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Awang, Siti Salmiah, Shaza Eva Mohamad, and S. Maria Awaluddin. "Humanitarian disaster: mental health disorders at primary healthcare clinic." Disaster and Emergency Medicine Journal 7, no. 1 (March 31, 2022): 1–10. http://dx.doi.org/10.5603/demj.a2022.0001.
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Nuako, Akua, Jingxia Liu, Giang Pham, Nina Smock, Aimee James, Timothy Baker, Laura Bierut, Graham Colditz, and Li-Shiun Chen. "Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system." PLOS ONE 17, no. 2 (February 10, 2022): e0263718. http://dx.doi.org/10.1371/journal.pone.0263718.
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Purpose The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system. Methods We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately. Findings Patients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits. Conclusions Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.
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Jordan, Jacob N., Thomas G. Wadsworth, Renee Robinson, Hayli Hruza, Amy Paul, and Shanna K. O’Connor. "Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic." Pharmacy 9, no. 4 (November 21, 2021): 187. http://dx.doi.org/10.3390/pharmacy9040187.
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(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS®, CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.
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Shabbir, Syed H., and Maria Teresa M. Santos. "The role of prehealth student volunteers at a student-run free clinic in New York, United States." Journal of Educational Evaluation for Health Professions 12 (October 30, 2015): 49. http://dx.doi.org/10.3352/jeehp.2015.12.49.
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Purpose: The medical student-run Einstein Community Health Outreach Clinic provides free healthcare to the uninsured adult population of New York, the United States. During the summer, prehealth student volunteers are recruited to assist with clinic operations. Methods: We designed a survey study to identify the baseline characteristics of the volunteers between June and August of 2013 and 2014 in order to evaluate the influence of working in a medical student-run free clinic on their education, impressions, and career goals. Results: A total of 38 volunteers (response rate, 83%) participated in the study. The volunteers were demographically diverse and interested in primary care specialties and community service. Conclusion: After the Einstein Community Health Outreach program, the volunteers showed an improved understanding of the healthcare process and issues relevant to uninsured patients. They also developed favorable attitudes towards primary care medicine and an increased level of interest in pursuing careers in primary care.
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Kovaleva, Mariya A., Melinda Higgins, Bonnie Mowinski Jennings, Mi-Kyung Song, Carolyn K. Clevenger, Patricia C. Griffiths, and Kenneth W. Hepburn. "THE INTEGRATED MEMORY CARE CLINIC AS A HEALTHCARE NETWORK." Innovation in Aging 3, Supplement_1 (November 2019): S559. http://dx.doi.org/10.1093/geroni/igz038.2067.
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Abstract The Integrated Memory Care Clinic (IMCC) at Emory Healthcare is a patient-centered medical home led by advanced practice registered nurses (APRNs) who provide dementia and primary care. This presentation describes the experiences of persons living with dementia and their caregivers during their first year at the IMCC, through the lens of the IMCC as a healthcare network. Forty-two caregivers were evaluated in three survey-based assessments over nine months. Twelve caregivers completed qualitative interviews about their experience at the IMCC. Severity of depression and delusions and total symptom severity improved significantly for persons living with dementia. Caregivers described their sense of belonging to the IMCC healthcare team and valued direct telephone access to APRNs. By enhancing care access and engaging clients in their care, the IMCC serves as a reliable and professional healthcare network for patient-caregiver dyads who often receive suboptimal dementia care in mainstream healthcare.
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Joughin, Andrea, Sarah Ibitoye, Amy Crees, David Shipway, and Philip Braude. "Developing a virtual geriatric perioperative medicine clinic: a mixed methods healthcare improvement study." Age and Ageing 50, no. 4 (May 15, 2021): 1391–96. http://dx.doi.org/10.1093/ageing/afab066.
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Abstract Background the Geriatric Perioperative Care clinic at North Bristol NHS Trust was suspended in March 2020 during the COVID-19 pandemic. A virtual clinic was piloted to deliver preoperative health optimisation and shared decision-making for patients undergoing critical elective surgery. No literature existed on virtual preoperative clinics for older people to support the development. Objective this healthcare improvement study describes the setup and delivery of the virtual clinic as its primary aim. Secondary aims included: assessing older people’s access to technology and their digital literacy for virtual consultation; to describe barriers and facilitators for consultations, as well as evaluation of patient and clinician satisfaction with the consultations' mode of delivery and outcomes. Methods a mixed methods healthcare improvement study was undertaken through plan-do-study-act cycles, semi-structure interviews, and quantitative service benchmarking. Results the pilot evaluated 67 preoperative consultations (43.3% video, 56.7% telephone, mean age 75) with a mix of surgical pathology (vascular 88.1%, colorectal 10.4%, urological 1.5%). Patient feedback demonstrated improved understanding of conditions (90.6%), and adequate opportunity to express opinions and questions (96.2%). Clinicians preferred video consultations (adequate to deliver services: 89.7% video; 68.4% telephone). The greatest barriers to engagement, none of which were exclusions to participation, included cognitive impairment, sensory impairment, or needing technical assistance setting up video consultations (52.2%). Conclusions delivering a virtual preoperative medical optimisation and shared decision clinic for older people is feasible. This study will aid other units in developing their own virtual preoperative clinics. Future work should evaluate perioperative outcomes of delivering a face-to-face versus virtual clinic.
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Waters, Nicole P., Trenton Schmale, Allison Goetz, Jason T. Eberl, and Jessica H. Wells. "A Call to Promote Healthcare Justice: A Summary of Integrated Outpatient Clinics Exemplifying Principles of Catholic Social Teaching." Linacre Quarterly 84, no. 1 (February 2017): 57–73. http://dx.doi.org/10.1080/00243639.2016.1272330.
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There is an urgent need to promote healthcare justice for patients as well as members of the healthcare team including physicians. In this article, we explain how principles of Catholic social teaching (i.e., dignity of the individual, common good, destination of goods, solidarity, and subsidiarity) are applied to health care, by featuring various types of outpatient clinics including free, charitable–direct primary care, hybrid, federally qualified health center, and rural health clinic. We describe how attempts have been made to improve the quality and access of health care by creating new medical schools (i.e., Marian University College of Osteopathic Medicine) and training programs as well as allocating government funding to alleviate the cost of training new healthcare providers through the National Health Service Corps. Finally, we suggest a few approaches (i.e., adopting new clinic models to include volunteer healthcare professionals and cross-training members of the healthcare team) to fill in current gaps in health care. Summary There is a need to promote justice in healthcare. In this article, we explain how principles of Catholic social teaching are applied to health care. To illustrate this, we feature various types of outpatient clinics. We also describe how attempts have been made to improve the quality and access of health care. Finally, we suggest further ways to improve healthcare reform based upon Catholic social teaching.
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Adily, Armita, Seham Girgis, Catherine D'Este, Veronica Matthews, and Jeanette E. Ward. "Syphilis testing performance in Aboriginal primary health care: exploring impact of continuous quality improvement over time." Australian Journal of Primary Health 26, no. 2 (2020): 178. http://dx.doi.org/10.1071/py19070.
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Data from 110 primary healthcare clinics participating in two or more continuous quality improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic’s STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.
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Fathima Begum Syed Mohideen1, Mohd Radzniwan A Rashid, Sharifah Najwa Syed Mohamad, Zuhairiah Mohamad, Muhammad Shamsir Bin Mohd Aris, and Azlan Jaafar. "Waqf concept health clinic – “Uniqueness in disguise” USIM experience." Malaysian Journal of Science Health & Technology 7, no. 2 (October 1, 2021): 54–57. http://dx.doi.org/10.33102/mjosht.v7i2.211.
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Waqf or religious endowment is of a benevolence instrument emerged to help reduce the burden of the disadvantaged people. As the cost for medical expenses are exorbitant, the availability of waqf should contribute to the improvement of the community health. The establishment of Universiti Sains Islam Malaysia (USIM) Specialist healthcare clinic was founded by the idea of waqf through healthcare for the less fortunate. With collaboration from many agencies the establishment of the clinic has served community in need to access better health care. The primary aim of waqf clinic establishment is to continually uphold the Islamic aspects in its establishment and management for betterment of health among disadvantaged people.
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Wang, Roy, Amanda Guth, Alyssa Tate, Michele Ly, and James Plumb. "Filling Gaps and Setting Boundaries: Examining Utilization of Health and Social services at JeffHOPE Student Run Clinics." Journal of Primary Care & Community Health 12 (January 2021): 215013272110375. http://dx.doi.org/10.1177/21501327211037532.
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The objective of this study was to describe the frequency that healthcare and social support services offered by JeffHOPE, a student run clinic for people experiencing homelessness in Philadelphia, PA, were utilized by patients. This study also aimed to investigate where patients would seek medical care on a given day had they not been able to access JeffHOPE. This study was conducted via mixed methods consisting of retrospective chart review of patient encounter records and a patient survey conducted weekly throughout 2019, both at a single clinic site, and retrospective chart review of January through March 2020 records at 5 clinic sites. This study found that the frequency of services utilized varied between clinic sites, and that Pharmacy and Procedure committees were the most utilized when examining the combined clinic data. Additionally, the survey found that JeffHOPE provided medical care to those that otherwise would not have sought it. Clinics also served as an alternative to accessing care for non-emergent issues in an Emergency Department (ED) for some patients, but for others it replaced seeing their primary care provider (PCP). This study confirmed that the services offered by JeffHOPE are well-utilized by patients experiencing homelessness in Philadelphia. It also revealed that while the organization’s medical services filled care gaps and potentially decreased unnecessary ED visits, they were also sometimes accessed in lieu of a PCP visit. A focused effort on linkage to formal primary care services for all JeffHOPE patients and expanding collection of more granular data to all clinics represent important future endeavors for this student run organization.
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Godzik, Cassandra, and Adam Sorscher. "377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings." Sleep 44, Supplement_2 (May 1, 2021): A150. http://dx.doi.org/10.1093/sleep/zsab072.376.
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Abstract Introduction Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia. Methods We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months. Results Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%). Conclusion Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting. Support (if any) Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553
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Makadia, Frini, Priya P. Mehta, Clayton E. Wisely, Juan E. Santiago-Torres, Katherine Hartmann, and Mary J. Welker. "Creating and Completing Service-Learning within Medical School Curricula: From the Learner’s Perspective." International Journal of Medical Students 3, no. 2 (August 31, 2015): 88–91. http://dx.doi.org/10.5195/ijms.2015.123.
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Background: This article describes a service-learning project implemented at local free clinics by students at the Ohio State University College of Medicine and identifies key factors in their success. Methods: In response to a lack of longitudinal patient-physician relationships at free clinics, the students developed an initiative linking free clinic patients with diabetes to primary care homes for longitudinal care and counseled patients on the benefits of establishing a longitudinal relationship with a primary care physician. Results: All patients counseled were linked, compared to a historical 10% linkage rate, and 78% of patients scheduling initial appointments. Five factors were identified and listed by the students as key to the project’s process, success, and impact. Conclusion: Although all of these listed factors may prove difficult to replicate, this case-study serves as a model for other medical schools incorporating service-learning and exhibits that medical students can become integral portions of healthcare infrastructure.
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Maragakis, Alexandros, Ragavan Siddharthan, Jill RachBeisel, and Cassandra Snipes. "Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness." Primary Health Care Research & Development 17, no. 05 (November 20, 2015): 421–27. http://dx.doi.org/10.1017/s1463423615000523.
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Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.
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Pimentel, Camilla, Kathryn Nearing, Laura Kernan, Eileen Dryden, and Lauren Moo. "The Integral Role of CBOCs in Rural Healthcare: Promises and Challenges." Innovation in Aging 5, Supplement_1 (December 1, 2021): 118–19. http://dx.doi.org/10.1093/geroni/igab046.455.
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Abstract Community-based outpatient clinics are critical to extending the geographic reach of VA’s healthcare delivery system. Nationwide, 733 CBOCs provide outpatient care to nearly half of the VA’s patient population. The 13 rural CBOCs in the study sample provide outpatient primary care, mental health care, and a limited number of specialty care services. Located 1–3.5 hours away from their closest VA Medical Center, these CBOCs have a wide—sometimes interstate—service catchment area. To effectively serve increasingly older and medically complex patient populations, they rely heavily on partnerships with larger VA Medical Centers and local community providers for inpatient, residential, and additional outpatient services. CBOCs experience myriad staffing challenges, including staff turnover, “access providers” working at multiple CBOCs, and highly variable training in rural health and geriatrics. While some CBOCs have robust telehealth offerings, others cannot currently grow their telehealth capacity owing to constraints in clinic space and provider schedules.
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Kuspanova, Tolkyn Arystangalievna, and Sergey Ivanovich Dvoinikov. "Motivation of nursing personnel in a primary care medical organization (primary healthcare)." Medsestra (Nurse), no. 6 (May 26, 2021): 58–64. http://dx.doi.org/10.33920/med-05-2106-08.
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The aim of the study the theoretical and methodological foundations of motivation in the professional activity of nurses and its impact on improving the efficiency of the polyclinic and the degree of patient satisfaction with the organization of primary health care. Results: the role and importance of labor stimulation in increasing the efficiency of the organization’s activities were considered, an analysis and assessment of the motivation of the labor activity of nurses was carried out, the main directions of improving the motivation of the labor of nurses and the efficiency of the polyclinic were developed. Conclusion: a properly developed effective functioning of the system of motivation and stimulation of labor in outpatient clinics will increase labor productivity, which will positively affect the performance of a medical institution and increase the level of team cohesion.
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Dua, Anahita, Sapan S. Desai, and Jennifer A. Heller. "Heterogeneity in venous disease practice patterns amongst primary healthcare practitioners." Vascular 23, no. 4 (September 22, 2014): 391–95. http://dx.doi.org/10.1177/1708538114552011.
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Introduction This study aimed to describe the practice patterns of primary healthcare practitioners who diagnose and manage venous disease to determine differences in clinical evaluation of disease, recognition of venous ulcers, and referral patterns. Methods A survey was distributed at the August 2011 Primary Care Medical Conference (Pri-Med) in Baltimore, Maryland. Pri-med is a medical education company that caters to the continued professional development needs of a variety of physicians. Results A total of 305 surveys were completed. Of the respondents, 91% were physicians and 9% were advanced level practitioners. In all, 93% prescribed compression stockings as first-line treatment. Heterogeneous referral patterns were reported with 81% referring to vascular surgery, 25% to a vein clinic, 10% to interventional radiology, and 3% to interventional cardiology. Up to 35% responded that they met resistance (did not have their referral accepted) when attempting referral to a vascular surgery colleague. There was substantial variation when asked about the treatment of deep vein thrombosis with 88% starting anticoagulation therapy, 54% prescribing compression stockings, 40% doing a thrombophilia workup, and 25% referring for lytic therapy. Conclusion Diagnosis and management aptitude of venous disease is highly variable. Further grassroots education is required to improve diagnosis and treatment in patients with chronic venous disease.
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Perialathan, Komathi, Mohammad Zabri Johari, Norrafizah Jaafar, Kong Yuke Lin, Low Lee Lan, Nur Aliyah Sodri, and Siti Nur Nabilah Mohd Yunus. "Enhanced Primary Health Care Intervention: Perceived Sustainability and Challenges Among Implementers." Journal of Primary Care & Community Health 12 (January 2021): 215013272110140. http://dx.doi.org/10.1177/21501327211014096.
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Purpose: This study aimed to assess and explore perceived sustainability and challenges of the intervention among Health Care Providers (HCPs) who were involved. Methods: The study applied mixed-method embedded design to analyze both quantitative and qualitative data. Quantitative approach was used to evaluate sustainability perception from 20 intervention clinics via self-reported assessment form whereas qualitative data were obtained through in-depth interview (IDI) and focus group discussions (FGDs) 14 health care professionals participated in IDI session and were either care coordinators, liaison officers (LOs)/clinic managers, or medical officers-in-charge for the clinic’s intervention. Nine FGDs conducted comprised 58 HCPs from various categories. Results: HCPs from all the 20 clinics involved responded to each listed Enhanced Primary Healthcare (EnPHC) intervention components as being implemented but the perceived sustainability of these implementation varies between them. Quantitative feedback showed sustainable interventions included risk stratification, non-communicable disease (NCD) screening form, referral within clinics and hospitals, family health team (FHT), MTAC services and mechanisms and medical adherence status. Qualitative feedback highlighted implementation of each intervention components comes with its challenges, and most of it are related to inadequate resources and facilities in clinic. HCPs made initiatives to adapt based on clinical setting to implement the interventions at best level possible, whereby this seems to be one of the core values for sustainability. Conclusion: Overall perceptions among HCPs on sustainability of EnPHC interventions are highly influenced by current experiences with existing resources. Components perceived to have inadequate resources are seen as a challenge to sustain. It’s crucial for stakeholders to understand implications affecting implementation process if concerns raised are not addressed and allocation of needed resources to ensure overall successfulness and long term sustainability.
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Downing, Sandra G., Colette Cashman, and Darren B. Russell. "Ten years on: a review of medical terminations of pregnancy performed in a sexual health clinic." Sexual Health 14, no. 3 (2017): 208. http://dx.doi.org/10.1071/sh16177.
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Background Access to medical termination of pregnancy (MToP) services in regional Queensland remains inadequate and it is still possible for women and providers to be criminally prosecuted for accessing or providing abortion. Cairns Sexual Health Service (CSHS) has been providing medical terminations of pregnancy for 10 years, demonstrating that this service can be safely and successfully integrated into a primary healthcare setting. Methods: A retrospective audit of MToPs performed between 2011 and 2015 was conducted to follow on from our previously reported audit covering 2006–09. Results: In total, 1859 MToPs have been performed by CHSH since 2006, with 1712 within the 5-year period of 2011–15. Changes in clinical practice over this time have streamlined the service and reduced unsuccessful outcomes from 12.2% between 2006 and 2009 to 0.9% between 2011 and 2015. Conclusion: The initial provision of MToP through CSHS was anticipated to be a short-term arrangement; however, 10 years on, this service continues with strong community demand. Provision of MToP services through primary healthcare settings can help improve access for women living outside of major metropolitan areas. If moves to decriminalise abortion in Queensland are successful, there is potential for even greater access.
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Szigethy, Eva, Francis Solano, Meredith Wallace, Dina L. Perry, Lauren Morrell, Kathryn Scott, Megan Jones Bell, and Megan Oser. "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 8, no. 1 (January 2018): e019108. http://dx.doi.org/10.1136/bmjopen-2017-019108.
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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.
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Tanbeer, Syed K., and Edward R. Sykes. "MyHealthPortal – A web-based e-Healthcare web portal for out-of-hospital patient care." DIGITAL HEALTH 7 (January 2021): 205520762198919. http://dx.doi.org/10.1177/2055207621989194.
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Current e-Health portal platforms provide support for patients only if they have previously registered and received service from a healthcare facility (e.g., hospital, healthcare clinic, etc.). These portals are usually connected to a central EMR/EHR system linked to a central system. Furthermore, these portals are restrictive in that they are only accessible by these patients at the exclusion of parents, relatives and others that participate in providing care to the patient. Further complications include the increasing demand from our healthcare systems for patients to receive more off-site, non-primary, in-homecare, and/or specialized healthcare services at home (e.g., therapy, nursing, personal support, etc.). Lastly, an increasing number of people would like to have more autonomy over their health in terms of increased access to their own medical records and the services they receive. In this work, we addressed these limitations by creating MyHealthPortal – a patient portal aimed at non-primary care, in-homecare, and/or special healthcare for patients. MyHealthPortal can assist homecare and clinic-based healthcare services along with the benefits of existing portals (e.g., online appointment scheduling, monitoring, and information sharing). MyHealthPortal is secure, robust, flexible and user-friendly. We developed it in partnership with our industry partner, Closing the Gap Healthcare. Closing the Gap is a prominent homecare and clinic-based healthcare service provider that became the first homecare agency to score 100% on standards from accreditation Canada and was awarded the exemplary standing. In this paper we present MyHealthPortal, the architectural framework that we designed and developed to support the system, and the results of a usability study conducted from real field studies. Our system was tested in a variety of conditions and achieved SUS usability scores of 92.5% (high).
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Carlstrom, Eric. "Implementing person-centered care in a general medical clinic: cultural barriers and driving forces." European Journal for Person Centered Healthcare 1, no. 2 (November 18, 2013): 333. http://dx.doi.org/10.5750/ejpch.v1i2.667.
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Public healthcare organisations in Sweden have been described as strongly hierarchical and coherent organisations [1]. To bring about control, generalized care models have been developed to handle hospital clinics and primary care sites [2]. This paper examines the preparedness to change in hospital settings. The purpose of the present study was to reveal barriers to the introduction of person-centred care (PCC). Organisational culture and resistance to change on hospital ward and clinical level and was based on the 2 concepts of “organisational culture” and “resistance to change”. These 2 concepts were measured by questionnaires based on theories of organisational culture and resistance to change.
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Bannon, Brittany L., Michelle Lucier, Angela Fagerlin, Jaewhan Kim, Bernadette Kiraly, Peter Weir, and Elissa M. Ozanne. "Evaluation of the intensive outpatient clinic: study protocol for a prospective study of high-cost, high-need patients in the University of Utah Health system." BMJ Open 9, no. 1 (January 2019): e024724. http://dx.doi.org/10.1136/bmjopen-2018-024724.
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IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC’s effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care.Methods and analysisHigh-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation and costs. For the secondary outcomes of patient health and care quality, a prepost design will be used to examine within-person change across the 18 months of follow-up (ie, before and after IOC intervention). Logistic regression and hierarchical, longitudinal growth modelling are the two primary modelling approaches.Ethics and disseminationThis work has received ethics approval by the UofU Institutional Review Board. Results from the evaluation of primary and secondary outcomes will be disseminated in scientific research journals and presented at national conferences.
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Heale, Roberta, Elizabeth Wenghofer, Susan James, and Marie-Luce Garceau. "Quality of Care for Patients With Diabetes and Mulitmorbidity Registered at Nurse Practitioner-Led Clinics." Canadian Journal of Nursing Research 50, no. 1 (December 7, 2017): 20–27. http://dx.doi.org/10.1177/0844562117744137.
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Background Nurse Practitioner-Led Clinics are a new model of primary healthcare in Ontario. Nurse Practitioner-Led Clinics are distinctive in that nurse practitioners are the primary care providers working with an interprofessional team. There have been no evaluations of the quality of care within the Nurse Practitioner-Led Clinic model. Purpose Evaluation of the Nurse Practitioner-Led Clinic model, specifically for complex clinical presentations, will provide insights that may be used to inform improvements to the delivery of care in the Nurse Practitioner-Led Clinics. The aim of this study was to evaluate the extent to which diabetes care was complete and to determine the impact of organizational tools, including electronic medical record tracking, diabetes care template, and referral to community programs, on the completeness of care for patients with diabetes and multimorbidity at Nurse Practitioner-Led Clinics. Methods An audit of 30 charts was conducted at five different Nurse Practitioner-Led Clinics (n = 150) for patients with diabetes and at least one other chronic condition. Indicators included patient and organizational characteristics as well as diabetes care items taken from diabetes clinical guidelines. Results Overall, care for patients with diabetes and multimorbidity in Nurse Practitioner-Led Clinics was complete. However, there were no significant associations between patient or organizational characteristics and the extent to which diabetes care was complete.
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Laucka, Paul V., Will B. Webster, and Jeffrey Kuch. "Pharmacist Review to Simplify Medication Regimens in a VAMC Primary Care Clinic." Journal of Pharmacy Technology 12, no. 2 (March 1996): 62–66. http://dx.doi.org/10.1177/875512259601200206.
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Objective: To assess the effect of a clinical pharmacist's prospective medication review of patients receiving multiple drug therapy, using the pharmaceutical care process, as determined by the number of concurrent medications the patient is receiving before and after clinic visits. Design: Assigned groups. Setting: Outpatient primary care clinic of a tertiary healthcare Veterans Affairs (VA) medical facility. Patients: Seven hundred twenty-seven patients who had eight or more active medication orders were selected. Four hundred forty-one patients (aged 67.2 ± 10.4 y) were in the intervention group; 286 others (aged 66.6 ± 11.9 y), whose medical records were not available, were assigned to the control group and received no clinical pharmacist intervention. Intervention: Medication regimens of VA ambulatory patients with eight or more active medications were reviewed by a clinical pharmacist, and a written communication to the prescriber was attached to the medical record. Main Outcome Measures: The number of active concurrent medications before and after clinic visits was measured. Results: There was a decrease in the medications in the intervention group from an average of 12.1 ±4 to 11.5 ± 4.2 (p < 0.05). The medications in the control group rose from an average of 11.8 ± 4.44 to 12.2 ± 4 (p = NS). A decrease of 0.6 prescriptions per patient was highly significant (p < 0.05). During the study, 1,336 recommendations were made to practitioners. From this group, 41% of the recommendations were accepted, and 477 medications were discontinued, the quantity dispensed or dosage was reduced, or an alternative medication was prescribed. Conclusions: These data suggest that clinical pharmacist intervention in an ambulatory care setting can affect practitioner prescribing habits and significantly decrease the number of medications prescribed.
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Day, Carolyn A., M. Mofizul Islam, Ann White, Sharon E. Reid, Stephen Hayes, and Paul S. Haber. "Development of a nurse-led primary healthcare service for injecting drug users in inner-city Sydney." Australian Journal of Primary Health 17, no. 1 (2011): 10. http://dx.doi.org/10.1071/py10064.
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Injecting drug users (IDUs) experience numerous health problems, but report barriers to utilising general practitioners (GPs). A nurse-led Harm Minimisation-based Primary Healthcare (HMPH) service for IDUs was established within a needle and syringe program in inner-city Sydney with Area Health Service medical support and clinical governance. This paper aimed to describe the HMPH service, review service utilisation and assess nurses’ perceptions of their work with IDUs. A review of the most recent 200 clinic files was undertaken. Service utilisation, GP and other health service use and access were extracted and analysed using SPSS. A semi-structured qualitative interview with clinic nurses regarding their experience working with IDUs and local GPs was conducted and analysed. Since its inception in mid-2006, the service has been utilised by 417 clients. Of the most recent 200 files, blood-borne virus and sexually transmitted infection screening were the primary reason for presentation (64.5%). At least one follow-up visit was attended by 90% of clients. A total of 62% of clients reported consulting a GP in the last 12 months. The service provided 102 referrals. Nurses believed that IDUs tend to utilise GPs ineffectively and that self-care is a low priority, but that they can support IDUs to overcome some barriers to GPs and facilitate access. Targeted primary health care services led by nurses with focussed medical support and co-located with needle and syringe programs can fill an important gap in delivering and facilitating health care to IDUs.
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Hansen, Michael, Barbara Trautner, Roger Zoorob, George Germanos, Osvaldo Alquicira, juanita Salinas, Kenneth Barning, et al. "140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S200. http://dx.doi.org/10.1093/ofid/ofaa439.450.
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Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures
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Banjac, Nada, Ilija Ramić, Snježana Đokić, Tijana Pejić, Igor Korać, Đorđe Stojisavljević, and Nevena Todorović. "COVID-19 in the Emergency Department of the Primary Healthcare Centre Banja Luka." Scripta Medica 53, no. 1 (2022): 21–28. http://dx.doi.org/10.5937/scriptamed53-36279.
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Background / Aim: COVID-19 is acute virus disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It was proclaimed as pandemic starting from March 2020 and is still ongoing. COVID-19 pandemic forced all segments of the society, particularly the health sector, to function in changed and aggravating circumstances and because of the transmission and new strains of the virus it resulted in the change of the number of infected people with peaks and oscillations. Aim of this study was to make analysis of the data related to COVID-19 positive/suspect patients examined in the Primary Healthcare Centre Banja Luka in the period 15 March 2020 - 15 March 2021, which refers to the incidence of the infected persons, sex and age representation, laboratory diagnostics and clinical parameters, applied therapy, as well as the number of patients sent for the hospital treatment. Methods: Data for the analysis were obtained by the retrospective analysis of the statistical data from the electronic medical record of the examined COVID-19 positive/suspect patients in the Outpatient Clinic for Acute Respiratory Infections (ARI) and in the field. Pearson's ch2 test of contingency was used for the comparison of differences of the observed characteristics of the examined groups. Results: Personnel of the Emergency Department (ED) of the Primary Healthcare Centre Banja Luka, in the period 15 March 2020 - 15 March 2021, examined the total of 3,937 COVID-19 positive patients and patients suspect of COVID-19. Out of that number, 3,601 patients were examined in the ED - ARI and 336 patients were examined in the field. The biggest number of patients was registered in November 2020 (768). Male sex prevailed (55.50 %) and patients of 20-50 years of age were most represented. There were 3.10 % of those highly febrile patients and 2.5 % of those with low SpO2 of under 90 %. 14.90 % of patients had higher values of troponin T and 45.50 % of them had higher values of D-dimer. In the field, 69.60 % of patients had pathological changes on lungs and 33.30 % had pathological ECG report. The number of patients sent from the ARI for further diagnostic procedure or hospitalisation to the Clinic for Infectious Diseases of the University Clinical Centre of Banja Luka was 1,191 and 258 patients were sent from the field. Conclusion: For the purpose of preventing the spread of epidemics, the ED reorganised the existing space by introducing temporary clinics - containers for the patients with acute respiratory infections and febrile status, COVID-19 suspects. Clinical parameters changed depending on the new virus strains, as well as on age distribution and infection complications.
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Jung, Hyemin, Min-Woo Jo, Hyun Joo Kim, Won Mo Jang, Sang Jun Eun, and Jin Yong Lee. "General Public’s Perspectives on Medical Doctors and Local Clinics in South Korea." International Journal of Environmental Research and Public Health 16, no. 11 (June 7, 2019): 2030. http://dx.doi.org/10.3390/ijerph16112030.
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As patients in South Korea play the main role in choosing healthcare providers, understanding their attitudes and beliefs toward medical institutions is essential. This study evaluated the public’s perspectives on doctors and local clinics. A face-to-face interview survey was conducted with 1000 participants who represent the South Korean adult population. The questionnaire consisted of four domains: personal information; trust level for nine professionals, including doctors; healthcare utilization behavior and attitudes regarding local clinics; and assessment of local clinics. The trust level of the doctor was highest (3.16 out of 4) among nine professionals. 85.3% of the participants frequently visited local clinics because of accessibility. The main reason for visiting hospitals over local clinics was the belief that doctors employed at hospitals would be better qualified. People were generally satisfied with the service of local clinics but wanted more facilities and equipment. Among six attributes of primary care, “first contact” and “accessibility” got higher scores in importance and current performance. Lastly, the participants suggested that improving the quality of doctors was most important for the reinforcement of primary care. Efforts to consider public opinion should be made before establishing healthcare policies for primary care.
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Hazra, Aniruddha, Jessica Schmitt, Alvie Bender, Michelle Moore, Cheryl Scott, Damaris Garcia, and David Pitrak. "745. Operationalization of Comprehensive Sexual Wellness Clinic at a Large Urban Emergency Department." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S333. http://dx.doi.org/10.1093/ofid/ofz360.813.
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Abstract Background Due to the closure of surrounding city-run sexually transmitted infection (STI) clinics, uninsured and underinsured patients living near an urban academic medical center have been relying on the Emergency Department (ED) for their sexual health needs. A novel Sexual Wellness Clinic (SWC) was created to provide comprehensive sexual healthcare and primary care linkage to patients presenting to the ED with STI complaints. Methods SWC-eligible patients are identified at ED intake and undergo a Medical Screening Exam (MSE) by a triage physician before transport to clinic. Notable exceptions to the SWC are patients who are pregnant, younger than 18 years of age, victims of sexual assault, or deemed to require higher acuity care. Once at the SWC, patients undergo a complete history and physical examination, comprehensive STI testing, and, if indicated, empiric treatment as well as same-day initiation of Pre-Exposure Prophylaxis (PrEP). Social services within the clinic also assist in arranging primary care follow-up either at the medical center or an affiliated Federally Qualified Health Center (FQHC). Results During its initial 8 weeks, 28 patients were seen in the SWC; 35.6% were cis-female and 64.2% were cis-male. All female patients identified as women who have sex with men, 89% of male patients identified as men who exclusively have sex with women. Patient ages ranged from 18 to 55 with a mean age of 25. Overall, 17.8% of patients tested positive for gonorrhea; 7.1% tested positive for chlamydia, and 0% tested positive for syphilis. One new HIV diagnosis was identified. Same-day PrEP was initiated in 28.5% of patients of which 62.5% (n = 5) were female and 37.5% (n = 3) were male. SWC linked 79% of patients to primary care. Conclusion We demonstrated the feasibility of this unique workflow bringing patients from the ED to a specialized sexual health clinic. The majority of patients visiting SWC identified as heterosexual men and women, which differs from other metropolitan STI clinics. Identifying these populations with untreated STIs and other HIV risk factors for targeted intervention is integral to local and national HIV elimination efforts. Disclosures All authors: No reported disclosures.
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Lim, Lisa, Craig M. Zimring, Jennifer R. DuBose, Jaehoon Lee, Robert J. Stroebel, and Marc R. Matthews. "Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study." International Journal of Environmental Research and Public Health 18, no. 16 (August 19, 2021): 8758. http://dx.doi.org/10.3390/ijerph18168758.
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Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communication, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness. However, precautions for COVID-19 make it more difficult to conduct face-to-face communications. In this paper we describe a model for understanding how layout affects these four teamwork needs and describe how the perception of teamwork by staff changed after COVID-19 precautions were put in place. Observations, interviews and two standard surveys were conducted in two primary care clinics before COVID-19 and again in 2021 after a year of precautions. In general, staff felt more isolated and found it more difficult to conduct brief consults, though these perceptions varied by role. RNs, who spent more time on the phone, found it convenient to work part time-from home, while medical assistants found it more difficult to find providers in the distanced clinics. These cases suggest some important considerations for future clinic designs, including greater physical transparency that also allow for physical separation and more spaces for informal communication that are distanced from workstations.
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Aggarwal, Sunil K., Amrita Ghosh, M. Jennifer Cheng, Kathleen Luton, Peter F. Lowet, and Ann Berger. "Initiating pain and palliative care outpatient services for the suburban underserved in Montgomery County, Maryland: Lessons learned at the NIH Clinical Center and MobileMed." Palliative and Supportive Care 14, no. 4 (September 16, 2015): 381–86. http://dx.doi.org/10.1017/s1478951515001030.
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AbstractObjective:With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation.Method:In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service.Results:The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23–67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as “very satisfied” or “extremely satisfied.”Significance of Results:This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.
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Balqis-Ali, Nur Zahirah, Pui San Saw, Anis Syakira Jailani, Tze Wei Yeoh, Weng Hong Fun, Noridah Mohd-Salleh, Tengku Putri Zaharah Tengku Bahanuddin, Catherine Anak Medan, Shaun Wen Huey Lee, and Sondi Sararaks. "Protocol for a cross-sectional study measuring person-centredness among healthcare providers in Malaysian primary care clinics: the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) Questionnaire." BMJ Open 10, no. 3 (March 2020): e034128. http://dx.doi.org/10.1136/bmjopen-2019-034128.
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IntroductionPerson-centred care (PCC) has become a global movement in healthcare. Despite this, the level of PCC is not routinely assessed in clinical practice. This protocol describes the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) tool that will be used to assess person-centred practices of primary healthcare providers in Malaysia.Methods and analysisTo ensure conceptual and item equivalence, the original version of the PCPI-S will be reviewed and adapted for cultural context by an expert committee. The instrument will subsequently be translated into Malay language using the forward-backward translation method by two independent bilingual speaking individuals. This will be pretested in four primary care clinics and refined accordingly. The instrument will be assessed for its psychometric properties, such as test-retest reliability, construct and internal validity, using exploratory and confirmatory factor analysis.Ethics and disseminationStudy findings will be disseminated to healthcare professionals and academicians in the field through publication in peer-reviewed journals and conference presentations, as well as at managerial clinic sites for practice improvement. The study was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (KKM/NIHSEC/ P18-766 (14) and Monash University Human Research Ethics Committee (2018-14363-19627).
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Russell, Vincent, Ching Ee Loo, Aisling Walsh, Arokiamary Bharathy, Umadevi Vasudevan, Irene Looi, and Susan M. Smith. "Clinician perceptions of common mental disorders before and after implementation of a consultation-liaison psychiatry service: a longitudinal qualitative study in government-operated primary care settings in Penang, Malaysia." BMJ Open 11, no. 6 (June 2021): e043923. http://dx.doi.org/10.1136/bmjopen-2020-043923.
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ObjectivesTo explore primary care clinician perceptions of barriers and facilitators in delivering care for common mental disorders (CMD) before and after implementation of a consultation-liaison psychiatry service (Psychiatry in Primary Care (PIPC)) in government-operated primary care clinics and to explore the clinicians’ experience of the PIPC service itself.DesignThis longitudinal qualitative study was informed by the Normalisation Process Model and involved audiotaped semi-structured individual interviews with front-line clinicians before (Time 1) and after (Time 2) the PIPC intervention. The Framework Method was used in the thematic analysis of pre/post interview transcripts.SettingTwo government-operated primary care clinics in Penang, Malaysia.Participants17 primary care medical, nursing and allied health staff recruited purposely to achieve a range of disciplines and a balanced representation from both clinics.InterventionPsychiatrists, accompanied by medical students in small numbers, provided one half-day consultation visit per week, to front-line clinicians in each clinic over an 8-month period. The service involved psychiatric assessment of patients with suspected CMDs, with face-to-face discussion with the referring clinician before and after the patient assessment.ResultsAt Time 1 interviewees tended to equate CMDs with stress and embraced a holistic model of care while also reporting considerable autonomy in mental healthcare and positively appraising their current practices. At Time 2, post-intervention, participants demonstrated a shift towards greater understanding of CMDs as treatable conditions. They reported time pressures and the demands of key performance indicators in other areas as barriers to participation in PIPC. Yet they showed increased awareness of current service deficits and of their potential in delivering improved mental healthcare.ConclusionsDespite resource-related and structural barriers to implementation of national mental health policy in Malaysian primary care settings, our findings suggest that front-line clinicians are receptive to future interventions designed to improve the mental healthcare capacity.
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Almalki, Adel. "Missed appointments at maternal healthcare clinics in primary healthcare centres in Riyadh city: reasons and associated factors." Journal of Hospital Administration 3, no. 4 (March 24, 2014): 92. http://dx.doi.org/10.5430/jha.v3n4p92.
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Background: The issue of missed appointments at maternal healthcare clinics in primary healthcare centers (PHCCs) has received increasing attention in recent years. The significant relationship between missed appointments and access to maternal healthcare has been recognized around the world. Missed appointments have serious health and economic consequences for women seeking maternal healthcare at PHCCs. Objectives: The objectives of this research were 1) to critically explore the reasons for and socio-demographic factors associated with missed appointments at maternal healthcare clinics at PHCCs; and 2) to provide recommendations for health policy that might help to eliminate the problem of “no-show” maternal patients. Methods: Descriptive statistics were used to analyze the responses of 250 women regarding demographics, as well as their reasons for missing appointments and their preferences regarding appointment confirmation at maternal healthcare clinics at five PHCCs in Riyadh, Saudi Arabia. Results: The most frequent reasons associated with missed appointments reported by women included a lack of supplies and medical equipment, such as ultrasound machines, the unavailability of transportation and a lack of respect from PHCC staff. Conclusion: Developing easily accessible, flexible, interactive appointment systems with reminder/recall, providing means of transportation, providing training courses to PHCC employees on how to address these women and the provision of necessary medical equipment and facilities, such as ultrasound machines to all PHCCs are highly recommended to reduce the occurrence of missed appointments at maternal healthcare clinics at PHCCs in Riyadh, Saudi Arabia.
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Mapp, Fiona, Kaye Wellings, Catherine H. Mercer, Kirstin Mitchell, Clare Tanton, Soazig Clifton, Jessica Datta, Nigel Field, Melissa J. Palmer, and Ford Hickson. "Help-seeking for genitourinary symptoms: a mixed methods study from Britain’s Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)." BMJ Open 9, no. 10 (October 2019): e030612. http://dx.doi.org/10.1136/bmjopen-2019-030612.
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ObjectivesQuantify non-attendance at sexual health clinics and explore help-seeking strategies for genitourinary symptoms.DesignSequential mixed methods using survey data and semistructured interviews.SettingGeneral population in Britain.Participants1403 participants (1182 women) from Britain’s Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3; undertaken 2010–2012), aged 16–44 years who experienced specific genitourinary symptoms (past 4 weeks), of whom 27 (16 women) who reported they had never attended a sexual health clinic also participated in semistructured interviews, conducted May 2014–March 2015.Primary and secondary outcome measuresFrom survey data, non-attendance at sexual health clinic (past year) and preferred service for STI care; semistructured interview domains were STI social representations, symptom experiences, help-seeking responses and STI stigma.ResultsMost women (85.9% (95% CI 83.7 to 87.9)) and men (87.6% (95% CI 82.3 to 91.5)) who reported genitourinary symptoms in Natsal-3 had not attended a sexual health clinic in the past year. Around half of these participants cited general practice (GP) as their preferred hypothetical service for STI care (women: 58.5% (95% CI 55.2% to 61.6%); men: 54.3% (95% CI 47.1% to 61.3%)). Semistructured interviews elucidated four main responses to symptoms: not seeking healthcare, seeking information to self-diagnose and self-treat, seeking care at non-specialist services and seeking care at sexual health clinics. Collectively, responses suggested individuals sought to gain control over their symptoms, and they prioritised emotional reassurance over accessing medical expertise. Integrating survey and interview data strengthened the evidence that participants preferred their general practitioner for STI care and extended understanding of help-seeking strategies.ConclusionsHelp-seeking is important to access appropriate healthcare for genitourinary symptoms. Most participants did not attend a sexual health clinic but sought help from other sources. This study supports current service provision options in Britain, facilitating individual autonomy about where to seek help.
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Tohid, Hizlinda, Sheen Dee Ng, Anis Azmi, Nur Farah Adrina Nur Hamidi, Syahirah Samsuri, Amir Hazman Kamarudin, and Khairani Omar. "Quality of asthma care at a university-based primary care clinic in Malaysia." Journal of Health Research 33, no. 5 (September 9, 2019): 425–34. http://dx.doi.org/10.1108/jhr-11-2018-0148.
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Purpose The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined. Design/methodology/approach This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent. Findings All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets. Research limitations/implications In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time. Practical implications This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care. Social implications This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised. Originality/value Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.
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Charest, Maxime, Malika Sharma, Allison Chris, Alexandre Schnubb, David C. Knox, James Wilton, Rita Shahin, et al. "Decentralizing PrEP delivery: Implementation and dissemination strategies to increase PrEP uptake among MSM in Toronto, Canada." PLOS ONE 16, no. 3 (March 18, 2021): e0248626. http://dx.doi.org/10.1371/journal.pone.0248626.
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Pre-exposure prophylaxis (PrEP) is traditionally prescribed by HIV specialist physicians. Given finite specialist resources, there is a need to scale up PrEP delivery by decentralizing services via other healthcare professionals. We aimed to assess the feasibility of delivering PrEP to men who have sex with men (MSM) through primary care physicians and sexual health clinic nurses. We piloted a multi-component, implementation and dissemination research program to increase provision of PrEP through primary care physicians and sexual health clinic nurses in Toronto, Canada. Community-based organizations (CBOs) provided prospective participants with information cards that contained links to an online module on engaging providers in a conversation about PrEP. In our patient-initiated continuing medical education (PICME) strategy, participants saw their family doctors and gave them the card, which also contained a link to a Continuing Medical Education module. In the nurse-led strategy, participants visited one of two participating clinics to obtain PrEP. We administered an optional online questionnaire to patients and providers at baseline and six months. CBOs distributed 3043 cards. At least 339 men accessed the online module and 196 completed baseline questionnaires. Most (55%) intended to visit nurses while 21% intended to consult their physicians. Among 45 men completing follow-up questionnaires at 6 months, 31% reported bringing cards to their physicians and obtaining PrEP through them; sexual health clinics delivered PrEP to 244 patients. Participants who went through the PICME approach reported no changes in relationships with their providers. Nurses showed fidelity to PrEP prescribing guidelines. Nurse-led PrEP and patient-initiated continuing medical education (PICME) for primary care physicians are feasible strategies to increase PrEP uptake. Nurse-led PrEP delivery was preferred by most patients.
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Press, Annie, Robert Lucito, Ilene Friedman, and Samara Ginzburg. "A Clinic to Improve Care of Patients with Sickle Cell Disease and the Role of Medical Students in Quality Improvement." Blood 126, no. 23 (December 3, 2015): 5586. http://dx.doi.org/10.1182/blood.v126.23.5586.5586.
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Abstract Background: At Hofstra-North Shore LIJ School of Medicine, we have opportunities for our medical students to participate in experiential quality improvement projects. As part of this initiative, some students participate on health-care improvement teams using a Clinical Microsystems approach. This approach is a conceptual framework that has been applied to various departments in the North Shore-LIJ Health System in order to improve quality and patient safety. The basis of Clinical Microsystems is to identify a need in the hospital that may be targeted in order to improve the efficacy of healthcare quality and delivery. Once the objective for healthcare improvement is determined, a multidisciplinary team is created spanning one or more microsystems to target the specific barrier. One of the multidisciplinary teams focuses on the care of patients with sickle cell disease. LIJ Hospital admits between 150 and 200 patients with sickle cell disease a year primarily due to recurrent pain crises. The initial sickle cell multidisciplinary improvement team included physicians, patients, nurses, social workers and two medical students. The role of the students on this team included literature searches and survey administration. The team's initial analysis found that a lack of consistent outpatient follow up was resulting in frequent readmissions for this population to acute care facilities for pain control. To address this, the team was instrumental in establishing a primary care outpatient clinic focused exclusively on caring for patients with sickle cell disease, run by a primary care physician, in 2012. The current study was conducted by a medical student, and her mentor, who were original members of the sickle cell improvement team. The study tested the hypothesis that enrolling patients with sickle cell disease in an outpatient clinic with a dedicated physician focused on sickle cell disease management and pain control would decrease the number of admissions this population has for acute care at LIJ. The study also highlights the opportunity to involve medical students in a meaningful way in hands-on quality improvement projects in the early stages of training. Methods: This was a retrospective study of all adults with sickle cell disease, 21 years or older, who were seen at the primary care outpatient sickle cell clinic. We compared the rates of hospital admissions and length of stay in the one-year prior and one-year after their establishment of care at the clinic. All data was identified through manual and automated searches of the Electronic Health Record. Results: Since the opening of the clinic in 2012, 107 adults established care at the clinic. Within the first year that a patient began being cared for by the clinic, their admission rate dropped 27%, from an average of 3.775 to 2.75 admissions per year (p=0.0003). There were a total of 151 admissions one-year pre-intervention and 110 admissions one-year post-intervention. Conclusion: This project supports the value of a dedicated primary care outpatient sickle cell clinic on decreasing the admission rates for patients with sickle cell disease. Within one year of establishing care at the clinic, admissions rates decreased significantly, emphasizing the role of dedicated outpatient primary care in the management of patients with sickle cell disease. This study also highlights the importance and feasibility of integrating medical students into a quality improvement project early on during medical school. There are opportunities for students to have meaningful roles on hospital based improvement projects and learn quality improvement methodologies. An important component to this success is faculty mentoring to support a student's involvement in the project. The student involved in this study experientially participated in multidisciplinary team-based rapid cycles of change, process mapping, data collection and analysis. Similar projects could offer students an opportunity to participate during medical school in a longitudinal quality improvement project to develop skills they will need as physicians to identify, participate and measure the effects of improvement efforts. Disclosures No relevant conflicts of interest to declare.
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Kaneko, Makoto, Kazuhisa Motomura, Hideki Mori, Ryuichi Ohta, Hiroki Matsuzawa, Akira Shimabukuro, and Masato Matsushima. "Gatekeeping function of primary care physicians under Japan’s free-access system: a prospective open cohort study involving 14 isolated islands." Family Practice 36, no. 4 (September 8, 2018): 452–59. http://dx.doi.org/10.1093/fampra/cmy084.
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Abstract Background Gatekeeping is important for strong primary care and cost containment. Under Japan’s free-access system, patients can access any medical institution without referral, which makes it difficult to evaluate the gatekeeping function of primary care physicians (PCPs). Objectives To examine the gatekeeping function of PCPs in Japan, we compared the frequencies of visits to primary care clinics, referrals to advanced care and hospitalizations between 14 remote islands and a nationwide survey. Methods This study was a prospective, open cohort study involving 14 isolated islands (12 238 inhabitants) in Okinawa, Japan. Participants were all patients who visited the clinics on these islands in 1 year. Main outcome measures were the incidence of on-island clinic visits and referrals to off-island advanced care. Results There were 54 741 visits to the islands’ clinics with 2045 referrals to off-island medical facilities, including 549 visits to emergency departments and 705 hospitalizations. The age- and sex-standardized incidences of healthcare use per 1000 inhabitants per month were: 360.0 (95% confidence interval: 359.9 to 360.1) visits to primary care clinics, 11.6 (11.0 to 12.2) referrals to off-island hospital-based outpatient clinics, 3.3 (2.8 to 5.2) visits to emergency departments and 4.2 (3.1 to 5.2) hospitalizations. Comparison with the nationwide survey revealed a lower incidence of visits to hospital-based outpatient clinics in this study, while more patients had visited PCPs. Conclusions The lower incidence of visits to secondary care facilities in this study might suggest that introduction of a gatekeeping system to Japan would reduce the incidence of referral to advanced care.
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Shamsuddin, Shafinaz, Muhammad Eid Akkawi, Syed Tabish Razi Zaidi, Long Chiau Ming, and Mohamed Mansor Manan. "Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation." International Journal of Infectious Diseases 52 (November 2016): 16–22. http://dx.doi.org/10.1016/j.ijid.2016.09.013.
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Davies, Rebecca, Anu Priya, Hardev Bhogal, Adesola Omodara, George Davies, and Shweta Mittal. "Physical health monitoring in antipsychotic depot clinic." BJPsych Open 7, S1 (June 2021): S317. http://dx.doi.org/10.1192/bjo.2021.836.
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AimsA service evaluation project to look at if annual bloods, ECG, physical examination, and medical review was completed within the last year for patients attending anti-psychotic depot clinic at Bassetlaw mental health services in Nottinghamshire HealthCare NHS Foundation Trust.MethodElectronic notes were examined in October 2020 for 25 patients who attend anti-psychotic depot clinic to ascertain if medical review and physical examination had been completed along with annual bloods and ECG.ResultOut of 25 patients attending depot clinic in 2020 at Bassetlaw Hospital, 21 had all their blood tests done, 1 patient had refused bloods and 2 patients did not have blood tests done. ECG was completed for 3 patients at Bassetlaw hospital and 8 patients had it requested from primary care with 2 patients refusing to have ECG done. For 12 patients there was no evidence of ECG being requested or completed. 8 patients had physical examination completed and rest 17 patients did not have the physical examination completed including due to refusal. Out of 25, only 14 patients had a medical review conducted.ConclusionPatients who attend depot clinic may have an allocated community psychiatric nurse (CPN) or get reviewed by medics in outpatient clinics and would usually have their blood tests, physical health examination and ECGs requested and monitored by them. Patients who do not have any allocated CPN or medic tend to miss out on blood tests and ECG. General Practitioners are expected to complete physical health checks for patients who do not have CPN or regular outpatient review. The results of these investigations may not always be received in depot clinic, hence there is no documentation on electronic RIO system. When these patients disengage from the depot clinic, it is often very difficult to track them. As a follow-up from this service evaluation, all depot clinic patients will be allocated a key worker/CPN. This will ensure that they have a responsible person to facilitate annual checks. This will be reviewed in a years' time to evaluate the effectiveness of this intervention.
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Unwin, Jason, and David Peters. "Gatekeepers and the Gateway – a Mixed-Methods Inquiry into Practitioners' Referral Behaviour to the Gateway Clinic." Acupuncture in Medicine 27, no. 1 (March 2009): 21–25. http://dx.doi.org/10.1136/aim.2008.000083.
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Background The Gateway Clinic is a specialist NHS service in South London providing acupuncture and Chinese medicine. The clinic receives a diverse range of referrals from an expanding population of local general practitioners (GPs). Objectives This study explores the referral behaviour of GPs and other primary care users of the Gateway Clinic. Methods A pragmatic mixed-methods approach was used, combining mapping of GPs’ usage of the Gateway as taken from the clinic's database between the years 2000 and 2005, a questionnaire survey of the referring primary care practitioners in 2005, and data, including a thematic analysis of the interview transcripts from semi-structured interviews of a purposive sample of those GPs who refer. Results Doctors in the community refer a wide range of health problems to the Gateway Clinic. The most common referrals were musculoskeletal conditions (38–44%), general and unspecified conditions (11–14%), blood and immune system conditions (6–12%), psychological conditions (8–13%), neurological conditions (6–9%), gynaecological conditions (5–6%) and digestive conditions (5–6%). The health problems referred by local healthcare practitioners correlate strongly with the patient profile seen in private acupuncture practice. Between 2000 and 2005 numbers of healthcare practitioners increased by 218% resulting in a 300% increase in patient referrals made to the clinic; the mean frequency of referral per practitioner increased by 71%. Analysis of the qualitative data suggests that positive clinical experience encourages GPs to increase the range of conditions they refer leading to the development of informal referral guidelines. Conclusion The Gateway Clinic has become an increasingly popular referral resource. The influences that drive referral to the clinic are multiple and follow “tacit guidelines”. GPs select patients on the basis of their individual clinical experience, informed by positive patient feedback and often only after more conventional medical treatment options have been exhausted.
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Ndubueze, Pleasant C., Eunice O. Igumbor, Otovwe Agofure, Anthonia C. Okwelum, Prince C. Ozuem, and Ezekiel U. Nwose. "Prospects of diabetes registry and standard care at primary health facilities in Nigeria: experiential note." International Journal Of Community Medicine And Public Health 7, no. 1 (December 25, 2019): 144. http://dx.doi.org/10.18203/2394-6040.ijcmph20195844.
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Background: As part of the series to advance diabetes register, the aim of this piece of the project was to evaluate the development of a diabetes register at primary healthcare (PHC) level in Delta State Nigeria. This is with a view to determine the PHC capacity for diabetes services.Methods: This clinical observational study was carried out in Novena University health centre in Ukwani Local Government Area and Ogume primary health centre in Ndokwa West Local Government Area, Delta State. A community-based screening was carried out in three communities of Amai, Ezionum and Ogume in July to September 2018, after which a diabetes registers were developed in Novena University health and Ogume primary health centres. Cases of probable diabetes were identified during screening and entered into the diabetes register being developed, which formed the sampled population (n=42). The data were analysed using Microsoft Excel Data Analysis ToolPak 2010.Results: Glucometer, stethoscope and sphygmomanometer were the most available equipment at the two facilities. Medical records of patients were incomplete with 81% missing home addresses and 62% did not have phone numbers. Others records such as date of entry, height, weight and type of diabetes were not recorded. The study also showed 35% prevalence of hypertension in diabetes cases.Conclusions: There is capacity to run diabetes screening and service clinic at the primary healthcare levels, but the limitation was incomplete patient information in the medical records. In development of a diabetes registry at the primary healthcare level, the study recommends comprehensive patients’ documentation during screening and routine medical check-up.
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Mohiuddin, AK. "The New Era of Pharmacists in Ambulatory Patient Care." INNOVATIONS in pharmacy 10, no. 1 (January 15, 2019): 4. http://dx.doi.org/10.24926/iip.v10i1.1622.
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Ambulatory care pharmacy practice is defined as the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs, developing sustained partnerships with patients, and practicing in the context of family and community. This is accomplished through direct patient care and medication management for ambulatory patients, long-term relationships, coordination of care, patient advocacy, wellness and health promotion, triage and referral, and patient education and self-management. The ambulatory care pharmacists may work in both an institutional and community-based clinic involved in direct care of a diverse patient population.
A variety of specialty clinics are available for allergy and immunology, pulmonology, endocrinology, cardiology, nephrology, neurology, behavioral health, and infectious disease. Such services for this population may exist as a primary care clinic or an independent specialty clinic, typically in a PCMH, which is instrumental in coordinating care between various providers. Once a practice site is identified, it is important to establish a strong, trusting, and mutually beneficial relationship with the various decision-makers (e.g., administrators, providers) involved with the clinic. If pharmacy services are currently in existence, the pharmacy director may be able to identify and initially contact the appropriate person. If another pharmacist is providing clinical services, this person would be a resource to help determine areas for expansion of patient care and to whom to direct the proposed business plan.
Additional individuals to consider as an initial point of contact include the clinic manager, clinic medical director, or administrative assistant to either of these persons. If the clinic setting is affiliated with a medical school, it may be necessary to contact the Department of Family Medicine head.
Article Type: Commentary
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Lyon, Alison. "A Primary Care Role in Building Local Capacity Following Volcanic Activity in Vanuatu." Prehospital and Disaster Medicine 34, s1 (May 2019): s52. http://dx.doi.org/10.1017/s1049023x19001201.
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Introduction:Vanuatu is situated in the Pacific Ring of Fire. In July 2018, there was increased volcanic activity on Ambae, an island with a population of 11,000 people. Due to the destruction of food sources, contamination of water supply, and respiratory issues caused by ash fall, an immediate compulsory evacuation was ordered by the government.Aim:To describe the role of the primary care team response to urgent and ongoing healthcare needs of evacuees following volcanic activity.Methods:A non-governmental organization (NGO) primary care team of a general practitioner, nurse practitioner, and two healthcare assistants undertook the initial assessment of a group of newly arrived evacuees. This allowed the identification and management of urgent care needs. Over the subsequent weeks, the primary care clinic provided care to the evacuees. A prospective database of anonymized case files was undertaken to monitor evolving primary healthcare needs of the evacuees.Results:Twenty-five patients were assessed initially. Two patients required urgent transfer to a hospital for acute management. Six diabetic patients required medication supplies. There were eight hypertensive patients. Two patients required urgent BP reduction and four required medication supplies. Over the following two weeks, 104 patients were reviewed at the clinic. During this time, 45 patients were treated for respiratory tract infections. Medication supplies were replenished for antihypertensives and diabetic medications for seven patients. Opportunistic cardiovascular and diabetes risk reviews were performed and follow up arranged for nine patients.Discussion:The primary care team role was part of a local services collaborative approach initiated by the government. Involving local primary care clinicians in disaster management builds local capacity. Patients are able to receive continuity of care for acute and ongoing medical problems. Clinicians are able to evaluate evolving care needs and gain an improved understanding of the impact of displacement on the community.
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Tobey, Leah, and Robin McAtee. "How 4Ms Age-Friendly Care Led to Improved Compliancy of Older Adult Fall Screenings in Rural Primary Care Clinics." Innovation in Aging 5, Supplement_1 (December 1, 2021): 821–22. http://dx.doi.org/10.1093/geroni/igab046.3015.
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Abstract Past medical history of falls and fear of falling are reliable indicators of future fall risk of an older adult (OA). As one of the HRSA funded Geriatric Workforce Enhancement recipients, the AR Geriatric Education Collaborative (AGEC) worked with a rural federally qualified healthcare clinic system to help incorporate fall screens to satisfy the Mobility factor in the 4Ms age-friendly care framework. After consultation with the practitioners, it was decided to use the Timed-Up-And-Go (TUAG) screen because it is evidence-based and appropriate for OAs. Training on the use of the TUAG was completed next as was the addition of the screen into the EMR. Fall screens in one clinic were only completed 7% before training and 7 months after the training, this rose to almost 100%. In a second clinic, the screens were completed 22% of the time and this was increased to 66% after training. Training on mobility continues to occur on a regular basis as staff turns over and as new priorities arise, but the use of the TUAG as a mobility screen has been a critical component in the process of these rural clinics providing age-friendly care. Next steps with improving fall risks will be the development of flags within the EMR that will force practitioners to complete a full falls plan of care if the OA scored within the moderate or high fall risk categories. The plan will include home safety education and/or evaluation, PT or OT referrals to further support healthy aging for the OA.
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Riffin, Catherine, Jennifer Wolff, Julianna Maisano, Sylvia Lee, and Karl Pillemer. "Family Caregiver Assessment in Primary Care: A Nationwide Survey." Innovation in Aging 4, Supplement_1 (December 1, 2020): 73. http://dx.doi.org/10.1093/geroni/igaa057.239.
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Abstract Family caregivers play an important role in the healthcare of older adults, but their circumstances, needs, and risks are often unknown to medical professionals. Standardizing how caregivers’ needs are assessed in healthcare delivery can help clinicians design care plans that take caregivers’ capabilities into account and provide targeted recommendations for caregiver support. Despite the potential of caregiver assessment, little is known about its use in primary care practice. The present study surveyed a national random sample of 1,000 U.S. primary care clinicians (physicians, nurses, social workers) to characterize current practices, barriers, and facilitators of caregiver assessment. A total of 231 completed responses were received. A minority of respondents (11%) reported that their practice or clinic had a standardized procedure for caregiver assessment; one in ten (10%) reported that they had personally conducted a caregiver assessment using a standardized instrument in the past year. The most common barriers to caregiver assessment were lack of time (65%), inability to have private discussions with caregivers (36%), lack of access to referral options (30%), inadequate reimbursement (30%), and reluctance of caregivers to discuss their needs (30%). The most frequently endorsed facilitators to aid future implementation included better availability of referral options (77%), easier referral mechanisms (67%), co-location of mental health specialists, care managers, or social workers (65%), and training in how to address caregiver issues (61%). Findings are discussed within the context of emerging healthcare policies and practice initiatives designed to promote caregiver assessment in health care settings.
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Kaigle, Allie, Ranya Sawan-Garcia, and Anthony Firek. "Approach to the provision of transgender health care in a veteran population." Mental Health Clinician 7, no. 4 (July 1, 2017): 176–80. http://dx.doi.org/10.9740/mhc.2017.07.176.
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Abstract Transgender patients often experience health disparities, including higher rates of psychiatric comorbidity, tobacco and substance use disorders, higher suicide risk, and reduced access and initiation of medical and mental health services. In 2011, the Department of Veterans Affairs (VA) health care system released a directive outlining the provision of transgender health care services. Since 2011, the number of transgender veterans seeking services has increased. To address these health care disparities and ensure competent comprehensive medical and mental health care for this population, an interprofessional team collaborated to develop the first formalized Transgender Healthcare Clinic at the VA Loma Linda Medical Center. The team consisted of an endocrinologist, primary care provider, clinical pharmacist, psychologist, and social worker. Each member of the team plays a key role in the management of mental and medical health care for transgender veterans. After implementation of the Transgender Healthcare Clinic and its respective model for appointments, access to gender transition–related health care has improved and expanded. Although the role of the clinical pharmacist is well established in this clinic, the addition of a psychiatric pharmacist to the transgender health care team could improve patient care through the integration of an expert understanding of behavioral and pharmacologic aspects facing transgender individuals. The psychiatric pharmacist is trained with the unique skill set required to address these concerns and facilitate the optimal management of co-occurring mental illnesses commonly seen in this patient population. Further research focusing on the integration of psychiatric pharmacists into transgender health care teams is needed.
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Mbunya, S., C. Asirwa, and D. Felker. "Telemedicine: Bridging the Gap Between Rural and Urban Oncologic Healthcare in Kenya." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 226s. http://dx.doi.org/10.1200/jgo.18.91500.
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Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximize time allocated for physicians to see patients; Decrease travel time to clinics as only 32% of Kenyans live in urban environments. Methods: Cost analysis of remote clinic locations and associated costs; Clinic budget estimate for networking and telemedicine support position; Cost summary and savings Results: Estimated costs for the operations budget for the 17 rural outreach clinics include the costs of hardware, solar networking setup, and internet at a total $3400/wk. This will decrease after the first year to $1700 for maintenance costs of equipment. Personnel consists of 1 local person to support the system and will be a weekly cost of $1870. Lost time for physicians due to road travel totals ∼100 hours weekly. Estimated salaries for an oncologist at $30/h leads to a cost of $3007/wk in lost productivity. It should be noted that lodging and per diem expenses are not included in the estimated expenses that total $6114/wk. By doing telemedicine at the rural clinics in an ideal 48 workable week situation. The savings of $528,000 is a clear evidence that this is financially feasible solely based on travel savings over 5 years. For this reason, the actual savings is ∼$264,000 and still makes a strong argument for this being the right move. Conclusion: Telemedicine is a viable and necessary resource for developing oncologic care in rural Kenya. We believe that telemedicine represents a natural evolution in healthcare in Kenya to support its rural population. Telemedicine helps maximize the limited physician resources and allows them to reach a larger audience without tying up their time in lengthy commutes. Last, telemedicine should assist patients to overcome the barriers of cost and time that limit their treatment. Future challenges and gains will be made with the evolution of the newly formed national health insurance system. Gaining support and reimbursement from telemedicine visits will be crucial to ensuring the success of telemedicine.
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Saluja, Sonali, Danny McCormick, Michael Cousineau, Janina Morrison, and Michael Hochman. "2250 Barriers to healthcare after the Affordable Care Act: A qualitative study of Los Angeles safety net patients’ experiences with insurance and healthcare." Journal of Clinical and Translational Science 2, S1 (June 2018): 64–65. http://dx.doi.org/10.1017/cts.2018.238.
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OBJECTIVES/SPECIFIC AIMS: N/A. METHODS/STUDY POPULATION: Over a million people gained insurance in Los Angeles (LA) County under the Affordable Care Act (ACA). The vast majority gained Medicaid—government sponsored insurance with low-cost sharing. LA County also made significant investments in the safety net including a program called MyHealthLA, which provides primary and tertiary care for the residually uninsured including poor undocumented individuals at specific sites. Despite this insurance expansion, approximately 3 quarters of a million people in the county remain uninsured. Regardless of insurance status, nearly a quarter of LA County residents reported having difficulty obtaining needed medical care, and among those making less than the poverty level, 43% had difficulties. There is still much to understand about barriers to obtaining insurance and accessing healthcare in Los Angeles in the post-ACA era. Our primary objective was to understand how safety net patients are obtaining, maintaining and using their insurance after the ACA. Specifically we hope to understand the barriers and drivers of these three processes. RESULTS/ANTICIPATED RESULTS: We conducted a qualitative study of 34 safety net patients with 3 different insurance types in LA County. We conducted in-person interviews with adult patients (ages 18–64 years), who had either MediCal, MyHealthLA, or were unsinsured. Our interview guide was based on existing literature, a previous qualitative study conducted in Massachusetts and input from experts in the field. We pilot tested our interviews in English and Spanish and then recruited our participants from 3 sites: LAC+USC (a publically funded county hospital), The Wellness Center (a resource center for safety net patients), and White Memorial Medical Center (a private safety net hospital). We approached patients in the ED and urgent care waiting rooms and obtained informed consent for this IRB approved study. We excluded patients who were non-English and non-Spanish speaking or too ill to interview. We recorded interviews, which were then transcribed and translated into English by a contracted agency. We analyzed our interviews using a framework approach, which included a set of a priori codes from the literature as well as emerging codes from patient responses. We will check a sample of our transcripts for coding consistency (aiming for an inter-rater reliability of >80%). DISCUSSION/SIGNIFICANCE OF IMPACT: We recruited a diverse group of patients that were demographically representative of those who gained insurance under the ACA (childless adults making less than 138% of the Federal Poverty Level). Our preliminary results (based on 17 transcripts), suggest that patients, regardless of insurance type have difficulty accessing primary care. We identified seven domains under the broader theme of barriers to accessing primary care: finding a primary care clinic or physician (PCP), getting timely appointments, geography and transportation, continuity of care, using the Emergency Department (ED) or urgent care as a PCP, switching PCPs or clinics, and cost or coverage.