scholarly journals A laboratory demand optimisation project in primary care

2018 ◽  
Author(s):  
Magda Bucholc ◽  
Maurice O’Kane ◽  
Brendan O’Hare ◽  
Ciaran Mullan ◽  
Paul Cavanagh ◽  
...  
Keyword(s):  
Primary Care ◽  
Laboratory Test ◽  
Urban Areas ◽  
Financial Incentive ◽  
List Type ◽  
Rural And Urban ◽  
Health And Social Care ◽  
Practice Variability ◽  
The Mean ◽  
Test Request

AbstractBackgroundThere is evidence of increasing use of laboratory tests with substantial variation between clinical teams which is difficult to justify on clinical grounds. The aim of this project was to assess the effect of a demand optimisation intervention on laboratory test requesting in primary care.MethodsThe intervention comprised educational initiatives, feedback to 55 individual practices on test request rates with ranking relative to other practices, and a small financial incentive for practices to engage and reflect on their test requesting activity. Data on test request numbers were collected from the laboratory databases for consecutive 12 month periods; pre‐intervention 2011-12, intervention 2012-13, 2013-14, 2014-15, and post-intervention 2015-16.ResultsThe intervention was associated with a 3.6% reduction in the mean number of profile test requests between baseline and 2015-16, although this was seen only in rural practices. In both rural and urban practices, there was a significant reduction in-between practice variability in request rates. The mean number of HbA1crequests increased from 1.9 to 3.0 per practice patient with diabetes. Variability in HbA1crequest rates increased from 23.8% to 36.6%. At all considered time points, test request rates and variability were higher in rural than in urban areas.ConclusionsThe intervention was associated with a reduction in both the volume and between practice variability of profile test requests, with differences noted between rural and urban practices. The increase in HbA1crequests may reflect a more appropriate rate of diabetes monitoring and also the adoption of HbA1cas a diagnostic test.Strengths & limitations of the studyWe assessed the effect of a laboratory demand optimisation intervention both on the value and between GP practice variability in laboratory test requesting.The changes in laboratory test requesting were separately evaluated for rural and urban GP practices.Other factors (GP practice organisation, characteristics of general practitioners) potentially affecting between practice differences in laboratory test ordering were not taken into account due to data unavailability.The demand management initiative was not accompanied by the cost-effectiveness analysis.The demand optimisation intervention was conducted in a Northern Ireland (NI) Western Health and Social Care Trust and the findings have not been independently replicated in any other NI trusts.

scholarly journals Effects of a demand optimization intervention on laboratory test utilization in primary care

2019 ◽  
Author(s):  
Magda Bucholc ◽  
Maurice O’Kane ◽  
Brendan O’Hare ◽  
Ciaran Mullan ◽  
Paul Cavanagh ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Financial Incentive ◽  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Intervention Package ◽  
Laboratory Service ◽  
Health And Social Care ◽  
Practice Variability ◽  
One Year ◽  
Test Request

AbstractThere is evidence of increasing use of laboratory tests with substantial variation between clinical teams which is difficult to justify on clinical grounds. The aim of this project was to assess the effect of a demand optimisation intervention project on laboratory test requesting by general practitioners (GPs) in an area of Northern Ireland supported by the Clinical Chemistry Laboratory service of Western Health and Social Care Trust (WHSCT). The intervention package was developed in conjunction with the Western Local Commissioning Group and consisted of educational initiatives, feedback to 55 individual practices on test request rates with ranking relative to other practices, and a small financial incentive for practices to reflect on their test requesting activity. Overall test utilization rates of profile tests, HbA1c, and PSA one year before, during, and one year after the intervention were measured using laboratory databases of the Altnagelvin Area Hospital, Tyrone County Hospital, and the Erne (South West Acute Hospital. The intervention was associated with mixed effects. First, we observed a reduction of 5.1% in the median profile test request rates and a decrease in their between practice variability. The overall downward trend in variability of profile test request rates was found statistically significant (p = 0.03). Second, we found a significant increase in both the volume (p < 0.0001) and between practice variability (p = 0.0001) of HbA1c requests per patient with diabetes. The increase in HbA1c requests may reflect a more appropriate rate of diabetes monitoring and also the adoption of HbA1c as a diagnostic test. Yet, the subsequent 600% increase in between practice variability of HbA1c ordering rates may imply an inconsistent implementation of recommended guidelines by GPs. Finally, there was a 29.3% increase in the median and 35% increase in between practice variability of request rates for PSA, the reasons for which are unclear.

Pocket Book to Enhance Knowledge and Attitude Regarding Prevention of Soil-transmitted Helmint

2017 ◽  
Vol 6 (3) ◽  
pp. 252
Author(s):  
Liena Sofiana ◽  
Suci Musvita Ayu
Keyword(s):  
Urban Areas ◽  
Soil Transmitted Helminths ◽  
Rural And Urban Areas ◽  
Tropical Area ◽  
Rural And Urban ◽  
Pocket Book ◽  
Before And After ◽  
Quasi Experimental ◽  
The Mean ◽  
Knowledge And Attitude

<p>Indonesia, being a tropical area with high humidity, is a source of proliferation of worms. Soil-Transmitted Helminths infection is widespread in all rural and urban areas. Children who are infected usually experience lethargy, pallor or anemia, weight loss and listlessness, as well as decreasing their learning concentration and productivity. Prevention effort to reduce the incidence of Soil-Transmitted Helminths infection is conducted by providing the information on Soil-Transmitted Helminths infection. Health promotion cannot be separated from media because messages delivered through media can be more interesting and easier to understand. The purpose of this study is to determine the effectiveness of a pocket book to increase preventive behavior for Soil-Transmitted Helminthes Infections. This type of research was a quasi-experimental study. The samples of this study were all elementary school infected students in grades 3, 4, and 5 with a package of interventions for the provision of a pocket book. The effectiveness of the pocket book is determined by using the t test. There are differences between the mean of knowledge and attitude, but the mean of behavior of Soil -Transmitted Helminths Infection before and after the pocket book is similar.</p>

Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care

2020 ◽  
pp. 107755872094591
Author(s):  
Hannah T. Neprash ◽  
Laura Barrie Smith ◽  
Bethany Sheridan ◽  
Ira Moscovice ◽  
Shailendra Prasad ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Urban Areas ◽  
The United States ◽  
Rural Primary Care ◽  
Rural And Urban ◽  
Clinical Autonomy ◽  
Care Practices ◽  
Primary Care Practices

The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

scholarly journals Comparing knowledge of diabetes mellitus among rural and urban diabetics

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Ahmad Ayaz Sabri ◽  
Muhammad Ahad Qayyum ◽  
Naif Usman Saigol ◽  
Khurram Zafar ◽  
Fawad Aslam
Keyword(s):  
Diabetes Mellitus ◽  
Rural Areas ◽  
Urban Areas ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
The Mean ◽  
Question Survey ◽  
Awareness Level

A questionnaire-based cross-sectional study was carried out to assess the awareness of diabetes mellitus among rural and urban diabetics. After analyzing the awareness level of both populations, the urban diabetics were found to be more educated about diabetes. A 25-question survey was used to judge the awareness level of diabetes mellitus. A total of 240 diabetics were surveyed, 120 each from rural and urban areas. The mean awareness among the rural population was 13 (SD± 2) correct answers out of a possible 25. Similarly, in the case of the urban diabetics the mean awareness was 18 (SD± 2) correct answers. The survey was conducted on randomly chosen diabetics belonging to Lahore and Faisalabad, (urban areas), as well as Habibabad, Haveli Koranga and Baba Kanwal (rural areas). The results emphasize the interrelation between demography and awareness of diabetes mellitus. The rural diabetics are far less knowledgeable about diabetes mellitus, its management and its complications. Thus, there is an urgent need to improve the awareness level of diabetes mellitus in rural areas. Doing so will give rise to a healthier workforce and a lessened economic burden on Pakistan.

COMPARATIVE ANALYSIS OF SOME MINERAL PROFILE OF HONEY MARKETED AND CONSUMED IN SOME OF THE STATES IN NORTHERN PART OF COUNTRY (NIGERIA)

2015 ◽  
Vol 1 (01) ◽  
pp. 22-32
Author(s):  
R. Odoh
Keyword(s):  
Heavy Metals ◽  
Heavy Metal ◽  
Urban Areas ◽  
Traditional Values ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Metal Poisoning ◽  
Mineral Profile ◽  
The Mean ◽  
Mean Concentration

Honey and honey trade is an important economic activity for many tropical rural and urban areas worldwide. In West Africa and other part of the world, honey and honey products holds high socio–cultural, religious, medicinal and traditional values. Therefore, to maximize benefits or to enhance profit, a variety of components are added to the raw, fresh and unprocessed honey, introducing the possibility of heavy metals contaminants. Therefore the honey sold in various places, markets and shops  in some states in Northern Nigeria (Benue, Nassarawa and Taraba) including Abuja FCT, in Nigeria was analyzed to determine the level of heavy metals (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn).All the honey samples contain heavy metals. The results ranged from 0.028–0.070, 0.023–0.058, 0.042–0.092, 4.231–8.589, 8.115–14.892, 0.078–0.922, 0.044–0.092, 0.041–0.087 and 18.234–28.654 μg/L for Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn respectively. The mean concentration (μg/L) of the heavy metals Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn of the regularly marketed honey is significantly higher than the mean concentration observed in raw, fresh and unprocessed honey. However, continued consumption of honey with high heavy metal content might lead to exposure to chronic heavy metal poisoning.

scholarly journals Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

2019 ◽  
Vol 64 (1) ◽  
pp. 65-78 ◽  
Author(s):  
Tayyab I. Shah ◽  
Andrew F. Clark ◽  
Jamie A. Seabrook ◽  
Shannon Sibbald ◽  
Jason A. Gilliland
Keyword(s):  
Primary Care ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Care Providers ◽  
Rural And Urban Areas ◽  
Geographic Accessibility ◽  
Rural And Urban

scholarly journals Effect of a price display intervention on laboratory test ordering behavior of general practitioners

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dennis M. J. Muris ◽  
Max Molenaers ◽  
Trang Nguyen ◽  
Paul W. M. P. Bergmans ◽  
Bernadette A. C. van Acker ◽  
...  
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Laboratory Test ◽  
General Practitioners ◽  
Laboratory Tests ◽  
Future Research ◽  
Post Intervention ◽  
Diagnostic Laboratory ◽  
The Mean ◽  
Test Ordering

Abstract Background Redundant use of diagnostic tests in primary care has shown to be a contributor to rising Dutch healthcare costs. A price display in the test ordering system of the electronic health records (EHRs) could potentially be a low-cost and easy to implement intervention to a decrease in test ordering rate in the primary care setting by creating more cost-awareness among general practitioners (GPs). The aim of this study was to assess the effect of a price display for diagnostic laboratory tests in the EHR on laboratory test ordering behavior of GPs in the Westelijke Mijnstreek region in the Netherlands. Methods A pre-post intervention study among 154 GPs working in 57 general practices was conducted from September 2019, until March 2020, in the Netherlands. The intervention consisted of displaying the costs of 22 laboratory tests at the time of ordering. The primary outcome was the mean test ordering rate per 1.000 patients per month, per general practice. Results Test ordering rates were on average rising prior to the intervention. The total mean monthly test order volume showed a non-statistically significant interruption in this rising trend after the intervention, with the mean monthly test ordering rate levelling out from 322.4 to 322.2 (P = 0.86). A subgroup analysis for solely individually priced tests showed a statistically significant decrease in mean monthly test ordering rate after implementation of the price display for the sum of all tests from 67.2 to 63.3 (P = 0.01), as well as for some of these tests individually (i.e. thrombocytes, ALAT, TSH, folic acid). Leucocytes, ESR, vitamin B12, anti-CCP and NT-proBNP also showed a decrease, albeit not statistically significant (P > 0.05). Conclusions Our study suggests that a price display intervention is a simple tool that can alter physicians order behavior and constrain the expanding use of laboratory tests. Future research might consider alternative study designs and a longer follow-up period. Furthermore, in future studies, the combination with a multitude of interventions, like educational programs and feedback strategies, should be studied, while potentially adverse events caused by reduced testing should also be taken into consideration.

scholarly journals Comparative health risk assessment of nitrate in drinking groundwater resources of urban and rural region(Isfahan, Iran), Using GIS

2021 ◽  
Author(s):  
Saba Aghapour ◽  
Bijan Bina ◽  
Mohammad Javad Tarrahi ◽  
Fahimeh Amiri ◽  
Afshin Ebrahimi
Keyword(s):  
Health Risk ◽  
Urban Areas ◽  
Groundwater Resources ◽  
World Health ◽  
Residential Areas ◽  
Isfahan Province ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
The Mean ◽  
Health Organization

Abstract Background : Groundwater contaminant such as nitrate (NO 3 - ) is one of the environmental factors that can affect human health . Methemoglobinemia of infants, thyroid disorders, and probably some carcinogenic effects, are health concerns associated with dietary nitrate. Isfahan province has a dry and semi-arid desert climate that the main source of various applications in this province is groundwater resources. This study evaluated spatial analysis of the concentration of NO 3 - in groundwater resources and its possible health risk to residents. Results : It was indicated that nitrate concentrations in the rural and urban areas were in the range of 0.4–137 mg/L NO 3 − with the mean of 33.72 mg/L NO 3 − , and 2.9-209 mg/L NO 3 - with the mean of 38.87 mg/L, respectively. As well, 226 samples (25%), and 104 (24%) ones were detected above the Iran and World Health Organization guidelines 50 mg/L as NO 3 − . While the highest levels of NO 3 − which were located in the west and central groundwater resources of the province were in the agricultural and residential areas. The HQ for Infants, in 32% of samples, urban 136 and rural 297 samples were higher than 1 (HQ>1). Also, in urban area HQ was more than 1 in 8, 5, 1, and 3 samples in children, teens, male and female, respectively. Conclusions : Infants were the most vulnerable compared with the other groups. Therefore, in some areas, there are potential risks of methemoglobinemia, especially for infants. So, it is critical to adopt specific strategies to reduce the nitrate concentration in the studied groundwater.

scholarly journals Rural and urban general practice: a comparison in 34 countries

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
P Groenewegen ◽  
M Bosmans ◽  
W Boerma
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Care Services ◽  
Multilevel Regression ◽  
Rural And Urban Areas ◽  
Care Services ◽  
Rural And Urban ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Rural areas have problems in attracting and retaining primary care workforce. Comparable problems but with a different background occur in deprived urban areas. Here we focus on primary care practices that do work in rural areas and not on the shortage or lack of access for the rural population. We answer the question whether these practices have a different organisation, lack resources and have different service profiles, compared to practices in semi-rural and urban areas. Methods We used data from the QUALICOPC study, conducted among approximately 7,000 GPs in 34 (mainly European) countries, on the organisation of practices, their human resources and equipment and their service profiles. Data were analysed using multilevel regression analysis, with countries and GPs as levels. Results In general the practices in rural areas are more often single-handed and have less other primary care workers available. In most countries they have more equipment and their service profiles are broader, in particular as compared to inner-city urban practices. Conclusions The combination of increasing demand for care and undersupply of health care services can lead to a primary care shortage in rural areas. However, the practices that are currently located in rural area in most countries seem to be able to cope with the situation by providing a broader range of services, compared to service-rich urban areas. Against growing health needs of an ageing and often poorer population, there is a risk of lack of facilities and equipment and ageing staff. Until now this is not manifest in the primary care practices in most countries.

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