scholarly journals Characteristics of primary care practices associated with high quality of care

2013 ◽  
Vol 185 (12) ◽  
pp. E590-E596 ◽  
Author(s):  
M.-D. Beaulieu ◽  
J. Haggerty ◽  
P. Tousignant ◽  
J. Barnsley ◽  
W. Hogg ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
High Quality ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Assessing methods for measurement of clinical outcomes and quality of care in primary care practices

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Michael E Green ◽  
William Hogg ◽  
Colleen Savage ◽  
Sharon Johnston ◽  
Grant Russell ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Clinical Outcomes ◽  
Care Practices ◽  
Primary Care Practices

Health plan enrollees with disability informing primary care practices and providers about their quality of care: A randomized trial

2018 ◽  
Vol 11 (4) ◽  
pp. 537-544 ◽  
Author(s):  
Lisa I. Iezzoni ◽  
Yuchiao Chang ◽  
Holly Matulewicz ◽  
Dennis Heaphy ◽  
Kimberley S. Warsett ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Randomized Trial ◽  
Health Plan ◽  
Care Practices ◽  
Primary Care Practices

Supporting Goal-Oriented Primary Health Care for Seniors’ with Multimorbidity and Complex Care Needs using Mobile Technology: Mixed-Methods, Stepped-Wedge Cluster Randomized Trial of the ePRO Tool. (Preprint)

2021 ◽  
Author(s):  
Carolyn Steele Gray ◽  
Phat (Eduard) Chau ◽  
Farah Tahsin ◽  
Sarah Harvey ◽  
Mayura Loganathan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Control Period ◽  
Self Management ◽  
Care Needs ◽  
Ethnographic Data ◽  
Care Practices ◽  
Primary Care Practices ◽  
Complex Care Needs

BACKGROUND Goal-oriented care is being adopted to deliver person-centred primary care to older adults with multimorbidity and complex care needs. While this model holds promise, implementation remains a challenge. Digital health solutions may enable processes to improve adoption, however, they require evaluation to determine feasibility and impact. OBJECTIVE This study evaluates the implementation and effectiveness of the electronic Patient Reported Outcome (ePRO) mobile application and portal system, designed to enable goal-oriented care delivery in inter-professional primary care practices. The research questions driving this study are: 1) Does ePRO improve quality of life and self-management in older adults with complex needs, and 2) what mechanisms are likely driving observed outcomes? METHODS A multi-method pragmatic randomized control trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrolment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the mid-point and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data was analyzed using qualitative description and framework analysis methods. RESULTS Recruitment challenges resulted in fewer sites and participants than expected; only 142 of the 176 eligible patients were identified due to lower than expected provider participation and fewer than expected patients willing to participate or perceived as ready to engage in goal setting. Of 142 patients approached, 45 patients participated (32%). Patients set a variety of goals related to self-management, mental health, social health and overall well-being. Due to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however the intervention group, ePRO plus usual care (M = 15.28, SD = 18.60), demonstrated non-significant slight decrease in quality of life, t(24)= -1.20, P = 0.24, when compared to usual care only (M = 21.76, SD = 2.17). The ethnographic data reveals a complex implementation process, in which the meaningfulness (or coherence) of the technology to individuals lives and work acted as a key driver to adoption and tool appraisal. CONCLUSIONS This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinic settings, dynamic goal-oriented care process, and readiness of provider and patient participants. CLINICALTRIAL ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954?intr=epro&cntry=CA&rank=1

scholarly journals A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive–behavioural programme with integrated coaching for anxious adults in primary care

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019108 ◽  
Author(s):  
Eva Szigethy ◽  
Francis Solano ◽  
Meredith Wallace ◽  
Dina L Perry ◽  
Lauren Morrell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Anxiety Disorder ◽  
Healthcare Utilisation ◽  
Anxiety Symptoms ◽  
Generalised Anxiety Disorder ◽  
Cognitive Behavioural ◽  
Care Practices ◽  
Primary Care Practices

IntroductionGeneralised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive–behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings.Methods and analysisThis pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive– behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app.Ethics and disseminationEthics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences.Trial registration numberNCT03035019.

scholarly journals Quality of Disease Management and Risk of Mortality in English Primary Care Practices

2015 ◽  
Vol 50 (5) ◽  
pp. 1452-1471 ◽  
Author(s):  
Mark Dusheiko ◽  
Hugh Gravelle ◽  
Stephen Martin ◽  
Peter C. Smith
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Risk Of Mortality ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Associations of primary care structures with polypharmacy and patient-reported indicators in patients with complex multimorbidity: a multicentre cross-sectional study in Japan

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e054348
Author(s):  
Takuya Aoki ◽  
Yasuki Fujinuma ◽  
Masato Matsushima
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Lower Prevalence ◽  
Cross Sectional ◽  
Community Orientation ◽  
Patient Reported ◽  
Care Facilities ◽  
Care Practices ◽  
Primary Care Practices

ObjectivesEvidence supporting the effects of primary care structures on the quality of care for patients with complex multimorbidity, which is one of the most important challenges facing primary care, is scarce internationally. This study aimed to examine the associations of the types of primary care facilities with polypharmacy and patient-reported indicators in patients with complex multimorbidity, with a focus on differences between community clinics and hospitals.DesignMulticentre cross-sectional study.SettingA total of 25 primary care facilities (19 community clinics and 6 small- and medium-sized hospitals).ParticipantsAdult outpatients with complex multimorbidity, which was defined as the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person.Primary outcome measurePolypharmacy, the Patient-Reported Experience Measure using the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF) and the Patient-Reported Outcome Measure using self-rated health status (SRH).ResultsData were analysed for 492 patients with complex multimorbidity. After adjustment for possible confounders and clustering within facilities, clinic-based primary care practices were significantly associated with a lower prevalence of polypharmacy, higher JPCAT-SF scores in coordination and community orientation, and a lower prevalence of poor or fair SRH compared with hospital-based primary care practices. In contrast, the JPCAT-SF score in first contact was significantly lower in clinic-based practices. The associations between the types of primary care facilities and JPCAT-SF scores in longitudinality and comprehensiveness were not statistically significant.ConclusionsClinic-based primary care practices were associated with a lower prevalence of polypharmacy, better patient experience of coordination and community orientation, and better SRH in patients with complex multimorbidity compared with hospital-based primary care practices. In the primary care setting, small and tight teams may improve the quality of care for patients with complex multimorbidity.

scholarly journals Workforce Configurations to Provide High-Quality, Comprehensive Primary Care: a Mixed-Method Exploration of Staffing for Four Types of Primary Care Practices

2018 ◽  
Vol 33 (10) ◽  
pp. 1774-1779 ◽  
Author(s):  
David Meyers ◽  
Lisa LeRoy ◽  
Michael Bailit ◽  
Judith Schaefer ◽  
Edward Wagner ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Method ◽  
High Quality ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study

2017 ◽  
Vol 67 (664) ◽  
pp. e764-e774 ◽  
Author(s):  
Jasmine Pawa ◽  
John Robson ◽  
Sally Hull
Keyword(s):  
Primary Care ◽  
Clinical Care ◽  
Structured Interview ◽  
Care Practice ◽  
Structured Interviews ◽  
London Borough ◽  
Practice Performance ◽  
Care Practices ◽  
Primary Care Practices

BackgroundPrimary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes.AimTo provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives.Design and settingA qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population.MethodNineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes.ResultsInterviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between ‘a given structure’ and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload.ConclusionCommissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale.

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