Factors associated with variation in emergency diagnoses of cancer at general practice level in England

2020 ◽  
Author(s):  
Kevin Joyce ◽  
Terezija Zermanos ◽  
Padmanabhan Badrinath
Keyword(s):  
Primary Care ◽  
Healthcare Professionals ◽  
Primary Care Trust ◽  
Logistic Regression Models ◽  
Practice Level ◽  
Emergency Presentation ◽  
Practice Characteristics ◽  
Primary Care Clinicians ◽  
Socio Demographic Factors ◽  
Cancer Networks

Abstract Background Cancer patients diagnosed following an emergency presentation have poorer outcomes. We explore whether practice characteristics are associated with differences in the proportion of emergency presentations. Methods Univariable and multivariable logistic regression models were fitted to investigate the relationships between 2017–18 emergency cancer presentations at practice level in England and access and continuity in primary care, trust in healthcare professionals, 2-week-wait (2WW) referrals, quality and outcomes framework (QOF) achievements and socio-demographic factors (age, gender and deprivation). Results Our analysis using comprehensive nationwide data found that the following practice level factors have significant associations with a lower proportion of emergency diagnosis of cancer: increased trust and confidence in the practice healthcare professionals; higher 2WW referral and conversion rate; higher total practice QOF score and higher satisfaction with appointment times or higher proportion able to see preferred GP. Our results also show that practices in more deprived areas are significantly associated with a higher proportion of emergency diagnoses of cancer. Conclusions Regional cancer networks should focus their efforts in increasing both the quantity and appropriateness of 2WW referrals from primary care. In addition, primary care clinicians should be supported to undertake high quality consultations, thus building trust with patients and ensuring continuity of care.

scholarly journals Willingness of general dental practices in South East London to engage with research

2019 ◽  
Vol 20 ◽  
Author(s):  
Marwah Afeef ◽  
Caillin Redican ◽  
Eduardo Bernabé
Keyword(s):  
Primary Care ◽  
Regression Models ◽  
Response Rate ◽  
Training Programme ◽  
Main Role ◽  
Willingness To Participate ◽  
Primary Care Research ◽  
Logistic Regression Models ◽  
Practice Characteristics ◽  
Dental Practices

Abstract This study assessed the willingness of general dental practices (GDPs) to participate in research. All 263 GDPs in South East London that provide dental care under National Health Service (NHS) contracts were invited. The survey instrument was adapted from previous studies and piloted before administration. Geographical factors and practice characteristics associated with willingness to participate in research were explored in logistic regression models. A total of 77 responses were received (response rate: 29%). Of them, 40 (53%) expressed interest in being involved in primary care research. They saw their main role as collecting data and facilitating access to patients. Time, bureaucracy and lack of energy were the main reasons behind a decision not to engage with research. Those spending more time in NHS services were more likely to be willing to participate in research. Other possible indicators were single-handed GDPs, participation in the dental foundation training programme and location in more affluent areas.

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 Healthcare Provider Perspectives on Lowering Colorectal Cancer Screening Initiation Age to 45 Years: Results From a Survey of Clinicians in the U.S.

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482097711
Author(s):  
Lila J. Finney Rutten ◽  
Philip Parks ◽  
Emily Weiser ◽  
Xuan Zhu ◽  
Joan M. Griffin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Current Debate ◽  
Practice Characteristics ◽  
Provider Perspectives ◽  
Primary Care Clinicians ◽  
Evidence Based Care ◽  
Healthcare Provider Perspectives

We conducted a survey of primary care clinicians and gastroenterologists (n = 938) between 11/06/19–12/06/19 to assess knowledge and attitudes regarding colorectal cancer screening. We assessed clinicians’ attitudes toward lowering the colorectal cancer screening initiation age to 45 years, a topic of current debate. We also evaluated provider and practice characteristics associated with agreement. Only 38.1% of primary care clinicians endorsed colorectal cancer screening initiation at age 45 years, compared to 75.5% of gastroenterologists (p < .0001). Gastroenterologists were over 5 times more likely than primary care clinicians to endorse lowering the screening initiation age (OR = 5.30, 3.54-7.93). Other factors found to be independently associated with agreement with colorectal cancer screening initiation at age 45 years included seeing more than 25 patients per day (vs. fewer) and suburban (vs. urban) location. Results emphasize the need for collaboration between primary care clinicians and gastroenterologists to ensure that patients receive consistent messaging and evidence-based care.

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 How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.

2020 ◽  
Author(s):  
Chiamaka Chiedozie ◽  
Mark Murphy ◽  
Tom Fahey ◽  
Frank Moriarty
Keyword(s):  
Primary Care ◽  
Time Trends ◽  
Level Variation ◽  
Practice Level ◽  
Practice Characteristics ◽  
Characteristics Method ◽  
Prescribing Quality ◽  
Observational Cohort ◽  
General Practices ◽  
The Mean

Aim: To apply the DU90% indicator (the number of unique drugs which make up 90% of a doctor's prescribing) to GP practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics Method: This is an observational cohort study of all general practices in England. It utilises publicly available prescribing data from the National Health Service (NHS) Digital platform for 2013-2017. The DU90% was calculated on an annual basis for each practice based on medication BNF codes. Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multi-level linear regression was used to examine the practice characteristics (relating to staff, patients, and deprivation of the practice area). Results: A total of 7,623 GP practices were included. The mean DU90% ranged from 130.1 to 133.4 across study years, and variation between practices was low (with a 1.4 fold difference between the lowest and highest 5% of practices). A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are female or aged 65+, higher number of GPs working in the practice, and being in a more deprived area were associated with a higher DU90%. Conclusion: GP practices typically use 130 different medications in the bulk of their prescribing. Increasing use of personal formularies may enhance prescribing quality and reduce costs.

scholarly journals How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043049
Author(s):  
Chiamaka Chiedozie ◽  
Mark E Murphy ◽  
Tom Fahey ◽  
Frank Moriarty
Keyword(s):  
Primary Care ◽  
Time Trends ◽  
Secondary Outcome ◽  
Omega 3 ◽  
Level Variation ◽  
Practice Level ◽  
Practice Characteristics ◽  
Prescribing Quality ◽  
General Practices ◽  
Multilevel Linear Regression

AimTo apply the drug utilisation 90% (DU90%) indicator (the number of unique drugs which makes up 90% of a doctor’s prescribing) to general practitioner (GP) practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics, prescribing costs and low-value prescribing.Study designRetrospective cohort study.SettingPrimary care in England, using publicly available prescribing data available from the National Health Service (NHS) digital platform for 2013–2017.ParticipantsAll general practices in England (n=7620).Primary and secondary outcome measuresThe DU90% was calculated on an annual basis for each practice based on medication British National Formulary codes. Low-value prescribing was defined using NHS 2017 guidance (including lidocaine plasters, liothyronine, omega-3 supplements). Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multilevel linear regression was used to examine the practice characteristics (relating to staff, patients and deprivation of the practice area).ResultsAmong 7620 practices, mean DU90% ranged from 130.0 to 131.0 across study years, and regarding variation between practices, there was a 1.4-fold difference between the lowest and highest 5% of practices. A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are women or aged ≥45 years, higher number of GPs working in the practice and being in a more deprived area were associated with a higher DU90%. Practices in higher quintiles of DU90% had higher levels of low-priority prescribing and prescribing costs.ConclusionGP practices typically use 130 different medications in the bulk of their prescribing. Higher DU90% was associated with higher levels of low-priority prescribing and prescribing costs. Increasing use of personal formularies may enhance prescribing quality and reduce costs.

scholarly journals A Cross-Sectional Analysis of Primary Care Practice Characteristics and Healthcare Professionals’ Behavioral Responses to Change

2021 ◽  
Vol 58 ◽  
pp. 004695802199651
Author(s):  
Victoria M. Grady ◽  
Tulay G. Soylu ◽  
Debora G. Goldberg ◽  
Panagiota Kitsantas ◽  
James D. Grady
Keyword(s):  
Primary Care ◽  
Healthcare Professionals ◽  
Behavioral Responses ◽  
Care Practice ◽  
Care Organization ◽  
Cross Sectional ◽  
Practice Characteristics ◽  
Care Practices ◽  
Attitudes Toward Change ◽  
Primary Care Practices

The recent decade brought major changes to primary care practices. Previous research on change has focused on change processes, and change implementations rather than studying employee’s feelings, perceptions, and attitudes toward change. The objective of this cross-sectional study was to examine the relationship between healthcare professionals’ behavioral responses to change and practice characteristics. Our study, which builds upon Conner’s theory, addresses an extensive coverage of individual behaviors, feelings, and attitudes toward change. We analyzed survey responses of healthcare professionals (n = 1279) from 154 primary care practices in Virginia. Healthcare professionals included physicians, advanced practice clinicians, clinical support staff, and administrative staff. The Change Diagnostic Index© (CDI) was used to measure behavioral responses in 7 domains: anxiety, frustration, delayed development, rejection of environment, refusal to participate, withdrawal, and global reaction. We used descriptive statistics and multivariate regression analysis. Our findings indicate that professionals had a significantly lower aptitude for change if they work in larger practices (≥16 clinicians) compared to solo practices ( P < .05) and at hospital-owned practices compared to independent practices ( P < .05). Being part of an accountable care organization was associated with significantly lower anxiety ( P < .05). Understanding healthcare professionals’ responses to change can help healthcare leaders design and implement successful change management strategies for future transformation.

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