Date : 2016-12-20DOI: 10.1017/S1463423616000426
D. Trivedi
Included studies targeted people with multimorbidity, defined as two or more chronic conditions in the same person. The term comorbidity referred to combinations of defined conditions that commonly exist, for example, diabetes and heart disease. This Cochrane review contained 18 randomised-controlled trials (RCTs) of which nine targeted people with a broad range of conditions or multimorbidity (Smith et al., 2016). The remaining nine included comorbidities: depression with hypertension, headache, diabetes and/or heart disease and one study with a sub-group of people who had at least two of diabetes, chronic obstructive pulmonary disease and irritable bowel syndrome. Most studies evaluated interventions involving changes to the organisation of care delivery with some studies delivering more patient-focussed interventions. Interventions were delivered in primary care or community settings and compared with usual care. In all, 16 studies were conducted in the United States, one in the United Kingdom and one in Canada. Studies that did not aim to specifically target multimorbidity were excluded.
纳入的研究针对多病人群，多病定义为同一个人有两种或两种以上的慢性疾病。合并症一词指的是通常存在的已定义疾病的组合，例如糖尿病和心脏病。这篇Cochrane综述包含18项随机对照试验(rct)，其中9项针对患有多种疾病或多重疾病的人群(Smith et al.， 2016)。剩下的9项包括合并症:抑郁症合并高血压、头痛、糖尿病和/或心脏病，还有一项研究是针对至少患有两种糖尿病、慢性阻塞性肺病和肠易激综合征的人进行的。大多数研究评估了干预措施，包括改变护理服务的组织，一些研究提供了更多以患者为中心的干预措施。干预措施在初级保健或社区环境中实施，并与常规护理进行比较。总共有16项研究在美国进行，一项在英国，一项在加拿大。没有专门针对多发病的研究被排除在外。
{"title":"Cochrane Review Summary: Interventions for improving outcomes in patients with multimorbidity in primary care and community settings","authors":"D. Trivedi","doi":"10.1017/S1463423616000426","DOIUrl":"https://doi.org/10.1017/S1463423616000426","url":null,"abstract":"Included studies targeted people with multimorbidity, defined as two or more chronic conditions in the same person. The term comorbidity referred to combinations of defined conditions that commonly exist, for example, diabetes and heart disease. This Cochrane review contained 18 randomised-controlled trials (RCTs) of which nine targeted people with a broad range of conditions or multimorbidity (Smith et al., 2016). The remaining nine included comorbidities: depression with hypertension, headache, diabetes and/or heart disease and one study with a sub-group of people who had at least two of diabetes, chronic obstructive pulmonary disease and irritable bowel syndrome. Most studies evaluated interventions involving changes to the organisation of care delivery with some studies delivering more patient-focussed interventions. Interventions were delivered in primary care or community settings and compared with usual care. In all, 16 studies were conducted in the United States, one in the United Kingdom and one in Canada. Studies that did not aim to specifically target multimorbidity were excluded.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79037113","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}
Pub Date : 2016-12-20DOI: 10.1017/S1463423616000414
F. Chang, T. Paramsothy, M. Roche, N. Gupta
Aim To conduct an environmental scan of a rural primary care clinic to assess the feasibility of implementing an e-communications system between patients and clinic staff. Background Increasing demands on healthcare require greater efficiencies in communications and services, particularly in rural areas. E-communications may improve clinic efficiency and delivery of healthcare but raises concerns about patient privacy and data security. Methods We conducted an environmental scan at one family health team clinic, a high-volume interdisciplinary primary care practice in rural southwestern Ontario, Canada, to determine the feasibility of implementing an e-communications system between its patients and staff. A total of 28 qualitative interviews were conducted (with six physicians, four phone nurses, four physicians’ nurses, five receptionists, one business office attendant, five patients, and three pharmacists who provide care to the clinic’s patients) along with quantitative surveys of 131 clinic patients. Findings Patients reported using the internet regularly for multiple purposes. Patients indicated they would use email to communicate with their family doctor for prescription refills (65% of respondents), appointment booking (63%), obtaining lab results (60%), and education (50%). Clinic staff expressed concerns about patient confidentiality and data security, the timeliness, complexity and responsibility of responses, and increased workload. Conclusion Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.
{"title":"Patient, staff, and clinician perspectives on implementing electronic communications in an interdisciplinary rural family health practice","authors":"F. Chang, T. Paramsothy, M. Roche, N. Gupta","doi":"10.1017/S1463423616000414","DOIUrl":"https://doi.org/10.1017/S1463423616000414","url":null,"abstract":"Aim To conduct an environmental scan of a rural primary care clinic to assess the feasibility of implementing an e-communications system between patients and clinic staff. Background Increasing demands on healthcare require greater efficiencies in communications and services, particularly in rural areas. E-communications may improve clinic efficiency and delivery of healthcare but raises concerns about patient privacy and data security. Methods We conducted an environmental scan at one family health team clinic, a high-volume interdisciplinary primary care practice in rural southwestern Ontario, Canada, to determine the feasibility of implementing an e-communications system between its patients and staff. A total of 28 qualitative interviews were conducted (with six physicians, four phone nurses, four physicians’ nurses, five receptionists, one business office attendant, five patients, and three pharmacists who provide care to the clinic’s patients) along with quantitative surveys of 131 clinic patients. Findings Patients reported using the internet regularly for multiple purposes. Patients indicated they would use email to communicate with their family doctor for prescription refills (65% of respondents), appointment booking (63%), obtaining lab results (60%), and education (50%). Clinic staff expressed concerns about patient confidentiality and data security, the timeliness, complexity and responsibility of responses, and increased workload. Conclusion Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79109436","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}
Pub Date : 2016-11-07DOI: 10.1017/S1463423616000402
P. Brauer, D. Royall, J. Dwyer, A. M. Edwards, T. Hussey, N. Kates, Heidi J. Smith, Ross Kirkconnell
Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services. Background It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity. Methods The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education. Conclusions Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.
{"title":"Obesity services planning framework for interprofessional primary care organizations – ERRATUM","authors":"P. Brauer, D. Royall, J. Dwyer, A. M. Edwards, T. Hussey, N. Kates, Heidi J. Smith, Ross Kirkconnell","doi":"10.1017/S1463423616000402","DOIUrl":"https://doi.org/10.1017/S1463423616000402","url":null,"abstract":"Aim\u0000 We report on a formative project to develop an organization-level planning framework for obesity prevention and management services.\u0000 Background\u0000 It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity.\u0000 Methods\u0000 The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft.\u0000 Findings\u0000 Providers identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education.\u0000 Conclusions\u0000 Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91150046","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}
Pub Date : 2016-10-25DOI: 10.1017/S1463423616000396
M. Ward
Aim To understand the frequency, urgency, and rationale of emergency department and urgent care (ED/UC) use by diabetic patients of a Family Medicine Health Team (FHT). Methods A retrospective, observational study with comparison control groups was conducted from 1 January 2013 to 31 December 2014. A total of 693 diabetic patients were compared with two, age-standardized non-diabetic groups: one with a higher disease burden based on International Classification of Diseases 9 diagnoses and the other from a randomized patient pool. Findings The diabetic group utilized ED/UC services 1.25 and 1.92 times more often than the two control populations, consistent with that observed in other studies. Canadian Triage and Acuity Scale scores were essentially the same for the diabetic population. Only 3.1% of visits were for diabetic related emergencies, in contrast to the expected 23% by surveyed physicians of the FHT. Diabetic patient’s sought treatment for cellulitis, wounds, abscesses, and infections more often than the control populations.
{"title":"Understanding the use of emergency department and urgent care services by diabetic patients of a Family Medicine Health Team: a retrospective observational study","authors":"M. Ward","doi":"10.1017/S1463423616000396","DOIUrl":"https://doi.org/10.1017/S1463423616000396","url":null,"abstract":"Aim To understand the frequency, urgency, and rationale of emergency department and urgent care (ED/UC) use by diabetic patients of a Family Medicine Health Team (FHT). Methods A retrospective, observational study with comparison control groups was conducted from 1 January 2013 to 31 December 2014. A total of 693 diabetic patients were compared with two, age-standardized non-diabetic groups: one with a higher disease burden based on International Classification of Diseases 9 diagnoses and the other from a randomized patient pool. Findings The diabetic group utilized ED/UC services 1.25 and 1.92 times more often than the two control populations, consistent with that observed in other studies. Canadian Triage and Acuity Scale scores were essentially the same for the diabetic population. Only 3.1% of visits were for diabetic related emergencies, in contrast to the expected 23% by surveyed physicians of the FHT. Diabetic patient’s sought treatment for cellulitis, wounds, abscesses, and infections more often than the control populations.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81028405","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}
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