Guidelines for infertility management in primary care did not improve patient care or reduce costs

2001 ◽  
Vol 3 (4) ◽  
pp. 200-201
Author(s):  
William Ledger
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Improve Patient Care ◽  
Improve Patient

scholarly journals 96 Will Routine Frailty Identification by GPS Improve Patient Care? A Review of the 2017 GMS Contract For General Practitioners (GPS) Using Pestle Analysis Tool

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i30-i32
Author(s):  
M Kaneshamoorthy
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Alternative Methods ◽  
Analysis Tool ◽  
Frail Patients ◽  
The Government ◽  
Improve Patient ◽  
Work Burden

Abstract Introduction It is well established in the literature that frailty is associated with high health costs (Bock 2016, England: BioMed Central). Early identification improves patient outcomes. The 2017 GMS contract for General Practioners’ (NHS England 2017) had tried to implement this. This is a result from the government wanting to improve care for frail patients from the “Five Year Forward Review”. This is first policy worldwide to introduce a policy on frailty screening (Reeves, 2018, BMJ, 362, pp. k3349). Majority of frail patients’ first contact with the NHS is through Primary Care. However, with ever reducing number of GPs and increasing work burden, is it appropriate to ask GPs to undertake this? Methods This review uses the policy analysis tool PESTLE (Political, Economical, Social, Technological, Legal, and Environmental) (Visconti 2016, Corporate Ownership and Control,13), to assess the implications of this new contract obligation on GPs and patients. Results Once frail patients are identified, it is advised that they are reviewed by GPs annually. Whether this actually benefits patients are not clear (Page 2017 British Journal of Clinical Pharmacology, 82(3), pp. 583–623). The evidence for interventions being cost-effective is also inconsistent (Hamilton 2017, BMJ, 358, pp. j4478). Alternative methods include implementing a nurse-led community frailty service, has shown some benefit in Netherlands (Bleijenberg 2017, JAMDA). Clinical Pharmacist can aid with medication reviews and focusing on Geriatrician “outreach” clinics in primary care can improve patient care and outcomes (Goldstein 2014, CJEM, 16(5), pp. 370). Due to the work burden, GPs are often seen to be reactive rather than proactive (Goodwin 2010, The King’s Fund). The shift in focus on frailty can simulate more constructive dialogue between primary care, secondary care, patients and their carers. The BMA has also tried to reassure GPs this is not an added burden, but this is controversial (BMA 2017). Conclusions To successfully implement such a policy, emphasis on clear objective outcomes and strategy is needed. There is a risk of frailty identification becoming a tick box exercise.

scholarly journals Acute General Practice – the 7 year itch

2015 ◽  
Vol 14 (3) ◽  
pp. 132-135
Author(s):  
Ben Jameson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Patient Care ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Service Design ◽  
Improve Patient Care ◽  
Medical Assessment ◽  
Improve Patient

The Acute GP Service has operated in Plymouth for the last 7 years. We have a mandate to improve patient care through supporting community GPs and their patients at the point of need for urgent medical assessment. I outline our service design and delivery and make the argument for the use of primary care physicians to help manage the interface between primary and secondary care.

Abstract 11119: Real-Time Nanopore Sequencing for Bacterial Pneumonia After Out-of-Hospital Cardiac Arrest, a Pilot Proof-of-Concept Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Alexandra Weissman ◽  
Mariam Bramah Lawani ◽  
Thomas Rohan ◽  
Clifton W CALLAWAY
Keyword(s):  
Patient Care ◽  
Pathogen Detection ◽  
Bacterial Pathogen ◽  
Improve Patient Care ◽  
Antibiotic Administration ◽  
Nanopore Sequencing ◽  
Proof Of Concept ◽  
Chi Square ◽  
Significant Difference ◽  
Improve Patient

Introduction: Pneumonia is common after OHCA but is difficult to diagnose in the first 72 hours following ROSC, this results in early untargeted antibiotic administration based on non-specific imaging and laboratory findings. Antibiotic resistance is rising, is influenced by untargeted antibiotic administration, and can increase patient morbidity and mortality as well as healthcare costs. Precision methods of bacterial pathogen detection in OHCA patients are needed to improve patient care. This proof-of-concept pilot study aimed to assess feasibility of bacterial pathogen sequencing and comparability of sequencing results to clinical culture after OHCA. Methods: Blood and bronchoalveolar lavage (BAL) were obtained from residual clinical specimens collected within 12 hours of ROSC. Bacterial DNA was extracted using the Qiagen PowerLyzer PowerSoil DNA kit, sequenced using the MinION nanopore sequencer, and analyzed with Oxford Nanopore Technologies’ EPI2ME bioinformatics software. Sequencing results were compared to culture results using McNemar’s chi-square statistic. Study-defined pneumonia was based on presence of at least two characteristics within 72 hours of ROSC: fever (temperature ≥38°C); persistent leukocytosis >15,000 or leukopenia <3,500 for 48 hours; persistent chest radiography infiltrates for 48 hours per clinical radiology read; bacterial pathogen cultured. Results: We enrolled 38 consecutive OHCA subjects: mean age 61.8 years (18.0); 16 (42%) female; 25 (66%) White, 7 (18%) Black, 6 (16%) “Other” race; 7 subjects (18%) survived and 31 (82%) died; 16 (42%) subjects had pneumonia. Sequencing results were available in 12 hours while culture results were available in 48-72 hours after collection. There was a non-significant difference in the proportion of the same pathogens identified for each method per McNemar’s chi-square: p = 0.38, difference of 0.095 (-0.095, 0.286). Conclusions: Nanopore sequencing detects pathogenic bacteria comparable to clinical microbiologic culture and in less time. This technology can produce a paradigm shift in early bacterial pathogen detection in OHCA survivors, which can improve patient care. The technology is applicable to other patient populations and for viral and fungal pathogens.

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