scholarly journals Primary care use of laboratory tests in Northern Ireland’s Western Health and Social Care Trust: a cross-sectional study

2019 ◽  
Author(s):  
Magda Bucholc ◽  
Maurice J O’Kane ◽  
Ciaran Mullan ◽  
Siobhan Ashe ◽  
Liam Maguire
Keyword(s):  
Laboratory Test ◽  
Social Care ◽  
Median Number ◽  
Cross Sectional Study ◽  
Practice Variation ◽  
Cross Sectional ◽  
Outcome Indicators ◽  
Health And Social Care ◽  
General Practices ◽  
Test Ordering

AbstractObjectivesTo describe the laboratory test ordering patterns by general practitioners (GPs) in Northern Ireland Western Health and Social Care Trust (WHSCT) and establish demographic and socio-economic associations with test requesting.DesignCross-sectional study.SettingWestern Health and Social Care Trust, Northern IrelandParticipants55 WHSCT general practices requesting laboratory tests in the period from 1 April 2011 to 31 March 2016OutcomesTo identify the temporal patterns of laboratory test ordering behaviour for 8 commonly requested clinical biochemistry tests/test groups in WHSCT. To analyse the extent of variations in laboratory test requests by GPs and to determine whether these variations can be accounted for by clinical outcomes or geographical, demographic, and socioeconomic characteristics.ResultsWe identified substantial changes in the median number of request rates over five consecutive years of the study period as well as a large variation of adjusted test request rates for individual tests (lowest for electrolyte profiles, liver profiles, and HbA1c and highest for immunoglobulins). No statistically significant relationship between ordering activity and either demographic (age and gender) and socioeconomic factors (deprivation) or Quality and Outcome Framework (QOF) scores was observed. We found that practice setting accounted for some of the between-practice variation in test requesting. Rural practices were characterized by both higher between practice variability and median number of order tests than urban practices at all time points.ConclusionsA large between-practice variation in GP laboratory test requesting appears unrelated to demographic and socioeconomic indicators of the practices or crude clinical outcome indicators, most likely reflects differences in the clinical practice of individuals, potentially amenable to change through clinical interventions.Strengths and limitations of this studyThe study provides a comprehensive analysis of temporal changes in laboratory test utilization patterns and establishes the extent of variability in test requesting activity across general practices in Northern Ireland’s Western Health and Social Care Trust.The substantial variation in test ordering, not related to demographic and socioeconomic characteristics of practices, practice location or clinical outcome indicators, may reflect inappropriate laboratory test utilization and hence, suggest a potential for more efficient demand management of laboratory services.Given a cohort of general practices within one catchment area, our results provide evidence of differences in behaviour of individual GPs when managing patients with similar clinical symptoms.Failure to collect and cross-tabulate data on characteristics of general practitioners (GPs), such as GP’s age, years of experience, medical training was a study limitation and a missed opportunity in assessing the influence of practitioner factors on the variation in test ordering behaviour.

scholarly journals Primary care use of laboratory tests in Northern Ireland’s Western Health and Social Care Trust: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026647
Author(s):  
Magda Bucholc ◽  
Maurice O’Kane ◽  
Ciaran Mullan ◽  
Siobhan Ashe ◽  
Liam Maguire
Keyword(s):  
Northern Ireland ◽  
Laboratory Test ◽  
Laboratory Tests ◽  
Social Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Socioeconomic Characteristics ◽  
Health And Social Care ◽  
Test Ordering

ObjectivesTo describe the laboratory test ordering patterns by general practitioners (GPs) in Northern Ireland Western Health and Social Care Trust (WHSCT) and explore demographic and socioeconomic associations with test requesting.DesignCross-sectional study.SettingWHSCT, Northern Ireland.Participants55 WHSCT primary care medical practices that remained open throughout the study period 1 April 2011–31 March 2016.OutcomesTo identify the temporal patterns of laboratory test ordering behaviour for eight commonly requested clinical biochemistry tests/test groups in WHSCT. To analyse the extent of variations in laboratory test requests by GPs and to explore whether these variations can be accounted for by clinical outcomes or geographical, demographic and socioeconomic characteristics.ResultsThe median number of adjusted test request rates over 5 consecutive years of the study period decreased by 45.7% for urine albumin/creatinine ratio (p<0.000001) and 19.4% for lipid profiles (p<0.000001) while a 60.6%, 36.6% and 29.5% increase was observed for HbA1c(p<0.000001), immunoglobulins (p=0.000007) and prostate-specific antigen (PSA) (p=0.0003), respectively. The between-practice variation in test ordering rates increased by 272% for immunoglobulins (p=0.008) and 500% for HbA1c(p=0.0001). No statistically significant relationship between ordering activity and either demographic (age and gender) and socioeconomic factors (deprivation) or Quality and Outcome Framework scores was observed. We found the rural–urban differences in between-practice variability in ordering rates for lipid profiles, thyroid profiles, PSA and immunoglobulins to be statistically significant at the Bonferroni-adjusted significance level p<0.01.ConclusionsWe explored potential factors of the interpractice variability in the use of laboratory tests and found that differences in requesting activity appear unrelated to either demographic and socioeconomic characteristics of GP practices or clinical outcome indicators.

scholarly journals Variation and statistical reliability of publicly reported primary care diagnostic activity indicators for cancer: a cross-sectional ecological study of routine data

2017 ◽  
Vol 27 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Gary Abel ◽  
Catherine L Saunders ◽  
Silvia C Mendonca ◽  
Carolynn Gildea ◽  
Sean McPhail ◽  
...  
Keyword(s):  
Primary Care ◽  
High Reliability ◽  
Routine Data ◽  
Practice Variation ◽  
Diagnostic Process ◽  
Cross Sectional ◽  
Outcome Indicators ◽  
Practice Level ◽  
Process Indicators ◽  
General Practices

ObjectivesRecent public reporting initiatives in England highlight general practice variation in indicators of diagnostic activity related to cancer. We aimed to quantify the size and sources of variation and the reliability of practice-level estimates of such indicators, to better inform how this information is interpreted and used for quality improvement purposes.DesignEcological cross-sectional study.SettingEnglish primary care.ParticipantsAll general practices in England with at least 1000 patients.Main outcome measuresSixteen diagnostic activity indicators from the Cancer Services Public Health Profiles.ResultsMixed-effects logistic and Poisson regression showed that substantial proportions of the observed variance in practice scores reflected chance, variably so for different indicators (between 7% and 85%). However, after accounting for the role of chance, there remained substantial variation between practices (typically up to twofold variation between the 75th and 25th centiles of practice scores, and up to fourfold variation between the 90th and 10th centiles). The age and sex profile of practice populations explained some of this variation, by different amounts across indicators. Generally, the reliability of diagnostic process indicators relating to broader populations of patients most of whom do not have cancer (eg, rate of endoscopic investigations, or urgent referrals for suspected cancer (also known as ‘two week wait referrals’)) was high (≥0.80) or very high (≥0.90). In contrast, the reliability of diagnostic outcome indicators relating to incident cancer cases (eg, per cent of all cancer cases detected after an emergency presentation) ranged from 0.24 to 0.54, which is well below recommended thresholds (≥0.70).ConclusionsUse of indicators of diagnostic activity in individual general practices should principally focus on process indicators which have adequate or high reliability and not outcome indicators which are unreliable at practice level.

scholarly journals The impacts of GP federations in England on practices and on health and social care interfaces: four case studies

2020 ◽  
Vol 8 (11) ◽  
pp. 1-118
Author(s):  
Ruth McDonald ◽  
Lisa Riste ◽  
Simon Bailey ◽  
Fay Bradley ◽  
Jonathan Hammond ◽  
...  
Keyword(s):  
Health Services ◽  
Case Studies ◽  
Quantitative Methods ◽  
Social Care ◽  
Research Programme ◽  
Central Authority ◽  
Cross Sectional ◽  
Health And Social Care ◽  
General Practices ◽  
Future Work

Background General practices have begun working collaboratively in general practitioner federations, which vary in scope, geographical reach and organisational form. Objectives The aim was to assess how federating affects practice processes, workforce, innovations in practices and the interface with health and social care stakeholders. Design This was a structured cross-sectional comparison of four case studies, using observation of meetings, interviews and analysis of documents. We combined inductive analysis with literature on ‘meta-organisations’ and networks to provide a theoretically informed analysis. Results All federations were ‘bottom-up’ voluntary membership organisations but with formal central authority structures. Practice processes were affected substantially in only one site. In this site, practices accepted the rules imposed by federation arrangements in a context of voluntary participation. Federating helped ease workforce pressures in two sites. Progress regarding innovations in practice and working with health and social care stakeholders was slower than federations anticipated. The approach of each federation central authority in terms of the extent to which it (1) sought to exercise control over member practices and (2) was engaged in ‘system proactivity’ (i.e. the degree of proactivity in working across a broader spatial and temporal context) was important in explaining variations in progress towards stated aims. We developed a typology to reflect the different approaches and found that an approach consisting of high levels of both top-down control and system proactivity was effective. One site adopted this ‘authoritative’ approach. In another site, rather than creating expectations of practices, the focus was on supporting them by attempting to solve the immediate problems they faced. This ‘indulgent’ approach was more effective than the approach used in the other two sites. These had a more distant ‘neglectful’ relationship with practices, characterised by low levels of both control over members and system proactivity. Other key factors explaining progress (or lack thereof) were competition between federations (if any), relationship with the Clinical Commissioning Group, money, history, leadership and management issues, size and geography; these interacted in a dynamic way. In the context of a tight deadline and fixed targets, federations were able to respond to the requirements to provide additional services as part of NHS Improving Access to General Practice policy in a way that would not have been possible in the absence of federations. However, this added to pressures faced by busy clinicians and managers. Limitations The focus was on only four sites; therefore, any federations that were more active than those federations in these four sites will have been excluded. In addition, although patients were interviewed, because most were unaware of federations, they generally had little to say on the subject. Conclusions General practices working collaboratively can produce benefits, but this takes time and effort. The approach of the federation central authority (authoritative, indulgent or neglectful) was hugely influential in affecting processes and outcomes. However, progress was generally slower than anticipated, and negligible in one case. Future work Future work would benefit from multimethod designs, which provide in-depth, longitudinal, qualitative and quantitative methods, to shed light on processes and impacts. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.

scholarly journals Integrated care: mobilising professional identity

2018 ◽  
Vol 32 (5) ◽  
pp. 726-740 ◽  
Author(s):  
Stephanie Best ◽  
Sharon Williams
Keyword(s):  
Professional Identity ◽  
Integrated Care ◽  
Social Care ◽  
Healthcare Systems ◽  
Cross Sectional Study ◽  
Key Factors ◽  
Cross Sectional ◽  
Content Type ◽  
Health And Social Care ◽  
The Uk

Purpose Integrated care has been identified as essential to delivering the reforms required in health and social care across the UK and other healthcare systems. Given this suggests new ways of working for health and social care professionals, little research has considered how different professions manage and mobilise their professional identity (PI) whilst working in an integrated team. The paper aims to discuss these issues. Design/methodology/approach A qualitative cross-sectional study was designed using eight focus groups with community-based health and social care practitioners from across Wales in the UK during 2017. Findings Participants reported key factors influencing practice were communication, goal congruence and training. The key characteristics of PI for that enabled integrated working were open mindedness, professional trust, scope of practice and uniqueness. Blurring of boundaries was found to enable and hinder integrated working. Research limitations/implications This research was conducted in the UK which limits the geographic coverage of the study. Nevertheless, the insight provided on PI and integrated teams is relevant to other healthcare systems. Practical implications This study codifies for health and social care practitioners the enabling and inhibiting factors that influence PI when working in integrated teams. Originality/value Recommendations in terms of how healthcare professionals manage and mobilise their PI when working in integrated teams are somewhat scarce. This paper identifies the key factors that influence PI which could impact the performance of integrated teams and ultimately, patient care.

scholarly journals Linkage of national health and social care data: a cross-sectional study of multimorbidity and social care use in people aged over 65 years in Scotland

2020 ◽  
Author(s):  
David A G Henderson ◽  
Iain Atherton ◽  
Colin McCowan ◽  
Stewart W Mercer ◽  
Nick Bailey
Keyword(s):  
Social Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Term Care ◽  
Logistic Regression Models ◽  
Care Services ◽  
Health And Social Care ◽  
Care Survey ◽  
Average Marginal Effects ◽  
The Relationship

Abstract Background little is known about the relationship between multimorbidity and social care use (also known as long-term care). The aim of this study was to assess the relationship between receipt of formal social care services and multimorbidity. Methods this retrospective data linkage, observational study included all individuals over the age of 65 in the population of Scotland in financial years 2014–15 and 2015–16 (n = 975,265). The main outcome was receipt of social care measured by presence in the Scottish Social Care Survey. Logistic regression models were used to assess the influence of multimorbidity, age, sex and socioeconomic position on the outcome reporting average marginal effects (AME). Findings 93.3% of those receiving social care had multimorbidity, 16.2% of those with multimorbidity received social care compared with 3.7% of those without. The strongest magnitudes of AME for receiving social care were seen for age and multimorbidity (respectively, 50 and 18% increased probability comparing oldest to youngest and most severe multimorbidity to none). A 5.5% increased probability of receiving social care was observed for the most-deprived compared with the least-deprived. Interpretation higher levels of social care receipt are observed in those with increasing age, severe multimorbidity and living in more deprived areas. Multimorbidity does not fully moderate the relationship between social care receipt and either age or deprivation.

scholarly journals Health Profile of Precarious Migrants Attending the Médecins Du Monde’s Health and Social Care Centres in France: a Cross-Sectional Study

2021 ◽  
Vol 66 ◽  
Author(s):  
Emeraude Halley ◽  
Joris Giai ◽  
Marielle Chappuis ◽  
Anne Tomasino ◽  
Roland Henaine ◽  
...  
Keyword(s):  
General Practice ◽  
Social Care ◽  
National Sample ◽  
Cross Sectional Study ◽  
Health Problems ◽  
Cross Sectional ◽  
Lipid Disorder ◽  
Health And Social Care ◽  
Gum Disease

Objective: The present study aimed to compare the precarious migrants’ health problems managed in Médecins du Monde’s health and social care centres (CASO) with those of patients attending general practice in France.Methods: We compared the most frequent health problems managed in the 19 CASO in metropolitan France with those of a national sample of usual general practice consultations, after standardisation for age and sex.Results: Precarious migrants had fewer health problems managed per consultation than other patients (mean: 1.31 vs. 2.16), and these corresponded less frequently to chronic conditions (21.3% vs. 46.8%). The overrepresented health problems among CASO consultations were mainly headache (1.11% vs. 0.45%), viral hepatitis (1.05% vs. 0.20%), type 1 diabetes (1.01% vs. 0.50%) and teeth/gum disease (1.01% vs. 0.23%). Their underrepresented health problems were mainly lipid disorder (0.39% vs. 8.20%), depressive disorder (1.36% vs. 5.28%) and hypothyroidism (0.50% vs. 3.08%). Prevention issues were nominal in precarious migrants (0.16%).Conclusion: Both chronic somatic and mental conditions of precarious migrants are presumably underdiagnosed. Their screening should be improved in primary care.

scholarly journals Impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e039939
Author(s):  
Sahdia Parveen ◽  
Sarah Jane Smith ◽  
Cara Sass ◽  
Jan R Oyebode ◽  
Andrea Capstick ◽  
...  
Keyword(s):  
Online Survey ◽  
Social Care ◽  
Education And Training ◽  
Care Staff ◽  
Cross Sectional ◽  
Health And Social Care ◽  
Training Content ◽  
The Impact ◽  
And Training ◽  
Dementia Education

ObjectivesThe aim of this study was to establish the impact of dementia education and training on the knowledge, attitudes and confidence of health and social care staff. The study also aimed to identify the most effective features (content and pedagogical) of dementia education and training.DesignCross-sectional survey study. Data collection occurred in 2017.SettingsHealth and social care staff in the UK including acute care, mental health community care trusts, primary care and care homes.ParticipantsAll health and social care staff who had completed dementia education and training meeting the minimal standards as set by Health Education England, within the past 5 years were invited to participate in an online survey. A total of 668 health and social care staff provided informed consent and completed an online survey, and responses from 553 participants were included in this study. The majority of the respondents were of white British ethnicity (94.4%) and identified as women (88.4%).OutcomesKnowledge, attitude and confidence of health and social care staff.ResultsHierarchical multiple regression analysis was conducted. Staff characteristics, education and training content variables and pedagogical factors were found to account for 29% of variance in staff confidence (F=4.13, p<0.001), 22% of variance in attitude (knowledge) (F=3.80, p<001), 18% of the variance in staff knowledge (F=2.77, p<0.01) and 14% of variance in staff comfort (attitude) (F=2.11, p<0.01).ConclusionThe results suggest that dementia education and training has limited impact on health and social care staff learning outcomes. While training content variables were important when attempting to improve staff knowledge, more consideration should be given to pedagogical factors when training is aiming to improve staff attitude and confidence.

scholarly journals Doctors’ Knowledge of Hypertension Guidelines Recommendations Reflected in Their Practice

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Nafees Ahmad ◽  
Amer Hayat Khan ◽  
Irfanullah Khan ◽  
Amjad Khan ◽  
Muhammad Atif
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Median Number ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Attitude Score ◽  
Cross Sectional ◽  
Uncomplicated Hypertension ◽  
Adequate Knowledge ◽  
Hypertension Guidelines

Aim. To evaluate doctors’ knowledge, attitude, and practices and predictors of adherence to Malaysian hypertension guidelines (CPG 2008). Methods. Twenty-six doctors involved in hypertension management at Penang General Hospital were enrolled in a cross-sectional study. Doctors’ knowledge and attitudes towards guidelines were evaluated through a self-administered questionnaire. Their practices were evaluated by noting their prescriptions written to 520 established hypertensive outpatients (20 prescriptions/doctor). SPSS 17 was used for data analysis. Results. Nineteen doctors (73.07%) had adequate knowledge of guidelines. Specialists and consultants had significantly better knowledge about guidelines’ recommendations. Doctors were positive towards guidelines with mean attitude score of 23.15±1.34 points on a 30-point scale. The median number of guidelines compliant prescriptions was 13 (range 5–20). Statistically significant correlation (rs = 0.635, P<0.001) was observed between doctors’ knowledge and practice scores. A total of 349 (67.1%) prescriptions written were guidelines compliant. In multivariate analysis hypertension clinic (OR = 0.398, P=0.008), left ventricular hypertrophy (OR = 0.091, P=0.001) and heart failure (OR = 1.923, P=0.039) were significantly associated with guidelines adherence. Conclusion. Doctors’ knowledge of guidelines is reflected in their practice. The gap between guidelines recommendations and practice was seen in the pharmacotherapy of uncomplicated hypertension and hypertension with left ventricular hypertrophy, renal disease, and diabetes mellitus.

scholarly journals Self-skincare knowledge and practice described by elderly persons in the mid-west of Minas Gerais

2016 ◽  
Vol 19 (1) ◽  
pp. 45-56 ◽  
Author(s):  
Juliana Ladeira Garbaccio ◽  
Amanda Domingos Ferreira ◽  
Amanda Laís Gonçalves Gama Pereira
Keyword(s):  
The Elderly ◽  
Median Number ◽  
Cross Sectional Study ◽  
Skin Aging ◽  
Minas Gerais ◽  
Sample Population ◽  
Elderly Persons ◽  
Cross Sectional ◽  
Basic Care ◽  
And Gender

The present study aimed to assess the knowledge and practices reported by the elderly in relation to basic care of one's skin. A cross sectional study was performed from November 2011 to August 2012 in Arcos, Minas Gerais, based on a structured questionnaire administered to 250 elderly persons, with answers statistically analyzed. Knowledge and practices of self-skincare were evaluated from the median number of ten questions answered by the elderly. Most of the sample population were women (54.8%), aged between 60 and 69 years (52.4%), with a primary education (71.6%) and working in a job where they were exposed to direct sunlight (58.0%). The majority (76.4%) said they did not use protective sun filter despite considering it important (77.6%). The use of body moisturizing creams was reported by 55.6%. An association (p<0.05) was identified between the variables practice/knowledge and gender and practice outdoor activity. Further studies can be conducted as a result of the present research to clarify factors related to non-adherence to self-skincare, and educational measures should be put in place for the entire population, regardless of age, to prevent pathological skin aging.

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