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.

scholarly journals Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

2021 ◽  
Vol 9 (2) ◽  
pp. e000780
Author(s):  
Lisanne Andra Gitsels ◽  
Ilyas Bakbergenuly ◽  
Nicholas Steel ◽  
Elena Kulinskaya
Keyword(s):  
Primary Care ◽  
Older People ◽  
Clinical Information ◽  
Cardiac Risk ◽  
Health Improvement ◽  
Network Database ◽  
Statin Prescription ◽  
The Health Improvement Network ◽  
Care Practices ◽  
Primary Care Practices

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

scholarly journals GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Leah Palapar ◽  
Laura Wilkinson-Meyers ◽  
Thomas Lumley ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Older People ◽  
Home Visiting ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Trial Registration ◽  
Primary Care Redesign ◽  
Practice Level ◽  
Practice Characteristics

Abstract Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified ASHs from the national dataset of hospital events for 3755 community-dwelling participants aged 75+ enrolled in a cluster randomised controlled trial involving 60 randomly selected general practices in three regions in New Zealand. Poisson mixed models of 36-month ASH rates were fitted for the entire sample, for complex participants, and non-complex participants. We examined variation in ASH rates according to GP- and practice-level characteristics after adjusting for patient-level predictors of ASH. Results Lower rates of ASHs were observed in female GPs (IRR 0.83, CI 0.71 to 0.98). In non-complex participants, but not complex participants, practices in more deprived areas had lower ASH rates (4% lower per deprivation decile higher, IRR 0.96, CI 0.92 to 1.00), whereas main urban centre practices had higher rates (IRR 1.84, CI 1.15 to 2.96). Variance explained by these significant factors was small (0.4% of total variance for GP sex, 0.2% for deprivation, and 0.5% for area type). None of the modifiable practice-level characteristics such as home visiting and systematically contacting patients were significantly associated with ASH rates. Conclusions Only a few GP and non-modifiable practice characteristics were associated with variation in ASH rates in 60 New Zealand practices interested in a trial about care of older people. Where there were significant associations, the contribution to overall variance was minimal. It also remains unclear whether lower ASH rates in older people represents underservicing or less overuse of hospital services, particularly for the relatively well patient attending practices in less central, more disadvantaged communities. Thus, reducing ASHs through primary care redesign for older people should be approached carefully. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12609000648224.

scholarly journals Investigating the mechanism of impact and differential effect of the Quality Premium scheme on antibiotic prescribing in England: a longitudinal study

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101052 ◽  
Author(s):  
Philip Emeka Anyanwu ◽  
Koen Pouwels ◽  
Anne Walker ◽  
Michael Moore ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Primary Care ◽  
Financial Incentives ◽  
Financial Incentive ◽  
Diabetes Prevalence ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Practice Characteristics ◽  
Antibiotic Drugs ◽  
Care Practices ◽  
Primary Care Practices

BackgroundIn 2017, approximately 73% of antibiotics in England were prescribed from primary care practices. It has been estimated that 9%–23% of antibiotic prescriptions between 2013 and 2015 were inappropriate. Reducing antibiotic prescribing in primary care was included as one of the national priorities in a financial incentive scheme in 2015–2016.AimTo investigate whether the effects of the Quality Premium (QP), which provided performance-related financial incentives to clinical commissioning groups (CCGs), could be explained by practice characteristics that contribute to variations in antibiotic prescribing.Design & settingLongitudinal monthly prescribing data were analysed for 6251 primary care practices in England from April 2014 to March 2016.MethodLinear generalised estimating equations models were fitted, examining the effect of the 2015–2016 QP on the number of antibiotic items per specific therapeutic group age–sex related prescribing unit (STAR-PU) prescribed, adjusting for seasonality and months since implementation. Consistency of effects after further adjustment for variations in practice characteristics were also examined, including practice workforce, comorbidities prevalence, prescribing rates of non-antibiotic drugs, and deprivation.ResultsAntibiotics prescribed in primary care practices in England reduced by -0.172 items per STAR-PU (95% confidence interval [CI] = -0.180 to -0.171) after 2015–2016 QP implementation, with slight increases in the months following April 2015 (+0.014 items per STAR-PU; 95% CI = +0.013 to +0.014). Adjusting the model for practice characteristics, the immediate and month-on-month effects following implementation remained consistent, with slight attenuation in immediate reduction from -0.172 to -0.166 items per STAR-PU. In subgroup analysis, the QP effect was significantly greater among the top 20% prescribing practices (interaction p<0.001). Practices with low workforce and those with higher diabetes prevalence had greater reductions in prescribing following 2015–2016 QP compared with other practices (interaction p<0.001).ConclusionIn high-prescribing practices, those with low workforce and high diabetes prevalence had more reduction following the QP compared with other practices, highlighting the need for targeted support of these practices and appropriate resourcing of primary care.

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

scholarly journals Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study

10.2196/24345 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e24345
Author(s):  
Kelsey Schweiberger ◽  
Alejandro Hoberman ◽  
Jennifer Iagnemma ◽  
Pamela Schoemer ◽  
Joseph Squire ◽  
...  
Keyword(s):  
Primary Care ◽  
Race And Ethnicity ◽  
Pediatric Primary Care ◽  
Office Visits ◽  
Level Variation ◽  
Practice Level ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices ◽  
Clinician Attitudes

Background Telehealth, the delivery of health care through telecommunication technology, has potential to address multiple health system concerns. Despite this potential, only 15% of pediatric primary care clinicians reported using telemedicine as of 2016, with the majority identifying inadequate payment for these services as the largest barrier to their adoption. The COVID-19 pandemic led to rapid changes in payment and regulations surrounding telehealth, enabling its integration into primary care pediatrics. Objective Due to limited use of telemedicine in primary care pediatrics prior to the COVID-19 pandemic, much is unknown about the role of telemedicine in pediatric primary care. To address this gap in knowledge, we examined the association between practice-level telemedicine use within a large pediatric primary care network and practice characteristics, telemedicine visit diagnoses, in-person visit volumes, child-level variations in telemedicine use, and clinician attitudes toward telemedicine. Methods We analyzed electronic health record data from 45 primary care practices and administered a clinician survey to practice clinicians. Practices were stratified into tertiles based on rates of telemedicine use (low, intermediate, high) per 1000 patients per week during a two-week period (April 19 to May 2, 2020). By practice tertile, we compared (1) practice characteristics, (2) telemedicine visit diagnoses, (3) rates of in-person visits to the office, urgent care, and the emergency department, (4) child-level variation in telemedicine use, and (5) clinician attitudes toward telemedicine across these practices. Results Across pediatric primary care practices, telemedicine visit rates ranged from 5 to 23 telemedicine visits per 1000 patients per week. Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28%-36% of visits) and dermatologic (15%-28%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, P=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, P=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. Conclusions Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine.

scholarly journals Practice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey Study (Preprint)

2020 ◽  
Author(s):  
Kelsey Schweiberger ◽  
Alejandro Hoberman ◽  
Jennifer Iagnemma ◽  
Pamela Schoemer ◽  
Joseph Squire ◽  
...  
Keyword(s):  
Primary Care ◽  
Race And Ethnicity ◽  
Pediatric Primary Care ◽  
Office Visits ◽  
Level Variation ◽  
Practice Level ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices ◽  
Clinician Attitudes

BACKGROUND Telehealth, the delivery of health care through telecommunication technology, has potential to address multiple health system concerns. Despite this potential, only 15% of pediatric primary care clinicians reported using telemedicine as of 2016, with the majority identifying inadequate payment for these services as the largest barrier to their adoption. The COVID-19 pandemic led to rapid changes in payment and regulations surrounding telehealth, enabling its integration into primary care pediatrics. OBJECTIVE Due to limited use of telemedicine in primary care pediatrics prior to the COVID-19 pandemic, much is unknown about the role of telemedicine in pediatric primary care. To address this gap in knowledge, we examined the association between practice-level telemedicine use within a large pediatric primary care network and practice characteristics, telemedicine visit diagnoses, in-person visit volumes, child-level variations in telemedicine use, and clinician attitudes toward telemedicine. METHODS We analyzed electronic health record data from 45 primary care practices and administered a clinician survey to practice clinicians. Practices were stratified into tertiles based on rates of telemedicine use (low, intermediate, high) per 1000 patients per week during a two-week period (April 19 to May 2, 2020). By practice tertile, we compared (1) practice characteristics, (2) telemedicine visit diagnoses, (3) rates of in-person visits to the office, urgent care, and the emergency department, (4) child-level variation in telemedicine use, and (5) clinician attitudes toward telemedicine across these practices. RESULTS Across pediatric primary care practices, telemedicine visit rates ranged from 5 to 23 telemedicine visits per 1000 patients per week. Across all tertiles, the most frequent telemedicine visit diagnoses were mental health (28%-36% of visits) and dermatologic (15%-28%). Compared to low telemedicine use practices, high telemedicine use practices had fewer in-person office visits (10 vs 16 visits per 1000 patients per week, <i>P</i>=.005) but more total encounters overall (in-office and telemedicine: 28 vs 22 visits per 1000 patients per week, <i>P</i>=.006). Telemedicine use varied with child age, race and ethnicity, and recent preventive care; however, no significant interactions existed between these characteristics and practice-level telemedicine use. Finally, clinician attitudes regarding the usability and impact of telemedicine did not vary significantly across tertiles. CONCLUSIONS Across a network of pediatric practices, we identified significant practice-level variation in telemedicine use, with increased use associated with more varied telemedicine diagnoses, fewer in-person office visits, and increased overall primary care encounter volume. Thus, in the context of the pandemic, when underutilization of primary care was prevalent, higher practice-level telemedicine use supported pediatric primary care encounter volume closer to usual rates. Child-level telemedicine use differed by child age, race and ethnicity, and recent preventive care, building upon prior concerns about differences in access to telemedicine. However, increased practice-level use of telemedicine services was not associated with reduced or increased differences in use, suggesting that further work is needed to promote equitable access to primary care telemedicine.

scholarly journals Does practice characteristics explain the impact of a financial incentive on antibiotic prescribing?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
P Anyanwu ◽  
C Costelloe
Keyword(s):  
Primary Care ◽  
Financial Incentive ◽  
Antibiotic Prescribing ◽  
Incentive Scheme ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices ◽  
The Impact ◽  
Specific Health

Abstract Background About 80% of the antibiotics prescribed in England are from primary care practices. The Quality Premium (QP) initiative that offers financial rewards on the quality of specific health services commissioned is one of the NHS England interventions to reduce antimicrobial resistance through reduced prescribing. Evaluations of the initiative suggest a reduction in antibiotic prescribing in primary care. We investigated whether the effect of this financial incentive on antibiotic prescribing is explained by variations in practice characteristics that can contribute to differences in antibiotic prescribing. Methods We used monthly prescribing data for 6,600 practices in England from NHS Digital for the year from April 2015 when antibiotic improvement was included as a QP priority and the preceding year. We fitted an initial linear generalised estimating equations model examining the effect of the incentive on antibiotic items/STAR-PU prescribed, adjusting for seasonality and number of months since implementation. We examined the consistency of the effect after the initial model was adjusted for variations in workforce, prevalence of co-morbidities (asthma, COPD, cancer, chronic kidney disease, diabetes), and deprivation index. Results Antibiotics prescribed in primary care practices in England reduced by 0.20 items/STAR-PU (95% CI:0.19-0.21) after the implementation of the initiative. This reduction flattened off in the following months with a month-on-month increase of 0.013 items (95% CI:0.012-0.013). After adjusting for practice characteristics, the immediate and month-on-month impacts remained consistent with slight attenuation of the immediate impact (0.18, 95% CI:0.17-0.18). Subgroup analyses showed the effect of the initiative was significantly more among 20% top prescribers. Conclusions Variations in practice characteristics are not a major explanation for the impact of the quality premium initiative on antibiotic prescribing in primary care practices in England. Key messages Our findings on the targeted impact of a financial incentive scheme to improve antibiotics prescribing on high prescribers are important to policymakers and antibiotic stewardship programs. Variations in practice characteristics are not a major explanation for the impact of a financial incentive scheme on antibiotics prescribing in primary care practices in England.

Completed Suicide Among Older Patients in Primary Care Practices: A Controlled Study

2000 ◽  
Vol 48 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Yeates Conwell ◽  
Jeffrey M. Lyness ◽  
Paul Duberstein ◽  
Christopher Cox ◽  
Larry Seidlitz ◽  
...  
Keyword(s):  
Primary Care ◽  
Older Patients ◽  
Controlled Study ◽  
Completed Suicide ◽  
Care Practices ◽  
Primary Care Practices
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