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1.
Ciênc. Saúde Colet ; 27(9): 3583-3602, set. 2022. tab
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-2032683

ABSTRACT

Resumo Este artigo tem o objetivo de apresentar uma proposta de compatibilização dos instrumentos utilizados nos três ciclos do PMAQ-AB e analisar as informações de acesso, cobertura, estrutura, organização e oferta de serviços na APS relacionadas ao cuidado para DM no Brasil, segundo regiões, a partir da perspectiva das equipes de saúde da família e dos usuários. Foi realizada uma análise do grau de compatibilidade das questões do PMAQ-AB (2012, 2014 e 2017). Para análise da evolução temporal dos componentes realizou-se teste de diferença de proporção. Calculou-se a diferença percentual entre a perspectiva das Equipes e dos Usuários, por ano analisado, para Brasil. Em geral, houve melhora da qualidade do cuidado e realização de exames, com exceção do pé diabético. Foram encontrados resultados piores para o Norte em relação às demais regiões. Apesar da melhora estrutural e na qualidade da atenção reportada pelas equipes, foram evidenciadas lacunas significativas na qualidade do cuidado ao paciente com DM no SUS. No cenário de investimento escasso e crescente prevalência de DM, os obstáculos tornam-se cada vez mais desafiadores e, por isso, o monitoramento e avaliação da qualidade dos serviços prestados são tarefas precípuas do SUS.


Abstract This article aims to present a proposal for making the instruments used in the three cycles of the PMAQ-AB compatible and to analyze the information on access, coverage, structure, organization and provision of services in PHC related to care for DM in Brazil, according to regions, from the perspective of family health professionals and users. We performed an analysis of the degree of compatibility of the PMAQ-AB questions (2012, 2014 and 2017). To analyze the temporal evolution of the components, we performed a proportion difference test. We calculated the percentage difference between the perspective of professionals and users, per year analyzed, for Brazil. In general, there was an improvement in the quality of care and examinations, except for the diabetic foot. Worse results were found for the North region in relation to the other regions. Despite the structural improvement and the quality of care reported by professionals, there are significant gaps in the quality of care for patients with DM in the SUS. In the scenario of scarce investment added to the growing prevalence of DM, obstacles become progressively more challenging. Therefore, monitoring and evaluating the quality of services provided are essential tasks of the Brazilian Health System.

2.
Journal of the Canadian Association of Gastroenterology ; 4, 2021.
Article in English | EMBASE | ID: covidwho-2032046

ABSTRACT

Background: Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions. Aims: To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service. Methods: This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%). Results: A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%). been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI. Conclusions: The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.

3.
Mayo Clin Proc Innov Qual Outcomes ; 2022 Aug 08.
Article in English | MEDLINE | ID: covidwho-2031554

ABSTRACT

Background: Cardiovascular disease (CVD) patients with COVID-19 are at higher risk of morbidity and mortality. This study describes the risks and outcome of CVD patients with COVID-19 attending primary health care corporation (PHCC) settings in Qatar. Aim/Objectives: To report whether CVD increase the risk for hospitalization and further complications in COVID-19 patients. Methods: Retrospective cohort study. Results: A total of 10,178 CVD patients' data who tested COVID-19 positive were extracted from electronic medical records based on the inclusion criteria and analysed during the period of February-December 2020 (11 months). Among these 64% (n=6527) were men and 36%(n=3651) were women, 23% (n=2299) were Qatari and 77%(n=7879) were non-Qatari. Among the selected age group of > 25 years and < 75 years, the median age was 50.83. More than half of the patients had diabetes (69.62%; n=7086) followed by hypertension (68.43%; n=6965) and dyslipidemia (45.1%; n= 4590). Other comorbidities are obesity (18.29%; n=1862) and kidney disease (6.5%; n=659), hematological problems (4.18%; n=425), liver disorders (1.4; n=142), rhematic heart disease (1.3%; n=131) and neurological complaints (1.26%; n=128). Multivariate analysis for factor associated with in patient admission in last 28 days for Cardiovascular patients shows that patients with age >70 years are 2.79 (1.86-4.18) times more likely to have the risk of hospital admission compared with the age 25-30 years. Conclusion: The pre-existing CVD with age and other comorbidities predict risk for hospitalization and further complications in COVID 19 patients. Further studies are needed to investigate the data from primary and secondary care about the long-term cardiovascular outcomes of patients who have survived COVID-19.

4.
BJGP Open ; 2022.
Article in English | PubMed | ID: covidwho-2030098

ABSTRACT

BACKGROUND: The onset of the COVID-19 pandemic and introduction of various restrictions resulted in drastic changes to "traditional" primary healthcare service delivery modalities. AIM: To understand the impact of virtual care on healthcare system performance within the context of Ontario Community Health Centres. DESIGN & SETTING: Thematic analysis of qualitative interviews with thirty-six providers and thirty-one patients. METHOD: Semi-structured phone interviews were conducted in the fall of 2020. Interviews were recorded, transcribed verbatim and analyzed thematically using the quadruple aim framework. RESULTS: Virtual care had removed certain barriers to care. Patients and providers, found that phone visits impacted quality of care due to the inability to read body language and relying solely on patient descriptions. Video visits allowed for a similar experience to in-person visits but technical issues constrained this. Depending on the service provided, some providers felt they were not providing the same quality of care. Providers reported reductions in no-show rates and highlighted the efficiency of virtual appointments. Providers also found they were able to collaborate at a similar level prior to the pandemic and saw improvements in work-life balance. Overall, patients and providers alike preferred virtual visits with those known to them and for less-complex/transactional aspects of care. CONCLUSION: Our study described positive and negative impacts on patient care, population health, health system costs and provider experience. These results will be useful for primary care organisations in post-pandemic planning, however future research is needed for a deeper exploration of the impact on quality of care specifically for more complex health concerns.

5.
Practice Nursing ; 33(9):380-382, 2022.
Article in English | CINAHL | ID: covidwho-2025630

ABSTRACT

Optimisation of hypertension identification and treatment is key to reducing health inequalities. Kate Phillips and Luke Evans highlight the role practice nurses can play in implementing the national Blood Pressure Optimisation Programme

6.
Rev. bras. enferm ; 75(supl.1): e20220028, 2022. tab
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-2022109

ABSTRACT

ABSTRACT Objective: to identify the frequency of occurrence of sickness absenteeism, according to the profile of Primary Health Care (PHC) professionals, and verify if there was an impact of the pandemic on absence duration and reason. Methods: a cross-sectional study, from January/2019 to December/2020, with PHC professionals from a municipality in northeastern São Paulo. Descriptive statistics were performed, with frequency calculation. Results: of the 977 PHC professionals, 633 (64.79%) used a medical certificate to justify their absence from work in 2019, and 837 (85.67%) in 2020. The main reason for leave was diseases of the musculoskeletal system and connective tissue in the two years. The mean duration of leave was 7.33 days (SD=17.33) in 2019 and 9.88 days (SD=16.05) in 2020. Nursing assistants were the ones who took the most leave in both years. Conclusions: there was an impact of the pandemic on absence duration and reason.


RESUMEN Objetivo: identificar la frecuencia de ocurrencia del ausentismo-enfermedad, según el perfil de los profesionales de la Atención Primaria de Salud (APS), y verificar si hubo impacto de la pandemia en la duración y motivos de las ausencias. Métodos: estudio transversal, de enero/2019 a diciembre/2020, con profesionales de la APS de un municipio del nordeste del estado de São Paulo. Se realizó estadística descriptiva, con cálculo de frecuencia. Resultados: de los 977 profesionales de APS, 633 (64,79%) utilizaron el certificado médico para justificar su ausencia al trabajo en 2019 y 837 (85,67%) en 2020. El principal motivo de baja fue por enfermedades musculoesqueléticas y del tejido conectivo en los dos años. La duración media de la licencia fue de 7,33 días (DE=17,33) en 2019 y de 9,88 días (DE=16,05) en 2020. Los auxiliares de enfermería fueron los que más disfrutaron de licencia en ambos años. Conclusiones: hubo un impacto de la pandemia en la duración y motivos de las ausencias.


RESUMO Objetivo: identificar a frequência de ocorrência do absenteísmo-doença, de acordo com o perfil dos profissionais da Atenção Primária à Saúde (APS), e verificar se houve impacto da pandemia na duração e motivos dos afastamentos. Métodos: estudo transversal, no período de janeiro/2019 a dezembro/2020, com os profissionais de APS de um município do nordeste do estado de São Paulo. Realizou-se estatística descritiva, com cálculo de frequências. Resultados: dos 977 profissionais da APS, 633 (64,79%) utilizaram o atestado médico para justificar sua ausência no trabalho em 2019, e 837 (85,67%), em 2020. O principal motivo dos afastamentos foi as doenças osteomusculares e do tecido conjuntivo nos dois anos. A duração média dos afastamentos foi de 7,33 dias (DP=17,33) em 2019 e de 9,88 dias (DP=16,05) em 2020. Os auxiliares de enfermagem foram os que mais se afastaram em ambos os anos. Conclusões: houve impacto da pandemia na duração e motivos dos afastamentos.

7.
International Journal of Environmental Research and Public Health ; 19(16):9940, 2022.
Article in English | ProQuest Central | ID: covidwho-2023641

ABSTRACT

The following study aims to describe the perception of international migrants who use the primary level of care by health personnel and to explore how this perception can affect the care process in the commune of Antofagasta, north of Chile. Methodology: The methodology was qualitative using a phenomenological descriptive design, through which the discourses of the health personnel of three primary health care centers (n = 14) were explored. Results: The participants presented two thematic categories. The first one related to experiences during delivery of care to migrants and included perceptions and beliefs, factors associated with using services, and reasons for consultation. The second category related to stereotypes towards migrants, including prejudices, beliefs about their lives and reasons for migration. Conclusions: The therapeutic relationship with migrants in primary care depends on the health care personnel’s acceptability of this population, hence, allowing the delivery of care based on respect for their culture and rights.

8.
International Journal of Environmental Research and Public Health ; 19(16):9816, 2022.
Article in English | ProQuest Central | ID: covidwho-2023634

ABSTRACT

Various studies indicate that workload metrics can be used to assess inequities in the division of labor according to gender and in the mental health of health care professionals. In most studies, the workload is portrayed in a way that does not integrate the different fields of work, that is, work in health services and unpaid domestic work. The objective was to determine the effects of the workload domains of health work and unpaid domestic work according to the gender division of health professionals working in primary health care (PHC), and to analyze the workload as an inducer of anxiety disorders and episodes of depression. This cross-sectional study consisted of 342 health care professionals recruited for interview at primary health care units in the extreme south of Rio Grande do Sul, Brazil. Sociodemographic and occupational variables, workload in PHC and unpaid domestic work, and dichotomies of anxiety disorders and episodes of depression were considered. Poisson and multivariate linear regression models were used for data analysis. Cohen’s standardized effect size was used to assess the magnitude of the difference between women and men in terms of workload. The female professionals presented higher scores in terms of PHC work and unpaid domestic work and higher proportions of episodes of depression and anxiety disorders compared to males. The male professionals showed that anxiety disorders presented a medium standardized effect size on domestic workload and the level of frustration with family involvement was higher in those with episodes of depression. The results illustrate that the workload metric is an important indicator of female vulnerability to working conditions in PHC and in the family environment.

9.
J Am Board Fam Med ; 2022.
Article in English | PubMed | ID: covidwho-2022517

ABSTRACT

INTRODUCTION: COVID-19 policies such as quarantining, social isolation, and lockdowns are an essential public health measure to reduce the spread of disease but may lead to reduced physical activity. Little is known if these changes are associated with changes in physical or mental health. METHODS: Between September 2017 and December 2018 (baseline) and March 2020 and February 2021 (follow-up), we obtained self-reported demographic, health, and walking (only at follow-up) data on 2042 adults in primary care with multiple chronic health conditions. We examined whether the perceived amount of time engaged in walking was different compared with prepandemic levels and if this was associated with changes in Patient-Reported Outcomes Measurement Information System-29 mental and physical health summary scores. Multivariable linear regression controlling for demographic, health, and neighborhood information were used to assess this association. RESULTS: Of the 2042 participants, 9% reported more walking, 28% reported less, and 52% reported the same amount compared with prepandemic levels. Nearly 1/3 of participants reported less walking during the pandemic. Multivariable models revealed that walking less or not at all was associated with negative changes in mental (ß = -1.0;95% CI [-1.6, -0.5];ß = -2.2;95% CI [-2.9, -1.4]) and physical (ß = -0.9;95% CI [-1.5, -0.3];ß = -3.1;95% CI [-4.0, -2.3]) health, respectively. Increasing walking was significantly associated with a positive change in physical health (ß = 1.3;95% CI [0.3, 2.2]). CONCLUSIONS: These findings demonstrate the importance of walking during the COVID-19 pandemic. Promotion of physical activity should be taken into consideration when mandating restrictions to slow the spread of disease. Primary care providers can assess patient's walking patterns and implement brief interventions to help patients improve their physical and mental health through walking.

10.
Health Affairs ; 41(9):1248-1254, 2022.
Article in English | MEDLINE | ID: covidwho-2021987

ABSTRACT

Growing enthusiasm for remote patient monitoring has been motivated by the hope that it can improve care for patients with poorly controlled chronic illness. In a national commercially insured population in the US, we found that billing for remote patient monitoring increased more than fourfold during the first year of the COVID-19 pandemic. Most of this growth was driven by a small number of primary care providers. Among the patients of these providers with a high volume of remote patient monitoring, we did not observe substantial targeting of remote patient monitoring to people with greater disease burden or worse disease control. Further research is needed to identify which patients benefit from remote patient monitoring, to inform evidence-based use and coverage decisions. In the meantime, payers and policy makers should closely monitor remote patient monitoring use and spending.

11.
PLoS Global Public Health ; 2(7), 2022.
Article in English | CAB Abstracts | ID: covidwho-2021491

ABSTRACT

Transmission of respiratory pathogens, such as Mycobacterium tuberculosis and severe acute respiratory syndrome coronavirus 2, is more likely during close, prolonged contact and when sharing a poorly ventilated space. Reducing overcrowding of health facilities is a recognised infection prevention and control (IPC) strategy;reliable estimates of waiting times and 'patient flow' would help guide implementation. As part of the Umoya omuhle study, we aimed to estimate clinic visit duration, time spent indoors versus outdoors, and occupancy density of waiting rooms in clinics in KwaZulu-Natal (KZN) and Western Cape (WC), South Africa. We used unique barcodes to track attendees' movements in 11 clinics, multiple imputation to estimate missing arrival and departure times, and mixed-effects linear regression to examine associations with visit duration. 2,903 attendees were included. Median visit duration was 2 hours 36 minutes (interquartile range [IQR] 01:36-3:43). Longer mean visit times were associated with being female (13.5 minutes longer than males;p<0.001) and attending with a baby (18.8 minutes longer than those without;p<0.01), and shorter mean times with later arrival (14.9 minutes shorter per hour after 0700;p<0.001). Overall, attendees spent more of their time indoors (median 95.6% [IQR 46-100]) than outdoors (2.5% [IQR 0-35]). Attendees at clinics with outdoor waiting areas spent a greater proportion (median 13.7% [IQR 1-75]) of their time outdoors. In two clinics in KZN (no appointment system), occupancy densities of ~2.0 persons/m2 were observed in smaller waiting rooms during busy periods. In one clinic in WC (appointment system, larger waiting areas), occupancy density did not exceed 1.0 persons/m2 despite higher overall attendance. In this study, longer waiting times were associated with early arrival, being female, and attending with a young child. Occupancy of waiting rooms varied substantially between rooms and over the clinic day. Light-touch estimation of occupancy density may help guide interventions to improve patient flow.

12.
Br J Gen Pract ; 2022 Apr 20.
Article in English | MEDLINE | ID: covidwho-2024377

ABSTRACT

BACKGROUND: NHS England has introduced a new structured medication review (SMR) service within primary care networks (PCNs) forming during the COVID-19 pandemic. Policy drivers are addressing problematic polypharmacy, reducing avoidable hospitalisations, and delivering better value from medicines spending. This study explores early implementation of the SMR from the perspective of the primary care clinical pharmacist workforce. AIM: To identify factors affecting the early implementation of the SMR service. DESIGN AND SETTING: Qualitative interview study in general practice between September 2020 and June 2021. METHOD: Two semi-structured interviews were carried out with each of 10 newly appointed pharmacists (20 in total) in 10 PCNs in Northern England; and one interview was carried out with 10 pharmacists already established in GP practices in 10 other PCNs across England. Audiorecordings were transcribed verbatim and a modified framework method supported a constructionist thematic analysis. RESULTS: SMRs were not yet a PCN priority and SMR implementation was largely delegated to individual pharmacists; those already in general practice appearing to be more ready for implementation. New pharmacists were on the primary care education pathway and drew on pre-existing practice frames, habits, and heuristics. Those lacking patient-facing expertise sought template-driven, institution-centred practice. Consequently, SMR practices reverted to prior medication review practices, compromising the distinct purposes of the new service. CONCLUSION: Early SMR implementation did not match the vision for patients presented in policy of an invited, holistic, shared decision-making opportunity offered by well-trained pharmacists. There is an important opportunity cost of SMR implementation without prior adequate skills development, testing, and refining.

13.
Journal of Ambulatory Care Management ; 45(4):299-309, 2022.
Article in English | MEDLINE | ID: covidwho-2018269

ABSTRACT

Investigation of nurses' perceptions of patient safety culture (PSC) might be beneficial in identifying safety areas that need improvement, especially during the COVID-19 pandemic. The study reports on the PSC in primary care from the nurses' perspective during the pandemic. Nurses (n = 117) evaluated teamwork (87.3%) and staff training (80.9%) positively but work pressure and pace (26.1%) and patient care tracking (45.3%) concerning PSC dimensions negatively. Limited care coordination and continuity lead to patient hospitalizations and care fragmentation. However, regular assessment of PSC can lead to adopting the necessary strategies to reinforce weaknesses and thus improve patient safety in primary care.

14.
Rqr Enfermeria Comunitaria ; 10(2):34-46, 2022.
Article in English | Web of Science | ID: covidwho-2011949

ABSTRACT

Since the SARS-CoV-2 coronavirus pandemic began, different protocols, clinical guides and documents have been developed with the objective of providing the most appropriate care to patients affected by Coronavirus infections with persistent symptoms. However, there is a great variability in the management and treatment of those patients affected by persistent COVID, because of an imprecise definition of their diagnosis, as well as the numerous and varied signs and symptoms they present, there is great difficulty in monitoring these patients. Primary Health Care is considered the most appropriate service for the holistic care of people affected by persistent COVID. Because of their training and skills, Primary Care Nursing can be the appropriate professional to monitor these patients and coordinate the different levels of care in a multidisciplinary team. The limited bibliography found about care in patients with persistent COVID has motivated the implementation of Patient Care Planning that is useful to improve the management of these patients. For this, the evaluation has been carried out in accordance with the functional patterns established by Marjory Gordon and has been used in the NANDA-NIC-NOC taxonomy. This nursing care plan must be individualized according to the characteristics of the patient we are attending.

15.
Dissertation Abstracts International: Section B: The Sciences and Engineering ; 83(10-B):No Pagination Specified, 2022.
Article in English | APA PsycInfo | ID: covidwho-2011219

ABSTRACT

Purpose: The purpose of this quality improvement project was to increase SARS-CoV-2 vaccination confidence and knowledge in adults who display reluctance or hesitancy through a brief educational discussion and a written pamphlet. Background: In recent history, the world was faced with an unprecedented challenge as a pandemic quickly encompassed the globe. In early 2020, this became commonly known and referred to as the COVID-19 pandemic. The severe health implications of this respiratory virus quickly overfilled hospitals and placed the health of communities at risk. To get ahead of further spread of COVID-19, it was pertinent to quickly develop an effective vaccine. Following rigorous clinical trials, two mRNA vaccines were approved by the United States (US) Food and Drug Administration (FDA). What seemed like a solution became a challenge within the US. The population of the US showed reluctance to participate in COVID-19 vaccination programs. Vaccine hesitancy related to COVID-19 mRNA vaccines prolonged communities achieving adequate herd immunity. Understanding why individuals were displaying vaccine hesitancy was pertinent for implementing strategies that would lead to increased mRNA COVID-19 vaccine compliance. Methods: Participants were recruited from Peak Family Practice in Colorado Springs, CO. A pre-survey was administered followed by a short one-on-one educational session reviewing a written pamphlet about mRNA vaccines and common misinformation related to COVID-19 vaccines. A post-survey was administered after the educational intervention. Each survey had the same five questions and assessed participant knowledge and confidence related to mRNA COVID-19 vaccines.Results: A total of 20 participants completed the pre- and post-survey responses, along with participating in the short educational session. No statistically significant differences were found, however, participants who changed their answers on post-survey showed an increase in confidence of mRNA vaccines as well as indicating they would be more likely to receive a COVID-19 vaccine. Conclusion: This educational intervention reviewing a written pamphlet of mRNA vaccine information was effective in increasing the confidence of mRNA COVID-19 vaccines in some participants. Participants who changed their post-survey answers indicated an increase in likeliness to receive COVID-19 vaccination and showed improvement in knowledge related to mRNA vaccines. Although there was evidence of clinical significance a larger sample size would be necessary to indicate true statistical significance. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

16.
Kai Tiaki Nursing New Zealand ; : 75-78, 2022.
Article in English | CINAHL | ID: covidwho-2010732
17.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009558

ABSTRACT

Background: The impact of clinician burnout on patient care is pervasive across medical delivery systems. The effects are also felt in preventive care where cancer screening efforts rely on clinician referrals through the electronic medical records (EMRs). Though designed to support healthcare, EMRs are a significant source of clinician burnout given the number of clicks or navigation time needed to refer a patient. This is a barrier to Patient Navigation (PN) when ordered tests do not materialize into screenings or when clinicians order labs/imaging and the pending orders are not created. This causes frustration for all clinical staff involved, delays the workflow processes, and leads to missed opportunities for PN. We implemented an 'order set' intervention to reduce the click burden linked to colorectal cancer (CRC) screening referral among clinicians in South Georgia. Methods: The 'order set' intervention was developed to facilitate PN for a Colorectal Cancer Control Program (CRCCP) aimed at implementing Evidence- Based Interventions to increase CRC screening rates in Georgia. The 'order set' was designed to address workflow issues by consolidating steps associated with CRC screening. This reduced typing input and the need to click between multiple windows within the EMR while making a referral to PN. The intervention was piloted in the Albany Area Primary Health Care (AAPHC) system after modifications were made to the EMR and clinician workflows. The monthly CRC screening rates continue to be generated and tracked post-implementation. Results: The use of the 'order set' reduced the click burden from 78 to 7 inputs and clinician EMR interaction time from 110 seconds to 29 seconds. Providers from 4/7 clinics have adopted the 'order sets' when making referrals for CRC screening. Two clinics provided post-implementation screening data. The pre-implementation screening rates for one clinic were comparable (August = 59.3%, September = 57.6%) to post-implementation (October = 56.3%, November = 56.6%, December = 57.2%), while the second clinic showed some increase (August = 58.6%, September = 60%) vs. (October = 61%, November = 62.1%, December = 62.8%). Conclusions: The 'order sets' intervention reduced the time clinicians spent creating referrals for CRC screening, including fecal immunochemical tests (FIT) and colonoscopies. Additional follow-up and rollout to clinics participating in the program is underway to evaluate further the impact of the order sets on CRC screening outcome and process measures, including qualitative interviews with clinicians. There is significant potential in the application of order sets to various workflow processes to aid in preventative health efforts. Challenges linked to the COVID-19 pandemic and staff turnover affected acquisition of patient referral data.

18.
BMC health services research ; 22(1):1113, 2022.
Article in English | MEDLINE | ID: covidwho-2009393

ABSTRACT

BACKGROUND: Despite a publicly funded system, health care in Canada has been shown to be deeply inequitable, particularly toward Indigenous people. Based on research identifying key dimensions of equity-oriented health care as being cultural safety, harm reduction and trauma- and violence-informed care, an intervention to promote equity at the organizational level was tested in primary health care, refined and adapted, and tested in Emergency Departments (EDs). METHODS: In partnership with clinical, community and Indigenous leaders in three diverse EDs in one Canadian province, we supported direct care staff to tailor and implement the intervention. Intervention activities varied in type and intensity at each site. Survey data were collected pre- and post-intervention from every consecutive patient over age 18 presenting to the EDs (n = 4771) with 3315 completing post-visit questions in 4 waves at two sites and 3 waves (due to pandemic constraints) at the third. Administrative data were collected for 12 months pre- and 12 months post-intervention. RESULTS: Throughout the study period, the participating EDs were dealing with a worsening epidemic of overdoses and deaths related to a toxic drug supply, and the COVID 19 pandemic curtailed both intervention activities and data collection. Despite these constraints, staff at two of the EDs mounted equity-oriented intervention strategies;the other site was experiencing continued, significant staff shortages and leadership changeover. Longitudinal analysis using multiple regression showed non-significant but encouraging trends in patient perceptions of quality of care and patient experiences of discrimination in the ED. Subgroup analysis showed that specific groups of patients experienced care in significantly different ways at each site. An interrupted time series of administrative data showed no significant change in staff sick time, but showed a significant decrease in the percentage of patients who left without care being completed at the site with the most robust intervention activities. CONCLUSIONS: The trends in patient perceptions and the significant decrease in the percentage of patients who left without care being completed suggest potential for impact. Realization of this potential will depend on readiness, commitment and resources at the organizational and systems levels. TRIAL REGISTRATION: Clinical Trials.gov #NCT03369678 (registration date November 18, 2017).

19.
Annals of the Rheumatic Diseases ; 81:1806, 2022.
Article in English | EMBASE | ID: covidwho-2008977

ABSTRACT

Background: The beginning of the COVID-19 pandemic led to a collapse of healthcare systems that was difficult to manage. Objectives: The aim of this study was to assess the impact of the COVID-19 pandemic on RMD patients' healthcare utilization. Methods: REUMAVID is an international cross-sectional study collecting data through an online survey on RMD in seven European countries led by the Health & Territory Research group of the University of Seville, together with a multidisciplinary team including patient representatives, rheumatolo-gists, and health researchers. Data were collected in two phases, the frst (P1) between April-July 2020 and the second (P2) between February-April 2021. Demographics, health behaviours, employment status, access to healthcare services, disease characteristics, WHO-5 Well-Being Index and Hospital Anxiety and Depression Scale (HADS) were collected in the survey. Healthcare utilization includes scheduled appointments and attendance at the rheumatol-ogist, consultation of possible treatment effects if COVID-19 is contracted with the rheumatologist, primary health care and psychological care. Descriptive analysis and Mann-Whitney test was used to explore association with healthcare utilization in both phases of REUMAVID. Results: There were a total of 2,002 participants across both phases with comparable demographic characteristics [mean age 52.6 (P1) vs. 55.0 years (P2);80.2% female (P1) vs 83.7% (P2);69.6% married (P1) vs 68.3% (P2), 48.6% university educated (P1) vs 47.8% (P2)]. Most prevalent RMD was axial spondyloarthritis in P1 (37.2%), and rheumatoid arthritis in P2 (53.1%). Only 39.2% could have a scheduled appointment with their rheumatologist during P1, compared to 72.5% of patients in P2 (p<0.001). In this sense, only 41.6% of participants in the P1 attended such an appointment while in P2 this figure was 61.5% (p<0.001). The majority of patients (83%) had their scheduled face-to-face appointment changed to an online or telephone phone in the P2, although this proportion was lower in the P1 (54.4%). The most frequent reason for canceling the face-to-face appointment was the alternative of making it by phone or online (54.4% in P1 vs. 83.0% in P2, p<0.001). Although, in P1, 38.1% of participants could contact with their rheumatolo-gist by phone or online, this proportion was 64.3% in P2 (p<0.001). In P1, 64.0% of patients were able to consult with their rheumatologist about the possible effects of treatment in case of contracting COVID-19 (vs. 41.2% in P2;p<0.001). With respect to general practitioners, 57.6% of patients in P1 declared to had accessed primary care or general practitioner (vs. 77.5% in P2;p<0.001). Furthermore, in P2, a higher proportion of participants (63.2%) were able to continue their psychological or psychiatric therapy either online or by phone (vs. 48.3% in P1;p<0.001;Figure 1) Conclusion: During the frst year of COVID-19 pandemic, RMD patients had easier access to the healthcare system, specifcally to their rheumatologist. This access was improved through phone and online care. In addition, access to primary care as well as psychological care improved during the second year of pandemic.

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The Australian journal of rural health ; 2022.
Article in English | MEDLINE | ID: covidwho-2008731

ABSTRACT

INTRODUCTION: Rural and remote general practices face increasing demands for care without the workforce required to meet patient needs. The coronavirus pandemic has created an opportunity to explore sustainable, telehealth-driven solutions to this chronic and complex problem. OBJECTIVE: This review examined interventions using offsite primary care providers to deliver ongoing patient care via telehealth to support rural and remote general practices. We aimed to understand the impact of such interventions on the Quadruple Aim (patient experience, provider experience, health care costs, and health outcomes). DESIGN: A rapid review of studies published from 2011 and grey literature published from 2016. FINDINGS: Six studies met the eligibility criteria. No eligible Australian studies were identified. Most studies investigated ongoing primary care services provided via telehealth by offsite pharmacists. Patients and rural primary care staff reported positive experiences with the interventions. One study demonstrated potential return on investment for rural practices. While one study reported clinically and statistically significant improvements in health outcomes over time, two studies did not observe statistically significant differences in health outcomes between intervention and control cohorts. DISCUSSION: The Quadruple Aim should be carefully considered when designing, implementing, and evaluating interventions that involve offsite primary care providers using telehealth to support a sustainable workforce in rural and remote general practice. CONCLUSION: Sustainable solutions to workforce shortages in rural and remote general practice are needed urgently. Using offsite primary care providers to deliver telehealth and support practices in these regions is one possible solution that warrants further investigation, particularly in Australia.

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