Patient Telephone Appointment System for High Volume Primary Care Sites

2000 ◽  
Author(s):  
Francine M. Worthington
Keyword(s):  
Primary Care ◽  
High Volume ◽  
Appointment System

scholarly journals Is continuity of primary care declining in England? Practice-level longitudinal study, 2012-2017

2020 ◽  
pp. BJGP.2020.0935
Author(s):  
Peter Tammes ◽  
Richard Morris ◽  
Mairead Murphy ◽  
Chris Salisbury
Keyword(s):  
Primary Care ◽  
Longitudinal Study ◽  
Continuity Of Care ◽  
Multilevel Modelling ◽  
Population Characteristics ◽  
Urban Location ◽  
Practice Level ◽  
Level Data ◽  
Appointment System ◽  
Over Time

Background: Continuity of care is a core principle of primary care and related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care is declining. Aim: (i) to confirm reports of declining continuity of care, (ii) to explore differences in decline according to practice characteristics, (iii) to examine associations between practice populations or appointment provision and changes in continuity of care. Design and Setting: Longitudinal study of aggregated practice-level data from repeated questions in GP-Patient surveys between 2012-2017 on having a preferred GP, seeing this GP always/often (usually), appointment system and practice population characteristics, linked to rural/urban location and deprivation. Method: Multilevel modelling; time (level-1) and practices (level-2). Results: 56.7% of patients had a preferred GP in 2012, declining by 9.4%-points (95%CI -9.6 to -9.2) by 2017. 66.4% of patients with a preferred GP saw this GP usually in 2012, which declined by 9.7%-points (95%CI -10.0 to -9.4) by 2017. This decline was visible in all types of practices, irrespective of baseline continuity, rural/urban location, or deprivation. At practice-level, an increase over time in the percentage of patients reporting good overall experience of making appointments was associated with an increase in both the percentage of patients having a preferred GP, and the percentage of patients being able to see that GP usually. Conclusion: Patients reported a steady decline in continuity of care over time, which should concern clinicians and policymakers. The ability of practices to offer patients a satisfactorily working appointment system could partly counteract this decline.

scholarly journals Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care

2017 ◽  
Vol 27 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Suzanne Grant ◽  
Bruce Guthrie
Keyword(s):  
Primary Care ◽  
Participant Observation ◽  
High Volume ◽  
Ethnographic Study ◽  
Trade Offs ◽  
High Workload ◽  
Organisational Routines ◽  
The Face ◽  
General Practices ◽  
Context Specific

BackgroundPrescribing is a high-volume primary care routine where both speed and attention to detail are required. One approach to examining how organisations approach quality and safety in the face of high workloads is Hollnagel’s Efficiency and Thoroughness Trade-Off (ETTO). Hollnagel argues that safety is aligned with thoroughness and that a choice is required between efficiency and thoroughness as it is not usually possible to maximise both. This study aimed to ethnographically examine the efficiency and thoroughness trade-offs made by different UK general practices in the achievement of prescribing safety.MethodsNon-participant observation was conducted of prescribing routines across eight purposively sampled UK general practices. Sixty-two semistructured interviews were also conducted with key practice staff alongside the analysis of relevant practice documents.ResultsThe eight practices in this study adopted different context-specific approaches to safely handling prescription requests by variably prioritising speed of processing by receptionists (efficiency) or general practitioner (GP) clinical judgement (thoroughness). While it was not possible to maximise both at the same time, practices situated themselves at various points on an efficiency-thoroughness spectrum where one approach was prioritised at particular stages of the routine. Both approaches carried strengths and risks, with thoroughness-focused approaches considered safer but more challenging to implement in practice due to GP workload issues. Most practices adopting efficiency-focused approaches did so out of necessity as a result of their high workload due to their patient population (eg, older, socioeconomically deprived).ConclusionsHollnagel’s ETTO presents a useful way for healthcare organisations to optimise their own high-volume processes through reflection on where they currently prioritise efficiency and thoroughness, the stages that are particularly risky and improved ways of balancing competing priorities.

Physical Activity Assessment and Recommendation for Adults With Arthritis by Primary Care Providers—DocStyles, 2018

2020 ◽  
pp. 089011712098137
Author(s):  
Dana Guglielmo ◽  
Louise B. Murphy ◽  
Kristina A. Theis ◽  
Charles G. Helmick ◽  
John D. Omura ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Nurse Practitioners ◽  
High Volume ◽  
Primary Care Providers ◽  
Physical Activity Assessment ◽  
Care Providers ◽  
Provider Education ◽  
Cross Sectional ◽  
Activity Assessment

Purpose: To examine primary care providers' (PCPs) physical activity assessment and recommendation behaviors for adults with arthritis. Design: Cross-sectional. Setting: 2018 DocStyles online national market research survey of US physicians and nurse practitioners. Sample: 1,389 PCPs seeing adults with arthritis. Measures: 2 independent behaviors (assessment and recommendation) as 3 non-mutually exclusive groups: “always assesses,” “always recommends,” and “both” (“always assesses and recommends”). Analysis: Calculated percentages of each group (overall and by PCP characteristics), and multivariable-adjusted prevalence ratios (PRs) using binary logistic regression. Results: Among PCPs, 49.2% always assessed and 57.7% always recommended physical activity; 39.7% did both. Across all 3 groups, percentages were highest for seeing ≥20 adults with arthritis weekly (“both”: 56.4%; “always assesses”: 66.7%; “always recommends”: 71.3%) and lowest among obstetrician/gynecologists (“both”: 26.9%; “always assesses”: 36.8%; “always recommends”: 40.7%). Multivariable-adjusted associations were strongest for seeing ≥20 adults with arthritis weekly (referent: 1-9 adults) and each of “always assesses” (PR = 1.5 [95% confidence interval (CI): 1.3−1.8] and “both” (PR = 1.6 [95% CI: 1.4−1.9]). Conclusions: Approximately 40% of PCPs sampled always engaged in both behaviors (assessing and recommending physical activity) with adults with arthritis; seeing a high volume of adults with arthritis was consistently related to engaging in each behavior. Evidence-based approaches to support PCP counseling include offering provider education and training, raising awareness of available resources, and using health system supports.

Paramedic independent prescribing: a qualitative study of early adopters in the UK

2021 ◽  
Vol 6 (1) ◽  
pp. 30-37
Author(s):  
Karen Stenner ◽  
Suzanne van Even ◽  
Andy Collen
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
High Volume ◽  
Urgent Care ◽  
Multidisciplinary Teams ◽  
Framework Analysis ◽  
Early Adopters ◽  
Independent Prescribing ◽  
Controlled Drugs ◽  
The Uk

Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care.Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK.Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme.Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes.Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice.Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

scholarly journals Setting up An Acupuncture Knee Clinic under Practice Based Commissioning

2008 ◽  
Vol 26 (3) ◽  
pp. 183-187 ◽  
Author(s):  
Jonathan Freedman ◽  
Marion Richardson
Keyword(s):  
Primary Care ◽  
High Volume ◽  
Osteoarthritis Of The Knee ◽  
The Uk

This paper outlines the setting up of a new service in primary care offering acupuncture to patients with severe osteoarthritis of the knee. The high volume clinic is funded under the Practice Based Commissioning initiative and is the first of its type in the UK. It appears to offer a model for similar services elsewhere.

Impact of an Internet-Based Emergency Department Appointment System to Access Primary Care at Safety Net Community Clinics

2009 ◽  
Vol 54 (2) ◽  
pp. 279-284 ◽  
Author(s):  
Theodore C. Chan ◽  
James P. Killeen ◽  
Edward M. Castillo ◽  
Gary M. Vilke ◽  
David A. Guss ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Safety Net ◽  
Community Clinics ◽  
Appointment System

scholarly journals Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London

2020 ◽  
Vol 71 (702) ◽  
pp. e31-e38
Author(s):  
Tom Margham ◽  
Crystal Williams ◽  
Jack Steadman ◽  
Sally Hull
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Improvement ◽  
Effective Practice ◽  
Missed Appointments ◽  
Post Intervention ◽  
Primary Care Sector ◽  
Appointment System ◽  
Times Series Analysis ◽  
The Impact

BackgroundMissed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector.AimTo evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions.Design and settingPractices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population.MethodStudy practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis.ResultsIn total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%.ConclusionForward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.

scholarly journals Aerosols created by dental procedures in a primary care setting

2020 ◽  
Author(s):  
Ross S Hobson ◽  
Shiv B Pabary ◽  
Kavita Amlani ◽  
Katherine Badminton
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Background Level ◽  
High Volume ◽  
Reading Level ◽  
Ultrasonic Scaler ◽  
Dental Procedures ◽  
Lower Extent ◽  
Average Change

The study was undertaken to record the amount of dental aerosol created using 3-in-1 syringe, air rotor, and ultrasonic scaler using high volume suction (HVS) in 5 primary care dental surgeries. The time for the aerosol to dissipate following completion of the procedure was also recorded. The amount of aerosol created above the background level for the surgery corresponding to the operating positions of the nurse, dentist, and patient was recorded using particle meters measuring the number of 2.5micron (PM2.5) and 10micron (PM10) particles respectively. The procedures were recorded in triplicate for each surgery and average change calculated for each procedure, lasting 90 seconds. PM2.5 remained at or very near background readings during all procedures, whereas PM10 increased with use of the air rotor and to a much lower extent with both 3-in-1, and ultrasonic scaler. The means time to return to background reading level was 2.5 minutes. It was concluded that PM2.5 levels did not rise and although PM10 increased for all procedures the increase was low and with a return to background readings within 2m:50s (95% CI: 2:34 to 3:37) of completing the procedures that a minimum fallow period of 5minutes would allow be more than ample to be safe.

OP86 Exploring Public Utilization Data For Primary Care Education Programs

2019 ◽  
Vol 35 (S1) ◽  
pp. 22-22
Author(s):  
Jason Mak ◽  
Renee Granger
Keyword(s):  
Primary Care ◽  
Anatomical Therapeutic Chemical ◽  
Oral Anticoagulants ◽  
High Volume ◽  
Fixed Dose ◽  
Care Education ◽  
Quality Use Of Medicines ◽  
Medical Tests ◽  
Horizon Scanning ◽  
Primary Care Education

IntroductionNPS MedicineWise delivers nationwide educational programs to improve quality use of medicines and medical tests in Australia. Targeted horizon scanning approaches are required to detect and address emerging challenges in the healthcare landscape such as overutilization and unexpectedly high expenditure on medicines and medical tests. Publicly available utilization and expenditure data from the Australian Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) may provide insights into identifying potential areas for intervention.MethodsFive financial years (2013-18) of publicly available PBS/MBS data was extracted from Australian Government websites and clustered according to medicine class, disease groups or anatomical therapeutic chemical classification (ATC). Usage and expenditure trends were explored with signals of potential inappropriate use identified as unusual spikes or changes.ResultsPBS data showed two fixed dose combination inhalers for respiratory conditions, three direct oral anticoagulants, four analgesics (including opioids) and two blood glucose lowering agents had high volume and expenditure growths in the 2016-17 financial year. Cholesterol-reducing medicines and anti-hypertensives also commonly had high utilisation growth. The highest growth classified by ATC level two codes were for urologicals. These signals were collated into themes of stroke prevention, cardiovascular, respiratory, pain management and type two diabetes. MBS data on pathology tests showed viral and bacterial testing had the highest growth, followed by vitamin B12 testing and vitamin D testing. Magnetic resonance imaging had the highest growth in expenditure and volume of services of the various imaging modalities and X-ray of the lower leg had the highest volume of services.ConclusionsSeveral medicines and medical tests were detected as possible targets for interventions based on high volume or expenditure growth. Themes identified from the data can then be further investigated and contextualized to inform topic areas for primary care education to support quality use of medicines and medical tests.

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