scholarly journals Clinical audit of management of smear positive adult pulmonary tuberculosis in PR1 tuberculosis clinic, KK Bandar Miri

2021 ◽  
Vol 16 (2) ◽  
pp. 50-57
Author(s):  
Rubini Cumarasamy ◽  
Fatimah Shahidah Dato’ Azmi ◽  
Norafini Salamon
Keyword(s):  
Medical Records ◽  
Current Practice ◽  
Clinical Audit ◽  
Primary Care Providers ◽  
Care Providers ◽  
Exclusion Criteria ◽  
Pulmonary Tb ◽  
Medication Side ◽  
Areas Of Concern

Introduction: Malaysian tuberculosis (TB) clinical practice guideline (CPG) standardises the management of TB to improve the quality of care for TB patients. Not all primary care providers adhere to this guideline, however. This audit aims to improve the management of smear positive adult pulmonary TB by identifying areas of concern and developing action plans. Methods: Data for the audit were gathered from August 2018 to August 2019 from medical records of diagnosed smear positive pulmonary TB patients. Patients were included based on inclusion and exclusion criteria. Results: Forty-eight smear positive pulmonary TB patients were recruited. The majority of patients were male (54.2%) and Malay (33.2%). TB symptoms were assessed for 29.2% of patients at two weeks and then in 81.3% at one month, 97.9% at two months, 16.7% at three months, 95.8% at four months, 22.9% at five months and 95.8% at six months. Medication side effects were assessed at two weeks for only 2.1% of patients, then for 8.3% of patients at one month, 2.1% at two months and 0% at subsequent months. At diagnosis, 25% and 4.2% of patients had their visual acuity and colour vision, respectively, assessed. Only 6.3% of patients were referred to pre-pregnancy counselling. Weights were recorded for 87.5% of patients at diagnosis, then for 27.1% at two weeks, 81.3% at one month, 91.7% at two months, 77.1% at three months, 97.9% at four months, 79.2% at five months and 93.8% at six months. Baseline investigations and Mycobacterium tuberculosis culture and sensitivity were conducted for all patients, but only 81.3% of patients were traced. No patients were referred to pharmacy for medication counselling. Conclusion: This audit shows that there is a difference between current practice and the national guideline. There are some downfalls in management and proper documentation, so interventions should be carried out to improve those aspects.

scholarly journals Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group

2018 ◽  
Vol 27 (01) ◽  
pp. 156-162 ◽  
Author(s):  
Harshana Liyanage ◽  
Siaw-Teng Liaw ◽  
Emmanouela Konstantara ◽  
Freda Mold ◽  
Richard Schreiber ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Medical Records ◽  
Panel Discussion ◽  
Care Quality ◽  
Care Providers ◽  
Consensus Statements ◽  
Online Access ◽  
The Impact

Background: Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs. Objective: To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM). Method: A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements. Results: Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements. Conclusion: Patients' online access to their CMRs should be part of all CMR systems. It improves the process of health care, but further evidence is required about outcomes. Online access improves efficiency of bookings and other services. However, there is scope to improve many of the processes of care it purports to support, particularly the provision of a more effective interface and the protection of the vulnerable.

scholarly journals Private ownership of primary care providers associated with patient perceived quality of care

Medicine ◽  
2017 ◽  
Vol 96 (1) ◽  
pp. e5755 ◽  
Author(s):  
Xiaolin Wei ◽  
Jia Yin ◽  
Samuel Y.S. Wong ◽  
Sian M. Griffiths ◽  
Guanyang Zou ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Primary Care Providers ◽  
Perceived Quality ◽  
Private Ownership ◽  
Care Providers ◽  
Perceived Quality Of Care

Improving diagnosis and treatment of benign paroxysmal positional vertigo

2021 ◽  
pp. 42-46
Author(s):  
Larry D. McIntire ◽  
Kindall Martin ◽  
Kunal Shah ◽  
Lauren Malinowski ◽  
John Paulson
Keyword(s):  
Primary Care ◽  
Population Health ◽  
Healthcare Costs ◽  
Benign Paroxysmal Positional Vertigo ◽  
Primary Care Providers ◽  
Diagnosis And Treatment ◽  
Care Providers ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care. Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated. Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.

Headaches

2021 ◽  
pp. 329-342
Author(s):  
Andrew D. Hershey
Keyword(s):  
Early Recognition ◽  
Primary Headache ◽  
Primary Care Providers ◽  
School Nurses ◽  
Primary Headaches ◽  
Care Providers ◽  
Primary Headache Disorders ◽  
Tension Type Headaches ◽  
The Impact

This chapter discusses recurrent headaches, especially when episodic, which are much more likely to represent primary headache disorders. Primary headaches are intrinsic to the nervous system and are the disease itself. Early recognition of the primary headaches in patients should result in improved response and outcome, minimizing the impact of the primary headaches and disability. Primary headaches can be grouped into migraine, tension-type headaches, and trigeminal autonomic cephalalgia, and an additional grouping of rarer headaches without a secondary cause. The primary headache that has the greatest impact on a child’s quality of life and disability is migraine, and subsequently is the most frequent primary headache brought to the attention of parents, primary care providers, and school nurses.

scholarly journals 01 Adolescent and Young Adult Central Nervous System Tumour Survivors: Documentation of late-effects risks and screening recommendations in British Columbia, Canada

2018 ◽  
Vol 45 (S3) ◽  
pp. S1-S1
Author(s):  
A. Fuchsia Howard ◽  
Jordan Tran ◽  
Avril Ullett ◽  
Michael McKenzie ◽  
Karen Goddard
Keyword(s):  
Primary Care ◽  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Young Adult ◽  
Late Effects ◽  
Medical Records ◽  
Primary Care Providers ◽  
Adolescent And Young Adult ◽  
Care Providers

Survivors of adolescent and young adult (AYA) central nervous system (CNS) neoplasms are at risk for late effects (LE) - treatment-related health problems occurring more than 5 years after therapy). Since, in Canada, AYA survivors are usually followed in the community, information must be conveyed to primary care providers to guide risk-based follow-up care. Objective: To assess documentation of LE risks and screening recommendations (SR) in medical records of AYA CNS tumor survivors treated with radiation therapy. Methods: The medical records of all patients diagnosed with a CNS neoplasm (benign or malignant) at ages 15-39 years, treated between 1985 and 2010 in the province of British Columbia, surviving >5 years and discharged to the community were assessed. Documentation of LE and SR were extracted, and analyzed descriptively. Results: Among 132 survivors (52% female), treated with radiation therapy (95% partial brain, 10% craniospinal, 8% partial spine, and 4% whole brain) and chemotherapy (17%), 19% of charts included no documentation of LE risks, 26% included only non-specific documentation, and 55% had minimal documentation (1 or 2 LE). Documentation of at least one specific LE increased from 24% in 1980-1989, to 54% in 1990-1999, to 86% in 2000 – 2010. Based on treatment information, all survivors were at high-risk for LE, such as radiation induced neoplasm, meningioma and cerebrovascular events. Yet, SR were documented in only 25% of charts. Conclusions: The documentation of LE risks and screening recommendations has been limited, highlighting the need to improve written communication with primary care providers.

Compliance, capacity, and quality in colonoscopy screening for CRC: A novel solution.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 357-357 ◽  
Author(s):  
S. C. Lloyd
Keyword(s):  
Primary Care ◽  
Training Program ◽  
Primary Care Physicians ◽  
African American Men ◽  
Primary Care Providers ◽  
Care Providers ◽  
Adenoma Detection ◽  
Before And After ◽  
Outstanding Quality

357 Background: CRC is predominately preventable with high quality colonoscopy screenings. Unfortunately, less than half of Americans are “up-to-date.” When referred by primary care providers, less than half complete the process. We proposed to include the primary care provider (PCP) in a novel training program to extend skills from sigmoidoscopy to full colonoscopy in a “mentored and monitored” model. We know that quality in colonoscopy can vary widely (ten fold within a single 12-man group). The protective benefits of colonoscopy reflect the thoroughness of the removal of polyps. Unfortunately, the ACS projections for 2010 predict an increase of 4,400 deaths from CRC over 2009, an 8% rise! Furthermore the death rate for African American men has RISEN 28% since 1960. We are loosing a battle for which we posses the tools to win. To achieve victory we must successfully address all three factors: compliance, capacity and quality. Methods: Thirty primary care physicians in two states (SC, FL) were recruited. We measured compliance rates within the practice before and after enrollment. We further evaluated quality of the colonoscopies as reflected in completion, yield and complications. Results: Compliance more than doubled (38% to 84%). As a compliance enhancement tool, the results were outstanding. The evaluation of quality then became of paramount importance. The gross completion rate was 98.3%, the adenoma detection rate (reflecting polyp yield) was 38%. In over 20,000 cases there were only 5 perforations, substantially below published rates. The quality was consistently at the level of experienced conscientious gastroenterologists. The details of the training program and the use of the “two-man” colonoscopy technique have been reviewed elsewhere (MEDICAL CARE, Aug 2010). Conclusions: If replicated nationally, this model has the potential for saving 25,000 lives annually. The participation of the patient's PCP is a powerful influence for improved compliance. The availability of an “expert” for mentoring and monitoring results in outstanding and consistent quality. The model has the potential to dramatically enhance compliance simultaneously increasing capacity while maintaining outstanding quality. No significant financial relationships to disclose.

Driving action through data: Delivering online cancer screening reports to primary care providers.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 174-174
Author(s):  
Nicki Cunningham ◽  
Shama Umar ◽  
Dafna Carr ◽  
Richard Smith ◽  
Patrick Flynn
Keyword(s):  
Primary Care ◽  
Cancer Screening ◽  
Clinical Guidelines ◽  
Management System ◽  
Primary Care Providers ◽  
Care Providers ◽  
Access Management ◽  
Screening Programs ◽  
Screening Activity

174 Background: The Screening Activity Report (SAR), a supplementary tool for primary care providers (PCPs), was released in April, 2014. Providers are able to access this comprehensive report securely via an online solution and view the screening activity of their patients across Cancer Care Ontario (CCO)’s three organized cancer screening programs; breast, cervical and colorectal. The objectives of the SAR are to improve the quality of cancer screening by increasing provincial screening rates, improving the rate of appropriate follow-up of abnormal results and promote the alignment of cancer screening practices with CCO’s evidence-based clinical guidelines. Methods: CCO partnered with eHealth Ontario in 2012 to leverage their identity and access management system to provide safe and secure online access to the report. Since this time, CCO has implemented a multi-faceted campaign to support registrations to the system, encourage report access, and gather feedback on how to improve the report for future iterations. Using a detailed methodology developed by a wide range of subject matter experts at CCO, the SAR employs numerous provincial data sources to provide an overview of the patient rosters. Actionable categories are assigned at the patient level using a unique algorithm based on the latest clinical guidelines. Results: Previous to April 2014, the SAR was referred to as the ColonCancerCheck SAR (CCC SAR) as it included colorectal cancer screening data only. The last release of the CCC SAR was in October, 2013. At this time 4,824 providers were registered to the identity and access management system and adoption of this report had reached 31% after being available for five months to providers. To date, 4,992 providers are now registered and adoption of the April SAR has already reached 27% after being available for almost two months. Conclusions: The SAR is the first tool of its kind to make widespread use of eHealth’s identity and access management system service and target a broad user base of PCPs. The successful launch of the SAR has provided key insights into how technology can be leveraged to share provincial data in a meaningful way with providers and support them in improving the quality of cancer screening.

The role of annual personal health visits (APHV) on patients' with cancer knowledge and perceptions of the harms of continued smoking.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 152-152
Author(s):  
Delaram Farzanfar ◽  
Lin Lu ◽  
Jie Su ◽  
Devon Alton ◽  
Rahul Mohan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Primary Care Providers ◽  
Smoking History ◽  
Care Providers ◽  
Risk Of Death ◽  
Increase Risk

152 Background: With improvements in cancer detection and therapies, important secondary prevention measures in survivorship include smoking cessation. Primary care providers have an opportunity to discuss these measures with cancer survivors at APHV. We evaluated whether having a recent APHV is associated with cancer patients’ awareness and perceptions of the harms of continued smoking. Methods: Cancer survivors were surveyed from April 2014 to May 2016 with respect to their smoking history, knowledge and perceptions of the harms of continued smoking along with the date of their most recent APHV (term changed from annual health physical examination in 2013). Multivariable logistic regression analyses assessed the association of having an APHV with knowledge and perceptions of the harms of continued smoking. Results: Of 985 cancer patients, 23% smoked at diagnosis; 34% quit > 1 year prior to diagnosis; 55% had tobacco-related cancers; 77% received curative therapy. From a knowledge viewpoint, over 52% reported being unaware that smoking negatively impacts cancer outcomes; despite this, most perceived smoking to negatively influence quality of life (75%), survival (76%), and fatigue (73%). Within the last year, 48% had an APHV, while 84% had an APHV at any time in the past; 18 (2%) reported not having a family doctor. Patients who had an APHV in the last year were more likely to be aware that continued smoking can increase risk of death (adjusted odds ratio (aOR)=1.49, 95% CI [1.13-1.96], P=0.004), and more likely to perceive smoking to negatively impact quality of life (aOR=1.37 [0.94-1.99], P=0.10), survival (aOR=1.60 [0.95-2.71], P=0.08), and fatigue (aOR=1.63 [1.11-2.39], P=0.01). Those ever having an APHV were more likely aware that smoking can increase risk of death (aOR=1.61 [1.07-2.43], P=0.02) and second primaries (aOR=1.53 [1.02-2.33], P=0.04). Conclusions: Having a recent APHV was associated with improved awareness and perceptions of the harms of continued smoking, but it is unclear whether this is related to provider counseling or a healthy bias effect. APHV may be an appropriate time for primary care providers to treat tobacco addiction in their cancer survivors.

Faster and better: Improving the diagnostic phase of lung cancer at a system level.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 115-115
Author(s):  
Melissa Kaan ◽  
Claire Holloway ◽  
Julie Gilbert ◽  
Vicky Simanovski ◽  
Garth Matheson
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Patient Experience ◽  
Cancer Care ◽  
Primary Care Providers ◽  
Diagnostic Process ◽  
Care Providers ◽  
The Past ◽  
Rule Out

115 Background: For many patients going through diagnostic testing for cancer, the time from suspicion to diagnosis or rule-out, can be a confusing and anxious time. In 2007, Cancer Care Ontario began investing in the implementation of diagnostic assessment programs (DAPs) across Ontario, Canada to improve the quality of care during the diagnostic phase of lung cancer. DAPs consist of multidisciplinary healthcare teams that manage and coordinate a patient’s diagnostic care from testing to a definitive diagnosis. The objectives of the DAPs are to: 1) decrease time from suspicion to diagnosis or resolution; 2) optimize the patient’s experience during the diagnostic process; 3) optimize satisfaction and experience among primary care providers and specialists; and 4) provide a sustainable solution by offering good value for money. Today over 35,000 patients have been diagnosed in one of the 18 lung DAPs that exist across the province. Methods: The implementation of DAPs featured the introduction of a patient navigator to act as the primary point of contact for patients, improve the patient experience and ensure their patients were progressing through any required diagnostic imaging and consultations in a timely manner. Cancer Care Ontario also engaged with primary care providers to refer patients with findings suspicious for lung cancer to DAPs as early as possible to ensure they benefited from organized assessment. Cancer Care Ontario has collected patient level data to measure wait times and implemented a patient survey to assess patient experience. Results: In the past five years, the median wait time from referral to a lung DAP to diagnosis or rule out has decreased by 19% to 24 days and the 90th %tile has decreased by 28% to 51 days. The large majority of patients have had a positive experience with their DAPs, with 95% of patients scoring their experience in the diagnostic process as “good” or “excellent”. Conclusions: The implementation of DAPs across the province is seen as a valuable component of quality of care by improving the diagnostic phase of cancer. The sustainability of the DAP model is demonstrated by the continued improvements in access and maintained patient experience in spite of growing volumes (91% increase in the past five years).

Serious illness communication among patients with head and neck cancer.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 2-2
Author(s):  
Floyd Buen ◽  
Emily J Martin ◽  
Neil Wenger ◽  
Kirsten Buen ◽  
Anne M. Walling
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Retrospective Analysis ◽  
Neck Cancer ◽  
Medical Records ◽  
Primary Care Providers ◽  
Treatment Preferences ◽  
Care Providers ◽  
Goals Of Care ◽  
Serious Illness

2 Background: Head and neck cancer is associated with significant morbidity and mortality, yet little is known about the frequency and content of discussions addressing patients’ values, goals of care, and treatment preferences. Methods: Using an institutional cancer registry, we conducted a retrospective analysis of 70 decedents who underwent surgical treatment for squamous cell carcinoma of the head and neck. We abstracted patients’ medical records using a standardized template. An independent reviewer re-abstracted 20% of the records. For abstracted data pertaining to documented values, goals of care, and/or treatment preferences our inter-rater reliability was greater than 93%. Results: The mean age at diagnosis was 66 years and 69% were male. An enduring advance directive, a completed Physician Order for Life Sustaining Treatment form, and a serious illness conversation documented in the medical record were noted in 27%, 4%, and 49% of the medical records, respectively. Half of the documented goals of care discussions were held in the inpatient setting, over 50% were held in the last month of life, and 25% were held in the last week of life. These conversations involved specialist palliative care providers (47%), hematologist/oncologists (41%), hospitalists (32%), head and neck surgeons (21%), radiation oncologists (19%), and intensivists (18%). None of these discussions involved patients’ primary care providers. Of those with a known location of death, 58% died in the hospital and 4 out of 5 of these patients died during attempted cardiopulmonary resuscitation. Conclusions: In this retrospective analysis, serious illness communication was documented in the minority of patients who died of head and neck cancer. These discussions occurred late in the trajectory of illness. The continuity relationships of teams treating head and neck cancer patients (e.g., head and neck surgeon, radiation/oncologist and hematologist/oncologist) situate these clinicians in the best position to enact serious illness conversations. These data suggest that opportunities to have these discussions upstream are often missed.

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