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"Primary Health Care -- methods"
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Depression in primary care : evidence and practice
\"Although depression is a major cause of illness and disability, the quality of care offered is often poor. Research evidence demonstrating how the quality of primary care can be improved is dispersed in different academic journals and written in technical jargon. Depression in Primary Care: Evidence and Practice summarizes this research in a clear and useable format. This collection of high quality reviews of research evidence takes the form of a series of clinical and economic evaluations. Each provides a clear summary of the best evidence from trials and an accessible 'how to do it' guide, written by international experts. Global approaches towards the organization and delivery of primary care for depression are presented, from the UK, North America, Europe and the developing world. An important source of practical guidance about how to implement quality improvement programs in clinical practice, this book will assist practitioners, researchers and policy makers alike. - Combines clear evidence summaries with a simple and practical guide about how to implement quality improvement programmes in practice - Prepared by international experts and of interest and relevance in all countries and healthcare settings - Addresses a major healthcare priority identified by the World Health Organization, US Agency for Healthcare Research and UK National Institute for Clinical Excellence\"--Provided by publisher.
Book
Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance
Manjulaa Narasimhan and colleagues argue that there is a pressing need for a clearer conceptualisation of self care to support health policy
Journal Article
The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting
Background
Patients with multi-morbidity have complex care needs that often make healthcare delivery difficult and costly to manage. Current healthcare delivery is not tailored to the needs of patients with multi-morbidity, although multi-morbidity poses a heavy burden on patients and is related to adverse outcomes. Patient-centered care and co-creation of care are expected to improve outcomes, but the relationships among patient-centered care, co-creation of care, physical well-being, social well-being, and satisfaction with care among patients with multi-morbidity are not known.
Methods
In 2017, a cross-sectional survey was conducted among 216 (of 394 eligible participants; 55% response rate) patients with multi-morbidity from eight primary care practices in Noord-Brabant, the Netherlands. Correlation and regression analyses were performed to identify relationships among patient-centered care, co-creation of care, physical well-being, social well-being, and satisfaction with care.
Results
The mean age of the patients was 74.46 ± 10.64 (range, 47–94) years. Less than half (40.8%) of the patients were male, 43.3% were single, and 39.3% were less educated. Patient-centered care and co-creation of care were correlated significantly with patients’ physical well-being, social well-being, and satisfaction with care (all
p
≤ 0.001). Patient-centered care was associated with social well-being (
B
= 0.387,
p
≤ 0.001), physical well-being (
B
= 0.368,
p
≤ 0.001) and satisfaction with care (
B
= 0.425,
p
≤ 0.001). Co-creation of care was associated with social well-being (
B
= 0.112,
p
= 0.006) and satisfaction with care (
B
= 0.119,
p
= 0.007).
Conclusions
Patient-centered care and co-creation of care were associated positively with satisfaction with care and the physical and social well-being of patients with multi-morbidity in the primary care setting. Making care more tailored to the needs of patients with multi-morbidity by paying attention to patient-centered care and co-creation of care may contribute to better outcomes.
Journal Article
Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada
Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada.
This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period.
Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%).
Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.
Journal Article
Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation
Background
Much research does not address the practical needs of stakeholders responsible for introducing health care delivery interventions into organizations working to achieve better outcomes. In this article, we present an approach to using the Consolidated Framework for Implementation Research (CFIR) to guide systematic research that supports rapid-cycle evaluation of the implementation of health care delivery interventions and produces actionable evaluation findings intended to improve implementation in a timely manner.
Methods
To present our approach, we describe a formative cross-case qualitative investigation of 21 primary care practices participating in the Comprehensive Primary Care (CPC) initiative, a multi-payer supported primary care practice transformation intervention led by the Centers for Medicare and Medicaid Services. Qualitative data include observational field notes and semi-structured interviews with primary care practice leadership, clinicians, and administrative and medical support staff. We use intervention-specific codes, and CFIR constructs to reduce and organize the data to support cross-case analysis of patterns of barriers and facilitators relating to different CPC components.
Results
Using the CFIR to guide data collection, coding, analysis, and reporting of findings supported a systematic, comprehensive, and timely understanding of barriers and facilitators to practice transformation. Our approach to using the CFIR produced actionable findings for improving implementation effectiveness during this initiative and for identifying improvements to implementation strategies for future practice transformation efforts.
Conclusions
The CFIR is a useful tool for guiding rapid-cycle evaluation of the implementation of practice transformation initiatives. Using the approach described here, we systematically identified where adjustments and refinements to the intervention could be made in the second year of the 4-year intervention. We think the approach we describe has broad application and encourage others to use the CFIR, along with intervention-specific codes, to guide the efficient and rigorous analysis of rich qualitative data.
Trial registration
NCT02318108
Journal Article
ABC of medically unexplained symptoms
This brand new title addresses the complex issues faced by primary health care practitioners in treating and managing patients with 'medically unexplained symptoms'. It aims to develop guidelines and principles to help identify patients with medically unexplained symptoms, as they are typically underdiagnosed, and to manage symptoms more effectively with active patient involvement.
eBook
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample
BACKGROUNDPosttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common.OBJECTIVEThe objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure.DESIGNWe compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5.PARTICIPANTSA convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White.MEASURESThe PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences.KEY RESULTSThe PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912– 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849–1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527–0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550–0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.CONCLUSIONSThe PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.
Journal Article