scholarly journals Strengthening Primary Care for Children through an integrated paediatrician-GP care model.

2021 ◽  
Vol 20 (3) ◽  
pp. 17
Author(s):  
Harriet Hiscock ◽  
Jessica Holman ◽  
Rachel O'Loughlin ◽  
Kim Dalziel ◽  
Gary Freed
Keyword(s):  
Primary Care ◽  
Care Model ◽  
Gp Care

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

2021 ◽  
pp. 193229682199872
Author(s):  
Gregg D. Simonson ◽  
Richard M. Bergenstal ◽  
Mary L. Johnson ◽  
Janet L. Davidson ◽  
Thomas W. Martens
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glucose Monitoring ◽  
Care Model ◽  
Time In Range ◽  
Glucose Management ◽  
The Impact ◽  
Primary Care Management

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

scholarly journals POS0261 DIAGNOSTIC PERFORMANCE AND CLINICAL UTILITY OF TWO REFERRAL RULES FOR INFLAMMATORY ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 353.1-353
Author(s):  
E. Van Delft ◽  
D. Lopes Barreto ◽  
A. Van der Helm - van Mil ◽  
C. Alves ◽  
J. Hazes ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Inflammatory Arthritis ◽  
Clinical Utility ◽  
Diagnostic Performance ◽  
Youden Index ◽  
Care Model ◽  
Net Benefit ◽  
Independent Population ◽  
The Right

Background:The Rotterdam Early Arthritis Cohort (REACH) rule [1] and Clinical Arthritis RulE (CARE) [2] are both evidence-based and easy-to-use methods developed to identify the presence of inflammatory arthritis (IA) in patients suspected by their general practitioner (GP). However, the clinical utility of both models in daily clinical practice in an independent primary care setting has not yet been established. While developed for recognizing IA, we believe that it is also important that the broader spectrum of inflammatory rheumatic diseases (IRDs) is correctly classified from primary care, to facilitate appropriate referral towards outpatient rheumatology clinics.Objectives:The primary objective was to determine the diagnostic performance and clinical utility of the REACH and CARE referral rules in identifying IA in an independent population of unselected suspected patients from primary care. Secondly we will assess the diagnostic performance and clinical utility of both models in identifying IRDs.Methods:This prospective observational diagnostic study consisted of adults newly suspected by their GP for the need of referral to the rheumatology outpatient clinic of the Maasstad Hospital in Rotterdam. Primary outcome was IA, consisting of rheumatoid arthritis, axial spondylitis and psoriatic arthritis. Secondary outcome was IRD, defined as IA plus arthritis in systemic disorders such as systemic lupus erythematosus, systemic sclerosis and morbus sjögren. Rheumatologist diagnosis was used as gold standard. To evaluate the clinical performance of the REACH and CARE referral rules in this population, diagnostic accuracy measures were investigated using the Youden index (J) [3]. Moreover, a net benefit approach [4] was used to determine clinical utility of both rules when compared to usual care.Results:This study consisted of 250 patients (22.8% male) with a mean age of 50.8 years (SD 13.9 years). In total 42 (17%) patients were diagnosed with IA and 55 (22%) with an IRD. Figure 1 presents the diagnostic performance in IA (Figure 1A) and in IRD (Figure 1B). For the primary outcome, the REACH model shows an AUC of 0.72 (95% CI 0.64-0.80) and the optimal cut-off point is indicated (J). The CARE model shows an AUC of 0.82 (95% CI 0.75-0.88) and at J there is a somewhat higher sensitivity and specificity. When taking the broader spectrum of IRDs as outcome, the AUC was 0.66 (95% CI 0.58-0.74) for the REACH and 0.76 (95% CI 0.69-0.83) for the CARE model. The net benefit analysis with either IA or IRD as outcome showed that the CARE was of the highest clinical value when compared to usual care.Conclusion:Both the REACH and CARE model showed a good diagnostic performance for detecting IA in an independent population of unselected suspected patients from primary care. Although not specifically developed to recognize the entire spectrum of IRDs, the CARE shows a good performance in doing so. When evaluating clinical utility, we see that both rules have a net benefit in recognizing IA as well as IRDs compared to usual care, however the CARE shows superiority over the REACH. By using the CARE, over half of all suspected patients can be withheld from expensive outpatient rheumatology care, implied by the high specificity of 70%. These results support the idea that incorporating these easy-to-use methods into primary care could lead to providing patients the right care at the right place and improving value based health care.References:[1]ten Brinck RM, van Dijk BT, van Steenbergen HW, le Cessie S, Numans ME. Development and validation of a clinical rule for recognition of early inflammatory arthritis. BMJ Open; 2018: 8[2]Alves, C. Improving early referral of inflammatory arthritis. In Early detection of patients at risk for rheumatoid arthritis – a challenge for primary and secondary care; 2015: 27-38 Ridderkerk, the Netherlands.[3]Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J; 2005: 47(4): 458-472[4]Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making; 2006: 26(6): 565-574Disclosure of Interests:None declared

scholarly journals Information and Communication Technologies (ICTs) Enabling Integrated Primary Care for Complex Patients: A Protocol for a Scoping Review

2021 ◽  
Author(s):  
Farah Tahsin ◽  
Alana Armas ◽  
Apery Kirakalaprathapan ◽  
Heather Cunningham ◽  
Mudathira Kadu ◽  
...  
Keyword(s):  
Primary Care ◽  
Information And Communication Technologies ◽  
Scoping Review ◽  
Communication Technologies ◽  
Integrated Primary Care ◽  
Multiple Chronic Conditions ◽  
Care Model ◽  
Primary Care Model ◽  
Complex Patients ◽  
Information And Communication

Abstract IntroductionAn increasing number of individuals are living with multiple chronic conditions, often combined with psychosocial complexities. For these patients with complex conditions, an integrated primary care model that provides care coordination and a team-based approach can help manage their multiple needs. Information and communication technologies (ICTs) are recognized as a critical enabler of integrated primary care. A better understanding of the use of ICTs in an integrated care setting and how ICTs are being leveraged would be beneficial to identify knowledge gaps and could lead to successful implementation for ICT-based interventions.ObjectiveThis study will systematically scope the literature on the topic of ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings. MethodThis study protocol outlines a scoping review of the peer-reviewed literature, using Arksey and O’Malley’s (enhanced by Levac et al.) scoping review methodology. Peer-reviewed- literature will be identified using a multi-database search strategy. The results of the search will be screened, abstracted, and charted in duplicate by 6 research team members. DiscussionThe key findings of the study will be thematically mapped to describe the implemented ICTs aimed for complex patients within the integrated primary care model and interactions of the elements (ICT, health model, and targeted patients). This review will be the first step to formally identify how ICT is used to support integrated primary health care models. The results will be disseminated through peer-reviewed publications, conference presentations, and special interest groups.

scholarly journals Barriers and Facilitators towards an Integrated Chronic Care Model as experienced by primary care health providers

2016 ◽  
Vol 16 (6) ◽  
pp. 78 ◽  
Author(s):  
Geert Goderis ◽  
Gunther D'hanis ◽  
Gert Merckx ◽  
Wim Verhoevven ◽  
Pierre Sijbers ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Barriers And Facilitators ◽  
Health Providers ◽  
Care Model ◽  
Primary Care Health ◽  
Care Health

scholarly journals Hospital-based chronic disease care model: protocol for an effectiveness and implementation evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037843
Author(s):  
Jennifer Sumner ◽  
Jason Phua ◽  
Yee Wei Lim
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Emergency Room ◽  
Clinical Outcomes ◽  
Qualitative Data ◽  
Emergency Room Visit ◽  
Type I ◽  
Care Model ◽  
Implementation Evaluation ◽  
Chronic Disease Patients

IntroductionNovel and efficient healthcare approaches are needed to better serve increasingly older chronic disease patients. Many effective integrated chronic disease management strategies have emerged from the primary care sector. However, in many Asian and developing countries, primary care is underdeveloped, and patients prefer secondary-based services. The Integrated Generalist-led Hospital (IGH) care model is a new approach, which may be better suited for chronic disease patients in the local context.Methods and analysisA hybrid type I study on the effectiveness and implementation of the IGH care model will be conducted. Implementation evaluation will be informed by the Consolidated Framework of Implementation Research (CFIR). Quantitative and qualitative data will be collected through in-depth interviews and focus group discussions with staff, a staff survey, patient interviews, clinical outcomes and cost data. Clinical outcomes include the length of stay, readmission, emergency room visit rate and mortality. Clinical outcomes will be summarised and compared with a propensity-matched ‘usual care’ group (derived from the general medicine ward(s) at a separate hospital). The Kaplan-Meier approach will be used to estimate time until death and time until first readmission (both within 30 days of discharge) and time until discharge. Multivariate regression models will be used to investigate the association between the care model and occurrence of readmission, emergency room visit and death, all within 30 days of discharge. Qualitative data will be analysed using a thematic analysis method. Qualitative and quantitative data will also be coded according to the five domains of the CFIR.Ethics and disseminationThis protocol was reviewed and approved by the National Healthcare Group Domain Specific Review Board (NHG DSRB 2019/00308). Results will be published in peer-reviewed scientific journals and conference presentations. Findings will also be discussed with key stakeholders through local dissemination events.

scholarly journals 53 Implementation of a Developmental Outreach Clinic housed within a Family Health Team - preliminary findings in building a shared care model for children and youth with mental health and developmental disorders

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e22-e22
Author(s):  
Elizabeth Young ◽  
Rachel Goldfarb ◽  
Laurie Green ◽  
Kathleen Hollamby ◽  
Karen Weyman ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Developmental Disorders ◽  
Family Health ◽  
Shared Care ◽  
Care Model ◽  
Roles And Responsibilities ◽  
Shared Care Model ◽  
Family Health Team

Abstract Background At our inner city hospital, we developed a shared care model between family health teams (FHTs), pediatricians and developmental pediatricians to care for children with mental health and developmental disorders. In phase one of our study, 84 FHT members participated in focus groups to inform the development of our clinic. Family physicians described their role as “referral agent”, “long term supporter” and “healthcare coordinator”. They expressed the desire to “learn” and “do more”, but noted barriers to providing care, including limited training, lack of service knowledge, limited communication, and cumbersome access to mental health and dual diagnosis services. Phase One was completed and accepted for publication. Phase Two describes the implementation of our clinic using a mixed methods approach and report preliminary findings. Objectives To evaluate the first two years of implementation of the developmental clinic housed within a family health team (FHT) an obtain feedback from members of the shared care model. Design/Methods Mixed methods were used including chart review of all patients referred to the clinic and semi structured interviews with primary care physicians, pediatricians and developmental pediatricians regarding their roles in managing children with developmental and mental health disorders, as well as use and impact of the developmental clinic. Results A total of 115 charts were reviewed between Feb 2016 and Jan 2018. Of all patients seen, 34% were female 64% male and 2% transgender. Ages ranged from 1-17 years. Eighty-one percent had an existing diagnosis and were referred for re-assessment while 43% received a new diagnosis: ASD (72%), ADHD (11%), GDD (11%), learning disorder (3%), Anxiety (1%), Other (1%). There was an 8% no show rate. Providers endorsed improved communication through use of a shared EMR for documentation and messaging, and improved service knowledge through availability of a pediatric service navigator who also used EMR to document service and funding applications. Longer term follow up, namely the roles and responsibilities of pediatrics vs. developmental pediatrics vs. primary care remained unclear. Conclusion Implementation of the shared care model for this population with primary care is feasible, and does address some stated barriers to care, including improved communication, increased service knowledge, and provision of reassessments. Further areas to develop include clarifying the roles and responsibilities of the different healthcare providers of children with mental health and developmental disorders, and determining what is needed for long-term follow up and transitional care.

The balanced care model for global mental health

2012 ◽  
Vol 43 (4) ◽  
pp. 849-863 ◽  
Author(s):  
G. Thornicroft ◽  
M. Tansella
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Mental Health System ◽  
Community Care ◽  
Care Model ◽  
Adult Mental Health ◽  
High Resource

BackgroundFor too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide.MethodWe conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings.ResultsLow-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop ‘general adult mental health services’, namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories.ConclusionsThe BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.

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