scholarly journals What contributes to delays? The primary care determinants of immunisation timeliness in New Zealand

2012 ◽  
Vol 4 (1) ◽  
pp. 12 ◽  
Author(s):  
Helen Petousis-Harris ◽  
Cameron Grant ◽  
Felicity Goodyear-Smith ◽  
Nikki Turner ◽  
Deon York ◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Social Deprivation ◽  
Vaccine Dose ◽  
Multiple Regression Model ◽  
Primary Care Settings ◽  
Primary Series ◽  
Care Family ◽  
Care Practices ◽  
Primary Care Practices

INTRODUCTION: Delay in receipt of the first vaccine dose in the primary series is one of the strongest and most consistent predictors of subsequent incomplete immunisation. AIM: To describe the on-time immunisation delivery of New Zealand infant scheduled vaccines by primary care practices and identify characteristics of practices, health professionals and patients associated with delays in receipt of infant immunisations. METHODS: Timeliness of immunisation delivery and factors associated with timely immunisation were examined in 124 randomly selected primary care practices in two large regions of New Zealand. RESULTS: A multiple regression model of demographic, practice, nurse, doctor and caregiver association explained 68% of the variance in immunisation timeliness between practices. Timeliness was higher in practices without staff shortages (ß-coefficient -0.0770, p= 0.01), where nurses believed parental apathy (ß-coefficient 0.0819, p=0.008) or physicians believed parental access (ß-coefficient 0.109, p=0.002) was a barrier, and lower in practices with Maori governance (ß-coefficient -0.0868, p=0.05), higher social deprivation (ß-coefficient -0.0643,<0.001) and where caregivers received immunisation-discouraging information (ß-coefficient -0.0643, p=0.04). DISCUSSION: Interventions supporting practice teams and providers in primary care settings could produce significant improvements in immunisation timeliness. KEYWORDS: Immunization; vaccination; immunization programs; primary health care; family practice

Primary Care Implementation of Instrument-Based Vision Screening for Young Children

2017 ◽  
Vol 57 (9) ◽  
pp. 1020-1026 ◽  
Author(s):  
Louis Vernacchio ◽  
Emily K. Trudell ◽  
Jason Nigrosh ◽  
Glenn Focht
Keyword(s):  
Primary Care ◽  
Young Children ◽  
Vision Loss ◽  
Interrupted Time Series ◽  
Vision Screening ◽  
Interrupted Time Series Analysis ◽  
Primary Care Settings ◽  
Care Practices ◽  
Primary Care Practices ◽  
Vision Screener

Vision screening for young children can detect conditions that may lead to amblyopia and vision loss if left untreated. Portable vision screening devices with high levels of precision are now available, but their effectiveness in busy primary care settings is unknown. We analyzed the effect of deploying instrument screening devices (SPOT Vision Screener, Welch-Allyn) in 19 pediatric practices. At baseline, using chart-based screening, 65.3% of 3- to 5-year-old children completed screening. A significant increase was observed starting 3 weeks after delivery of devices, and a stable level was reached 12 weeks after implementation, with 86.5% of children completing vision screening ( P = .007 by interrupted time series analysis). Improvement was greatest among 3-year-olds (44.0%-79.8%) but was also seen among 4-year-olds (70.9%-88.4%) and 5-year-olds (80.3%-90.8%). The deployment of vision screening devices in primary care practices substantially improved completed screening among preschool-aged children.

scholarly journals Usual primary care of older people in New Zealand: association between practice characteristics and practice activities

2017 ◽  
Vol 9 (1) ◽  
pp. 78 ◽  
Author(s):  
Leah Palapar ◽  
Laura Wilkinson-Meyers ◽  
Thomas Lumley ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Older People ◽  
Older Patients ◽  
Home Visits ◽  
Assessment Tools ◽  
Future Research ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices

ABSTRACT INTRODUCTION Information on the processes used by primary care practices to help identify older patients in need of assistance are limited in New Zealand. AIM To describe the processes used to promote early problem detection in older patients in primary care and the practice characteristics associated with the use of these proactive processes. METHODS Sixty practices were randomly selected from all primary care practices in three regions (52% response rate) and surveyed in 2010 to identify characteristics of practices performing the following activities: using assessment tools; auditing the practice; conducting specific clinics; providing home visits; and providing active patient follow-up. Practice level variables were examined. RESULTS Only 4 (7%) of 57 practices did not perform any of the activities. We found the following associations in the many comparisons done: no activities and greater level of deprivation of practice address (p = 0.048); more activities in main urban centres (p = 0.034); more main urban centre practices doing home visits (p = 0.001); less Canterbury practices conducting specific clinics for frail older patients (p = 0.010); and more Capital and Coast practices following-up patients who do not renew their prescriptions (p = 0.019). DISCUSSION There are proactive processes in place in most New Zealand practices interested in a trial about care of older people. Future research should determine whether different types of practices or the activities that they undertake make a difference to older primary care patients’ outcomes.

Integrated Care for Anxiety Disorders

2017 ◽  
Author(s):  
Robert D. Davies ◽  
Isabelle Guillemet ◽  
Adam Trosterman
Keyword(s):  
Primary Care ◽  
Anxiety Disorders ◽  
Integrated Treatment ◽  
High Yield ◽  
Obsessive Compulsive ◽  
Treatment Pathways ◽  
Compulsive Disorder ◽  
Primary Care Settings ◽  
Care Practices ◽  
Primary Care Practices

Anxiety disorders are among the most common psychiatric disorders in the general population and among patients in primary care settings. However, the majority of anxiety disorders go unrecognized and untreated in primary care practices. The most common anxiety disorders in primary care settings are panic disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. These disorders are readily treated with medications and/or evidence-based therapies once accurately identified and diagnosed. This chapter will describe targeted, high-yield screening practices for anxiety disorders, as well as collaborative, integrated treatment pathways for primary care settings and integrated health care environments.

scholarly journals Clinical effectiveness and cost effectiveness of individual mental health workers colocated within primary care practices: a systematic literature review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042052
Author(s):  
Jean-Baptiste Woods ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Health Worker ◽  
Health Workers ◽  
Risk Of Bias ◽  
Mental Health Workers ◽  
Mental Health Worker ◽  
Care Practices ◽  
Primary Care Practices

ObjectivesMental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.DesignSystematic literature review.Data sourcesWe searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases.Eligibility criteriaAll quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible.Data extraction and synthesisData were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration’s tool for assessing risk of bias in randomised trials.ResultsFifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.ConclusionsWhile there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices.

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