BMC primary care最新文献

Background: General practices have been tasked with increasing detection of atrial fibrillation (AF) to reduce stroke. Paroxysmal AF is often missed through usual care but can be detected through screening with repeated ECGs over a period of time using hand-held ECG devices. As part of the drive to detect AF, screening with such devices is being encouraged by both policy makers and industry. It is unclear whether general practice should be leading this effort. Previously, we showed that there was no quantitative difference between a centralised administration and general practice-delivered AF screening programme in terms of the quality and numbers of ECGs generated. Here, we aimed to assess the strengths and weaknesses of each approach using qualitative methods.

Methods: We compared programme delivery by one UK general practice and by a non-clinical centralised administration for two UK general practices in a qualitative study to explore how to conduct screening for AF in a planned trial. From September to December 2020, we conducted semi-structured interviews with 19 staff members. We took field notes of implementation issues arising during observation of 4.5 h of training and collected 15 training evaluation forms. Data were analysed thematically sensitised by the Consolidated Framework for Implementation Research. Analysis focused on the strengths and weaknesses of the different approaches.

Results: While both general practice staff and centralised administrators showed motivation to deliver a screening programme, there were differences in skills and capacity. General practice staff provided continuity of care and offer other care in parallel. They could use relational and communication skills to potentially engage those from underserved communities, but were limited by resources. Centralised administrators, with a singular focus on screening, could deliver a consistently high performance and undertake more complicated administration. Their initial anxieties about communication skills reduce with training and experience.

Conclusions: In screening for AF, primary care and centralised administration demonstrate different strengths and weaknesses. A hybrid approach with centralised screening and primary care signposting, particularly for underserved communities, might be optimal. Awareness of this may help policy makers optimise the use of primary care in the drive to detect AF.

Primary care offers an important pathway for timely diagnosis and treatment of mild cognitive impairment and dementia. Transformative changes require a structured approach to implementation of early diagnosis workflows. Planning, designing, implementing, and sustaining are important aspects of these improvements. A practical approach for health system leaders is provided.

Background: As the COVID-19 pandemic accelerated the uptake of virtual primary care (VPC) in Canada, debates over how it ought to be encouraged or discouraged, governed and paid for have intensified. Within these debates there has been little attention paid to the details of which technologies are being deployed to deliver VPC and how those technologies interact with non-technical factors to ensure efficiency and effectiveness.

Methods: The aims of the study included drawing out pragmatic considerations for policy makers by identifying the various constellations of VPC technology that are being deployed; characterizing how key informants see them working and to what purpose; and describing how those technologies are interacting with non-technical factors to shape success. 29 qualitative interviews were conducted with mid-level VPC experts from the provinces of Alberta, Nova Scotia, and Ontario.

Results: Key informants saw a broad range of VPC technologies as improving access to primary care by increasing efficiency and coordination. They deployed VPC to improve the accessibility, availability, and accommodativeness of care. They described VPC technologies interacting with and relying on: human efforts, funding models, and the institutional contexts for their success.

Conclusions: Policy-makers seeking to optimize VPC will want to consider ways to support not just purchases of technology, but: the human effort required to choose and manage technology; the funding mechanisms that incentivize the efficient use technology; and the institutional contexts and cultures that underpin access improvements through technology.