Practicalities of care closer to home: seven key questions for community psychiatrists

2020 ◽  
Vol 26 (3) ◽  
pp. 183-189
Author(s):  
Prasanna N. de Silva
Keyword(s):  
Primary Care ◽  
Emerging Treatments ◽  
Consultation Skills ◽  
Key Competencies ◽  
Bed Days ◽  
Community Psychiatrist ◽  
Key Questions

SUMMARYThis article aims to clarify what ‘care closer to home’ means to a community psychiatrist. Care closer to home can be operationalised as primary care liaison and the article reviews experience across England of how a liaison service can work with the recently organised primary care networks. Key competencies needed for liaising with primary care are discussed using seven questions, including bias mitigation, reducing bed-days, consultation skills, knowledge of emerging treatments and reducing administrative overheads while improving access.

scholarly journals Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028744 ◽  
Author(s):  
Geraldine McDarby ◽  
Breda Smyth
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital System ◽  
Bed Days ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

scholarly journals Collaboration amongst general practitioners and gynaecologists working in primary health care in Germany: a cross-sectional study

2021 ◽  
Vol 22 ◽  
Author(s):  
Barbara Trusch ◽  
Christoph Heintze ◽  
Elena Petelos ◽  
Lorena Dini
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Interprofessional Collaboration ◽  
Cross Sectional Study ◽  
Postal Survey ◽  
Sectional Study ◽  
Healthcare Provision ◽  
Cross Sectional ◽  
Federal States ◽  
Key Competencies

Abstract Aim: This cross-sectional study is the first one to explore the collaboration of the influencing factors thereof amongst general practitioners (GPs) and gynaecologists (Gyns) working in primary care in urban and rural settings in Germany. Background: The number of women aged ≥ 50 years is predicted to increase in the next years in Germany. This coincides with the ageing of primary care specialists providing outpatient care. Whereas delegation of tasks to nurses as a form of interprofessional collaboration has been the target of recent studies, there is no data regarding collaboration amongst physicians in different specialisations working in primary care. We explored collaboration amongst GPs and Gyn regarding the healthcare provision to women aged ≥ 50 years. Methods: A quantitative postal survey was administered to GPs and Gyns in three federal states in Germany, focusing on care provision to women aged ≥ 50 years. A total of 4545 physicians, comprising 3514 GPs (67% of the total GP population) randomly selected, and all 1031 Gyns practicing in these states received the postal survey in March 2018. A single reminder was sent in April 2018 with data collection ending in June 2018. Multiple logistic regressions were performed for collaboration, adjusted by age and sex, alongside descriptive methods. Findings: The overall response rate was 31% (1389 respondents): 861 GPs (25%) and 528 Gyns (51%), with the mean respondent age being 54.4 years. Seventy-two per cent were female. Key competencies of collaboration are associated with working in rural federal states and with network participation. Physicians from rural states [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.2, 1.9] and physicians in networks (OR = 3.0, CI = 2.3, 3.9) were more satisfied with collaboration. Collaboration to deliver services for women aged ≥ 50 years is more systematic amongst GPs and Gyns who are members of a network; increased networking could improve collaboration, and ultimately, outcomes too.

scholarly journals Identifying patients with axial spondyloarthritis in primary care: how useful are items indicative of inflammatory back pain?

2011 ◽  
Vol 70 (10) ◽  
pp. 1782-1787 ◽  
Author(s):  
A Braun ◽  
E Saracbasi ◽  
J Grifka ◽  
J Schnitker ◽  
J Braun
Keyword(s):  
Primary Care ◽  
Back Pain ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Age At Onset ◽  
Inflammatory Back Pain ◽  
Single Item ◽  
Inflammatory Drugs ◽  
Waking Up ◽  
Key Questions

BackgroundThe value of clinical items defining inflammatory back pain to identify patients with axial spondyloarthritis (SpA) in primary care is unclear.ObjectiveTo identify predictive clinical parameters for a diagnosis of axial SpA in patients with chronic back pain presenting in primary care.MethodsConsecutive patients aged <45 years (n=950) with back pain for >2 months who presented to orthopaedic surgeons (n=143) were randomised based on four key questions for referral to rheumatologists (n=36) for diagnosis.ResultsThe rheumatologists saw 322 representative patients (mean age 36 years, 50% female, median duration of back pain 30 months). 113 patients (35%) were diagnosed as axial SpA (62% HLA B27+), 47 (15%) as ankylosing spondylitis (AS) and 66 (21%) as axial non-radiographic SpA (nrSpA). Age at onset ≤35 years, improvement by exercise, improvement with non-steroidal anti-inflammatory drugs, waking up in the second half of the night and alternating buttock pain were identified as most relevant for diagnosing axial SpA by multiple regression analysis. Differences between AS and nrSpA were detected. No single item was predictive, but ≥3 items proved useful for good sensitivity and specificity by receiver operating characteristic modelling.ConclusionThis study shows that a preselection in primary care of patients with back pain based on a combination of clinical items is useful to facilitate the diagnosis of axial SpA.

Strategic Choices for a Primary Care Advantage: Re-Engineering Osteopathic Medicine for the 21st Century

2000 ◽  
Vol 13 (3) ◽  
pp. 156-163 ◽  
Author(s):  
Saundra H. Glover ◽  
Patrick Asubonteng Rivers
Keyword(s):  
Primary Care ◽  
High Technology ◽  
Professional Group ◽  
Holistic Medicine ◽  
Osteopathic Medicine ◽  
Strategic Choices ◽  
Life Saving ◽  
Alternative Approach ◽  
Defined Benefits ◽  
Key Questions

The rapidly growing area of osteopathic medicine takes us beyond high technology, life-saving equipment, or at least the most accurate diagnostic test. Whether it is called ‘alternative’, ‘complementary’ or ‘holistic’ medicine, it cannot be ignored as a legitimate healthcare choice, with well-defined benefits for healthcare consumers. This paper examines the history, development, philosophy of practice and challenges facing the viability of osteopathic medicine. More specifically, we address the following key questions: What is osteopathy medicine? What role does osteopathic medicine play in the provision of health services? What challenges face this professional group? And is osteopathic medicine an alternative approach to healthcare?

scholarly journals Pandemic trends in health care use: From the hospital bed to the general practitioner with COVID-19

2021 ◽  
Author(s):  
Fredrik Methi ◽  
Kjersti Helene Hernaes ◽  
Katrine Damgaard Skyrud ◽  
Karin Magnusson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Age Groups ◽  
Health Care Use ◽  
Specialist Care ◽  
Care Services ◽  
Primary Care Services ◽  
Hospital Bed ◽  
Bed Days ◽  
The Mean

Aim: To explore whether the acute 30-day burden of COVID-19 on health care use has changed from the beginning to the end of the pandemic. Methods: In all Norwegians (N=122 699) who tested positive for SARS-CoV-2 in three pandemic waves (March 1st-July 31st 2020 (1st wave), August 1st-December 31st 2020 (2nd wave), and January 1st-May 31st 2021 (3rd wave)), we studied the age- and sex-specific share of patients (by age groups 1-19, 20-67, and 68 or more) who had: 1) Relied on self-care, 2) used primary care, and 3) used specialist care. Results: We find that a remarkably high and stable share (70-80%) of patients with COVID-19 exclusively had contact with primary care in the acute phase, both in the 1st, 2nd and 3rd wave. The mean number of primary care visits ranged between 2 and 4. We also show that the use of specialist care in the acute 30-day phase of COVID-19 has decreased, from 14% being hospitalized at least once during spring 2020, to 4% during spring 2021. The mean number of hospital bed-days decreased significantly for men from the 1st to the 2nd wave (from 13 days, 95% CI=11.5-14.5 to 10 days (9-11) for men aged ≥68 years, and from 11 days (10-12) to 9 days (8-10) for men aged 20-67 years), but not for women. Conclusion: COVID-19 places a continued high demand on the primary care services, and a decreasing demand on the specialist care services.

scholarly journals Implementing STEADI in Academic Primary Care to Address Older Adult Fall Risk

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Elizabeth Eckstrom ◽  
Erin M Parker ◽  
Gwendolyn H Lambert ◽  
Gray Winkler ◽  
David Dowler ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
High Risk ◽  
Fall Risk ◽  
Primary Care Providers ◽  
Care Providers ◽  
High Risk Patients ◽  
Risk Patients ◽  
Fall Screening ◽  
Key Questions

Abstract Background and Objectives Falls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation of the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire. Design and Methods We systematically incorporated STEADI into routine patient care via team training, electronic health record tools, and tailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (Stay Independent), and comparison with a 3-item subset of this questionnaire (three key questions). Results Eighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170 (22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment, orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gait impairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequate vitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questions compared to the full Stay Independent questionnaire decreased screening burden, but increased the number of high-risk patients. Discussion and Implications We successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients received recommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge. Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.

scholarly journals Identifying depression among adolescents using three key questions: a validation study in primary care

2016 ◽  
Vol 66 (643) ◽  
pp. e65-e70 ◽  
Author(s):  
Wenche Haugen ◽  
Ole Rikard Haavet ◽  
Manjit Kaur Sirpal ◽  
Kaj Sparle Christensen
Keyword(s):  
Primary Care ◽  
Validation Study ◽  
Key Questions

scholarly journals Proton pump inhibitor use in a university teaching hospital

2012 ◽  
Author(s):  
Maria Meli ◽  
Renato Malta ◽  
Luigi Aprea ◽  
Andrea Pasquale ◽  
Concetta La Seta ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Proton Pump Inhibitor ◽  
Adverse Events ◽  
Obesity Surgery ◽  
Proton Pump ◽  
General Surgery ◽  
University Teaching ◽  
Total Cost ◽  
Bed Days

Introduction Proton pump inhibitors (PPIs) are highly prescribed drugs in Italy and in particular in the Sicilian region but little is known about their use in the hospital setting.Materials and methods PPI utilization and related costs were reviewed retrospectively by examining the pharmaceutical records of drug dispensation to the various wards of the Policlinico Universitario P. Giaccone of Palermo in 2010. Differences in the prescribing rates and drug preferences among the different clinical wards were analyzed.Results A total of 20,420 patients were hospitalized at the Policlinico of Palermo in 2010. Overall, the consumption of PPIs was 120 DDD/100 bed-days for the year 2010 with a total cost of 42,780 euros. Omeprazole and esomeprazole were the most commonly prescribed molecules accounting for over 70% of all prescriptions: nevertheless, wide differences in drug choices were noted even within the same ward. As expected, greater utilization rates were registered in the Internal Medicine and General Surgery departments. In particular, the highest consumption was observed in the Oncology, Geriatry and Obesity Surgery wards, with about 250 DDD/100 bed-days. All wards reported intravenous PPI administration suggesting some inappropriate use.Discussion From our data, PPIs appear to be moderately over-used at the Policlinico of Palermo. This practice may lead to the inappropriate continuation of therapy in primary care, further increasing costs and risks of adverse events. A survey evaluating in more detail the appropriateness of prescriptions is advisable.

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