Quality in Primary Care

BACKGROUND: Patient-centered medical homes incorporate strategies to increase healthcare access as a means of improving health at the patient and population level. We hypothesized that quality improvement initiatives based in a patient-centered medical home would improve hypertension control for adult patients, regardless of race. METHODS: This prospective cohort study included patients of a hospital-based Internal Medicine practice in the southeastern U.S. whose systolic blood pressure was uncontrolled (criteria ≥140mmHg) prior to patient-centered medical home certification...

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BACKGROUND: Improving health and controlling healthcare costs requires better tools for predicting future health needs across populations. We sought to identify factors associated with transitioning of enrollees in an indigent care program from an intermediate cost segment to a high cost segment of this population. METHODS: We analyzed data from 9,624 enrollees of the Virginia Coordinated Care program between 2010 and 2013. Each fiscal year included all enrollees who were classified in intermediate cost segment in the preceding year and also enrolled in the program in the following year...

The escalating amount of kidney transplant recipients (KTRs) represents a significant dilemma for primary care providers. As the number of physician assistants (PAs) has been steadily increasing in primary care in the United States, the utilization of these healthcare professionals presents a solution for the care of post-kidney transplant recipients. A physician assistant (PA) is a state licensed healthcare professional who practices medicine under physician supervision and can alleviate some of the increasing demands for primary patient care...

INTRODUCTION: In the current financial climate faced by the NHS, it is important that we reduce the amount of inappropriate referrals made to secondary care specialties. ENT Emergency Clinics are one-stop clinics provided by many UK ENT departments to allow more rapid access to ENT services from primary care. However, many referrals to these clinics were considered to be inappropriate, overloading the clinic and delaying referrals to more specialist clinics. We conducted a service improvement project through introduction of referral guidelines and liaising with local GPs...

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The systems-based management of laboratory test ordering and results handling is a significant patient safety concern in primary care internationally. In this pilot study, we describe the testing of a method to systematically measure and monitor compliance with basic safe performance in this area in different European primary care settings. The findings show high overall compliance with the safe system measures developed although the data indicates performance variation within and between the different systems audited, which suggests that aspects of the reliability (and safety) of these systems could be improved by care teams...

BACKGROUND: The global economic crisis has affected Greece. Data on patients' adherence to medications for chronic diseases are missing. The objective of this study was to identify to what extent the financial crisis and the repeated pharmacists strike have influenced patients adherence to therapy. DESIGN: A quantitative and qualitative study in rural Crete was designed and implemented in February 2013 with the use of a pretested questionnaire with opened and closed questions...

BACKGROUND: The NHS Health Checks is a cardiovascular disease (CVD) risk assessment and management programme for individuals in England aged between 40 and 74 with the aim of identifying previously unassessed individuals that are at high risk of CVD. Little research to date has explored patient perceptions and opinions of Health Checks. OBJECTIVE: This paper aims to investigate the perceptions and opinions of patients who had attended a Health Check appointment within a cohort of 83 General Practices in Gloucestershire...

UNLABELLED: In Jordan, despite being one of the most modern countries in the Middle East, postnatal care services are still under-utilized by rural Jordanian mothers. The purpose of this study is to explore, analyse and critique the postnatal cultural health beliefs, knowledge and practices of rural Jordanian mothers. DESIGN: a critical ethnographic approach was used to critically investigate the cultural health issues of 13 rural Jordanian postpartum mothers from four rural areas in the Northeast governorate which is characterized rural populated governorate...

UNLABELLED: Aims was undertaken to ensure concomitant usage of proton pump inhibitors (PPIs) with Non-Steroidal Anti-inflammatory Drugs (NSAIDs) in Elderly, in order to avoid upper gastrointestinal (GI) symptoms and ulcers. METHODS: Reviewing of 386 patients' prescription on the EMIS (Egton Medical Information Systems) Web, on April 2014. Checking who have not been prescribed PPIs with NSAIDs, offering them appointment for prescription and discussion about risks and benefits of PPIs...

BACKGROUND: Doctors' opinions about quality improvement tools likely influence their uptake and eventual impact on patient care. Little is known about physicians' perception of the comparative utility of various quality improvement tools. METHODS: We conducted a mail survey of doctors in Geneva, Switzerland (2745 physicians, of whom 56% participated), to measure the perceived usefulness of 9 quality improvement tools. RESULTS: In decreasing order of perceived utility these tools were regular continuous education (rated as very or extremely useful by 75% of respondents), mortality and morbidity conferences (65%), quality circles (60%), patient satisfaction measurement (42%), assessment of the fulfillment of therapeutic objectives (41%), assessment of compliance with guidelines (36%), periodic evaluation of doctors' skills (14%), onsite visits with peer-review of medical records (11%), and certification of office practices (8%)...

BACKGROUND: Treatment for colorectal cancer (CRC) may result in physical, social, and psychological needs that affect patients' quality of life post-treatment. A comprehensive assessment should be conducted to identify these needs in CRC patients post treatment, however, there is a lack of tools and processes available in general practice. AIMS: This study aimed to develop a patient-completed needs screening tool that identifies potentially unmet physical, psychological, and social needs in CRC and facilitates consultation with a general practitioner (GP) to address these needs...

BACKGROUND: Achieving glycaemic control in diabetes reduces complications and improves outcomes. Glycaemic control requires both good quality clinical care and effective self-management support. However, the relationship between these factors in routine clinical practice is unclear. AIMS: To evaluate baseline levels of self-management and clinical quality of care in patients with type 2 diabetes in primary care in Mexico and to explore relationships between measures of self-management and clinical quality of care...

BACKGROUND: The ordering of thyroid function tests (TFTs) is increasing but there is not a similar increase in thyroid disorders in the general population, leading some to query whether inappropriate testing is taking place. Inconsistent clinical practice is thought to be a cause of this, but there is little evidence of the views of general practitioners, practice nurses or practice managers on the reasons for variation in the ordering of TFTs. AIM: To find out the reasons for variation in ordering of TFTs from the perspective of primary healthcare professionals Methods: Fifteen semi-structured interviews were carried out with primary healthcare professionals (general practitioners, practice nurses, practice managers) that used one laboratory of a general hospital in South West England for TFTs...

BACKGROUND: The substantial prevalence of bacterial lower urinary tract infections (LUTIs) in out-of-hours (OOH) primary care is a reason for frequent prescription of antibiotics. Insight in guideline adherence in OOH primary care concerning treatment of LUTIs is lacking. AIMS: To check feasibility of the use of OOH routine data to assess guideline adherence for the treatment of LUTI in OOH primary care, in different regions of Europe. METHODS: We compared guidelines for diagnosis and treatment of uncomplicated LUTIs in nine European countries, followed by an observational study on available data of guideline adherence...

BACKGROUND: The number of tests ordered in primary care continues to increase influenced by a number of factors not all of which are concerned with diagnosis and management of disease. Liver function tests (LFTs) are a good example of inexpensive tests that are frequently ordered in patients with non-specific symptoms. They remain among the most frequently ordered tests despite their lack of specificity yet the full range of motives behind the decision to order an LFT remains unexplored...

BACKGROUND: NHS policy documents continue to make a wide-ranging commitment to patient involvement. The Patient Participation Direct Enhanced Service (PP-DES), launched in 2011, aimed to ensure patients are involved in decisions about the range and quality of services provided and commissioned by their practice through patient reference groups (PRGs). The aim of this exploratory study is to review the impact of the PP-DES (2011-13) on a sample of PRGs and assess how far it has facilitated their involvement in decisions about the services of their general practices...

BACKGROUND: Among medication reconciliation studies, varying methods are used to determine which medications patients are actually taking. One recommended approach is to ask patients to "brown bag" their medications for routine office visits. AIMS: To determine if 'brown bag' practices performed during routine office visits improve the accuracy of provider-documented medication lists. METHODS: This cross-sectional pilot study was conducted in a university affiliated community geriatric clinic...

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