Personal, health system, and geosocial disparities in appointment nonadherence at family medicine clinics in southcentral Pennsylvania, United States.

Background: To assess the relationship between patients' demographic, health system-related, and geosocial characteristics and the risk of missed appointments among patients in family medicine practice. Methods: The study was based on a retrospective cross-sectional design using electronic health records and neighborhood-level social determents of health metrics linked by geocoded patients' home address. The study population consisted of patients who had a primary care provider and at least one appointment at 14 family medicine clinics in rural and suburban areas in January-December 2022. Negative binomial regression was utilized to examine the impact of personal, health system, and geosocial effects on the risk of no-shows and same-day cancellations. Results: A total of 258,614 appointments were made from 75,182 patients during the study period, including 7.8% no-show appointments from 20,256 patients. The analysis revealed that individuals in the ethnic minority groups were 1.24-1.65 times more likely to miss their appointments than their White counterpart. Females and English speakers had 14% lower risk for no-show. A significant increase (32%-64%) in the odds of no-shows was found among individuals on Medicaid and uninsured. Persons with prior history of no-shows or same day cancellations were 6%-27% more likely to miss their appointments. The no-show risk was also higher among people living in areas experiencing socioeconomic disadvantage. Conclusion: The risk of missed appointments is affected by personal, health system, and geosocial contexts. Future efforts aiming to reduce no-shows could develop personalized interventions targeting the at-risk populations identified in the analysis.

Midwifery continuity of care, breastfeeding and neonatal hyperbilirubinemia: A retrospective cohort study.

AIM: To examine the association between Midwifery Continuity of Care (MCoC) and exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia. METHODS: A matched cohort design was employed using data from the Swedish Pregnancy Register. The study included 12,096 women who gave birth at a university hospital in Stockholm, Sweden from January 2019 to August 2021. Women and newborns cared for in a MCoC model were compared with a propensity-score matched set receiving standard care. Risk ratios (RR) were determined with 95 % confidence intervals (CI) based on the matched cohort through modified Poisson regressions with robust standard error. A mediation analysis assessed the direct and indirect effects of MCoC on exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia and to what extent the association was mediated by preterm birth. FINDING: Findings showed that MCoC was associated with a higher chance of exclusive breastfeeding rate (RR: 1.06, 95 % CI: 1.01-1.12) and lower risk of neonatal hyperbilirubinemia (RR: 0.51, 95 % CI: 0.32-0.82) compared with standard care. Mediation analysis demonstrated that lower preterm birth accounted for approximately 28 % of total effect on the reduced risk of neonatal hyperbilirubinemia. DISCUSSION/CONCLUSION: This matched cohort study provided preliminary evidence that MCoC models could be an intervention for improving exclusive breastfeeding rates at hospital discharge and reducing the risk of neonatal hyperbilirubinemia.

Different Models of Cardiac Telerehabilitation for People with Coronary Artery Disease: Features and Effectiveness: A Systematic Review and Meta-Analysis.

Objectives: Cardiac telerehabilitation (TR) for coronary artery disease (CAD) is a feasible alternative to the center-based rehabilitation delivery model. However, the features of exercise-based cardiac TR are still heterogeneous among studies, making it difficult to disentangle the preferable reference strategies to be recommended for the adoption of this new delivery of care. In addition, little is known about the effectiveness of different models, such as the hybrid model (CRh) including both center-based and home-based telerehabilitation approaches, and the solely home-based telerehabilitation (CTR). Methods: We conducted a systematic review of randomized controlled trials (RCTs) that included TR intervention in patients with CAD to profile the features of the telerehabilitation approach for CAD. We also conducted a meta-analysis to separately assess the effectiveness of CTR and CRh on medical benefit outcome measures compared to conventional intervention (CI). Results: Out of 17.692 studies, 28 RCTs involving 2.662 CAD patients were included in the review. The studies presented an equal proportion of the CTR and CRh models. The interventions were mainly multidimensional, with a frequency of 1 month to 6 months, with each session ranging between 20 to 70 min. In CRh, the intervention was mainly consecutive to center-based rehabilitation. All studies adopted asynchronous communication in TR, mainly providing monitoring/assessment, decisions, and offline feedback. Few studies reported mortality, and none reported data about re-hospitalization or morbidity. Adherence to the CTR and CRh interventions was high (over 80%). The meta-analyses showed the superior effect of CTR compared to CI in exercise capacity. An overall noninferiority effect of both CTR and CRh compared to CI was found with factors including risk control and participation. Conclusions: The results of the review and meta-analyses indicated that CTR and CRh are equally effective, safe, convenient, and valid alternatives to cardiac conventional interventions. The evidence suggests that telerehabilitation may represent a valid alternative to overcome cardiac rehabilitation barriers.

The Impact of a Pediatric Continuity Care Intensivist Program on Patient and Parent Outcomes: An Unblinded Randomized Controlled Trial.

Objectives We studied the impact of a standardized continuity care intensivists (CCIs) program on patient and family outcomes for long-stay patients in the pediatric intensive care unit (PICU), also assessing the intervention's acceptability and feasibility. Methods A patient-level, unblinded randomized-controlled trial in a PICU at a large children's hospital. Participants included: (1) patients with ≥ 7 days PICU admission and likely to stay another 7 days; (2) their parents; (3) PICU attendings participating as continuity attendings; and (4) PICU attendings providing usual care (UC). We examined a bundled intervention: (1) standardized continuity attending role, (2) communication training course for CCI, and (3) standardized timing of contact between CCI and patient/family. Results Primary outcome was patient PICU length of stay. Secondary outcomes included patient, parental, and clinician outcomes. We enrolled 115 parent-patient dyads (231 subjects), 58 patients were randomized into treatment arm and 56 into the UC arm. Thirteen attendings volunteered to serve as CCI, 10 as UC. No association was found between the intervention and patient PICU length of stay ( p = 0.5), other clinical factors, or parental outcomes. The intervention met a threshold for feasibility of enrollment, retention, and implementation while the majority of providers agreed the intervention was acceptable with more efficient decision making. Thirty percent CCIs felt the role took too much time, and 20% felt time was not worth the benefits. Conclusion CCI intervention did not impact patient or family outcomes. PICU attendings believed that the implementation of the CCI program was feasible and acceptable with potential benefits for efficiency of decision making.

Observations of substance use treatment engagement during the period of community re-entry following residential treatment.

BACKGROUND: The period of community re-entry following residential substance use treatment is associated with elevated risk for return to substance use. Although continuity of care is best practice, many individuals do not engage in follow-up treatment, struggle to engage in follow-up treatment, or continue to use substances while participating in follow-up treatment. There is a need to both characterize treatment engagement during community re-entry following residential substance use treatment as well as understand how treatment impacts substance use during this high-risk period. METHOD: This observational study used retrospective self-report to examine treatment engagement and substance use among individuals who had exited residential substance use treatment. Participants completed a Timeline Follow-back interview reporting substance use and treatment engagement in the 30 days following residential treatment. RESULTS: Most participants (83.1 %) reported engaging in substance use treatment following discharge. The most common treatments were Alcoholics Anonymous/Narcotics Anonymous (61.1 %), medication for addiction treatment (40 %), and outpatient therapy (29.2 %). Participants were less likely to use substances on a day in which they engaged in outpatient therapy (OR = 0.32, 95 % CI [0.12, 0.90], p = 0.030) and more likely on days they engaged in medication treatment (OR = 21.49, 95 % CI [1.46, 316.74], p = 0.025). CONCLUSION: Findings characterize engagement in substance use treatment in the month following residential treatment. Treatment engagement was common during community re-entry; however, only outpatient therapy was found to reduce substance use during this high-risk period. Findings may inform intervention efforts during the high-risk period of community re-entry.

A scoping review of hospital to home transitional care programmes for stroke survivors.

AIM: The study was aimed at exploring the current scope of hospital to home transitional care programmes for stroke survivors. BACKGROUND: Stroke survivors face the dilemma of solving many complex problems that leave survivors at high risk for readmission as they discharge from hospital. The transitional care model has proved to be effective in reducing readmissions and mortality, thereby improving health outcomes and enhancing patient satisfaction for survivors with stroke. DESIGN: A scoping review. METHODS: Conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCES: A comprehensive search was conducted in nine databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL, Medline, China Knowledge Net-work, Wanfang Database and China Biomedical Literature Database (SinoMed) from January 2014 to June 2023. RESULTS: Title and abstract screening was performed on 10,171 articles resulting in 287 articles for full-text screening. Full-text screening yielded 49 articles that met inclusion criteria. CONCLUSION: This study identified transitional care programmes for stroke survivors, as well as areas for future consideration to be explored in more depth to help improve transitional care for stroke survivors as they transition from hospital to home. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study demonstrates that multidisciplinary collaboration becomes an integral part of the transitional care model for stroke survivors, which provides comprehensive and precise medical care to them. REPORTING METHOD: PRISMA checklist for scoping reviews. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution was part of this study.

Transitional care for older persons with need of geriatric rehabilitation nursing interventions.

BACKGROUND: The literature review notes that people in need of care from Rehabilitation Programs do not always see their continuity ensured. OBJECTIVE: This study aim to analyze the perspective of Specialists Nurse in Rehabilitation Nursing in relation to the organization and specialized intervention of transitional care for older people in need of rehabilitation programs. METHODS: This is a qualitative study within the interpretivist paradigm. A focus group with 8 nurses and 13 interviews with Portuguese nurses were carried out between April 2022 and February 2023. Content analysis was carried out. RESULTS: The triangulation of the data made it possible to identify 3 categories: Coordination of a transitional care program; Empowering the person to self-manage the transitional care process and Empowering the Informal Caregiver. CONCLUSIONS: It is imperative to promote the coordination of transitional care, increase the functional capacity of the person and empower the informal caregiver.

Challenges related to transitioning from hospital to temporary care at a skilled nursing facility: a descriptive study.

PURPOSE: With decreasing number of hospital beds, more citizens are discharged to temporary care at skilled nursing facilities, requiring increasingly complex care in a non-hospital setting. We mapped challenges related to the transition of citizens from hospital to temporary care at a skilled nursing facility in relation to medication management, responsibility of medical treatment, and communication. METHODS: Descriptive study of citizens discharged from Odense University Hospital to temporary care from May 2022 to March 2023. RESULTS: We included 209 citizens (53% women, median age 81 years). Most citizens (97%; n = 109/112) had their medication changed during hospital admission. Citizens used a median of eight medications, including risk medications (96%, n = 108). Medication-related challenges occurred for 37% (n = 77) of citizens and most often concerned missing alignment of medication records. Half of citizens (47%, n = 99) moved into temporary care with all medication needed for further dispensing. Nurses conducted in median three telephone calls (interquartile range [IQR 1-4]) and sent in median two correspondences (IQR 1-3) per citizen within the first 5 days. Nurses most often called the hospital physician (41% of telephone calls, n = 265/643) and sent correspondences to the general practitioner (55% of correspondences, n = 257/469). For 31% (n = 29/95) of citizens requiring action from nursing staff, this could have been avoided if the nurses had had access to the discharge letter. CONCLUSION: We identified several challenges related to the transition of patients from hospital to temporary care, most often related to medication. A third of actions related to medication management were considered avoidable with improved practices around communication.

The Impact of Structural Racism on Continuity of Care at Pediatric Academic Primary Care Clinics.

OBJECTIVE: Using a structural racism framework, we assessed racial inequities in continuity of care, using the Usual Provider Continuity Index (UPC - the proportion of visits with the provider the patient saw most frequently out of all visits), in a set of large pediatric academic clinics. METHODS: We conducted a retrospective cohort study. Patients 12-24 months seen at three pediatric academic primary care clinics for any visit during October 1-31, 2021 were included. We then reviewed continuity for these patients in the preceding 12 months. Outcomes included each patient's UPC for all visits, and a modified UPC for well child checks only (UPC Well). Covariates included race, ethnicity, insurance, clinic site, age, sex, care management, or seeing a social worker. We evaluated for differences in outcomes using bivariate analyses and multivariable regression models. RESULTS: Our cohort included 356 patients (74% Black, 5% Hispanic, 85% Medicaid, 52% female, median age 15.8 months). The median UPC was 0.33 and median UPC Well was 0.40. Black patients had significantly lower median values for UPC (0.33 Black vs 0.40 non-Black, P < .01) and UPC Well (0.33 Black vs 0.50 non-Black, P < .01). There were similar inequities in continuity rates by insurance and clinic site. In multivariable models, clinic site was the only variable significantly associated with continuity. CONCLUSIONS: Clinic sites serving higher percentages of Black patients had lower rates of continuity. The main driver of racial inequities in continuity rates was at the institutional level.

A beautiful bush space on Country: Indigenous women's perspectives on the cultural significance of a placenta garden.

BACKGROUND: Australian Aboriginal and Torres Strait Islanders, hereafter respectfully referred to as First Nations women, often experience maternity care incongruent with their cultural needs. To date, there is limited research on First Nations women's perceptions of the role that placental burial and a placenta garden may play in promoting connection to culture for women and their babies. AIM: This study aimed to understand First Nations women's perceptions of placenta burial and a dedicated placenta garden in supporting connection to their culture. METHODS: In this qualitative descriptive study, decolonising methods were used to recruit eight First Nations women using message stick sampling via First Nations mentors. Stories were told through yarns using a semi-structured yarning guide. Reflexive thematic analysis led to theme generation. Member-checking of preliminary themes by participants and endorsement by First Nations mentors occurred before finalisation of themes. FINDINGS: Four themes captured the women's perspectives on the significance of placental burial and gardens. Recognising the Barriers explores factors impacting on culture and maternity care experiences. Enabling Continuity of Care describes a desire to work with a midwife towards a continuum throughout the perinatal period. Promoting Connection for Mum and Baby explores how the placenta garden can act as a conduit for connection. Finally, Creating Opportunity for Healing describes the essential healing that can be initiated through engaging in cultural placental burial. CONCLUSION: First Nations women described placental burial as essential to strengthening their connection to culture and perceived that continuity of care with a culturally knowledgeable midwife facilitated connection.

The performance of general practice in the English National Health Service (NHS): an analysis using Starfield's framework for primary care.

General practice in the English National Health Service (NHS) is in crisis. In response, politicians are proposing fundamental reform to the way general practice is organized. But ideas for reform are contested, and there are conflicting interpretations of the problems to be addressed. We use Barbara Starfield's "4Cs" framework for high-performing primary care to provide an overall assessment of the current role and performance of general practice in England. We first assessed theoretical alignment between Starfield's framework and the role of general practice in England. We then assessed actual performance using publicly available national data and targeted literature searches. We found close theoretical alignment between Starfield's framework and the model of NHS general practice in England. But, in practice, its model of universal comprehensive care risks being undermined by worsening and inequitable access, while continuity of care is declining. Underlying causes of current challenges in general practice in England appear more closely linked to under-resourcing than the fundamental design of the system. General practice in England must evolve, but wholesale re-organization is likely to damage and distract. Instead, policymakers should focus on adequately resourcing general practice while supporting general practice teams to improve the quality and coordination of local services.

General practice is the foundation of the UK's National Health Service (NHS). But these foundations are creaking. More and more people need care, but there are fewer general practitioners (GPs). Job satisfaction for doctors is falling, and public satisfaction with general practice has plummeted. Politicians are promising major changes to the way general practice is organized, but it's not clear what these changes will be. We wanted to understand whether fundamental changes to the whole model of general practice in England are needed. To do this, we measured the performance of general practice in England against a set of features, widely regarded as defining the characteristics of high-performing primary care systems. We found that, although, in theory, the design of English general practice aligns well with these features, in practice, performance is less good and is getting worse. In particular, people are struggling to access care, and their ability to see the same doctor regularly is declining. There are also unfair differences between population groups. We conclude that the crisis in English general practice has more to do with previous policy decisions and longstanding lack of funding than the fundamental design of NHS general practice. Policymakers should focus on giving the system enough resources and supporting GPs to improve the quality of local services.

The Association of Physiotherapy Continuity of Care with Duration of Time Loss Among Compensated Australian Workers with Low Back Pain.

PURPOSE: The aims of this study are to determine how continuous the care provided by physiotherapists to compensated workers with low back pain is, what factors are associated with physiotherapy continuity of care (CoC; treatment by the same provider), and what the association between physiotherapy CoC and duration of working time loss is. METHODS: Workers' compensation claims and payments data from Victoria and South Australia were analysed. Continuity of care was measured with the usual provider continuity metric. Binary logistic regression examined factors associated with CoC. Cox regression models examined the association between working time loss and CoC. RESULTS: Thirty-six percent of workers experienced complete CoC, 25.8% high CoC, 26.1% moderate CoC, and 11.7% low CoC. Odds of complete CoC decreased with increased service volume. With decreasing CoC, there was significantly longer duration of compensated time loss. CONCLUSION: Higher CoC with a physiotherapist is associated with shorter compensated working time loss duration for Australian workers with low back pain.

"I do not know the advantages of having a general practitioner" - a qualitative study exploring the views of low-acuity emergency patients without a regular general practitioner toward primary care.

BACKGROUND: Emergency departments (ED) worldwide have to cope with rising patient numbers. Low-acuity consulters who could receive a more suitable treatment in primary care (PC) increase caseloads, and lack of PC attachment has been discussed as a determinant. This qualitative study explores factors that contribute to non-utilization of general practitioner (GP) care among patients with no current attachment to a GP. METHOD: Qualitative semi-structured telephone interviews were conducted with 32 low-acuity ED consulters with no self-reported attachment to a GP. Participants were recruited from three EDs in the city center of Berlin, Germany. Data were analyzed by qualitative content analysis. RESULTS: Interviewed patients reported heterogeneous factors contributing to their PC utilization behavior and underlying views and experiences. Participants most prominently voiced a rare need for medical services, a distinct mobility behavior, and a lack of knowledge about the role of a GP and health care options. Views about and experiences with GP care that contribute to non-utilization were predominantly related to little confidence in GP care, preference for directly consulting medical specialists, and negative experiences with GP care in the past. Contrasting their reported utilization behavior, many interviewees still recognized the advantages of GP care continuity. CONCLUSION: Understanding reasons of low-acuity ED patients for GP non-utilization can play an important role in the design and implementation of patient-centered care interventions for PC integration. Increasing GP utilization, continuity of care and health literacy might have positive effects on patient decision-making in acute situations and in turn decrease ED burden. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00023480; date: 2020/11/27.

Hospital Readmission Rates for Patients Receiving In-Person vs. Telemedicine Discharge Follow-Up Care.

INTRODUCTION: Unplanned readmissions can be avoided by standardizing and improving the coordination of care after discharge. Telemedicine has been increasingly utilized; however, the quality of this care has not been well studied. Standardized measures can provide an objective comparison of care quality. The purpose of our study was to compare quality performance transitions of care management in the office vs telemedicine. METHODS: The Epic SlicerDicer tool was used to compare the percentage of encounters that were completed via telemedicine (video visits); or via in-person for comparison, Chi-squared tests were used. RESULTS: A total of 13,891 patients met the inclusion criteria during the study time frame. There were 12,846 patients in the office and 1,048 in the telemedicine cohort. The office readmission rate was 11.9% with 1,533 patients out of 12,846 compared with telemedicine with the rate of readmission at 12.1% with 126 patients out of 1,045 patients. The P-value for the Chi-squared test between the prepandemic and study time frame was 0.15 and 0.95, respectively. Demographic comparability was seen. DISCUSSION: Our study found a comparable readmission rate between patients seen via in-office and telemedicine for Transitions of Care Management (TCM) encounters. The findings of this study support the growing body of evidence that telemedicine augments quality performance while reducing cost and improving access without negatively impacting HEDIS performance in health care systems. CONCLUSION: Telemedicine poses little threat of negatively impacting HEDIS performance and might be as effective as posthospitalization traditional office care transitions of care management.

Managing Multiple Chronic Conditions during COVID-19 Among Patients with Social Health Risks.

BACKGROUND: Optimal care for persons with multiple chronic conditions (MCC) requires primary and specialty care continuity, access to multiple providers, social risk assessment, and self-management support. The COVID-19 pandemic abruptly changed primary care delivery to increase reliance on telehealth and virtual care. We report on the experiences of individuals with MCC and their family caregivers on managing their health and receiving health care during the initial pandemic. METHODS: Semistructured qualitative interviews with 30 patients (19 English speaking, 11 Spanish speaking) plus 9 accompanying care partners, who had 2+ primary care encounters between March 1, 2020, and November 30, 2020, 2+ chronic conditions, and 1 or more self-reported social risks. Questions focused on access to and experiences with care, roles for care partners, and self-management during the first 6 months of the pandemic. RESULTS: Participants experienced substantial changes in care delivery. The most commonly reported changes were a shift to more virtual relative to in-person care and shifting roles for care partners. Changes fostered new perspectives on self-management and an appreciation of personal resilience and self-reliance. Virtual care was an acceptable complement to in-person care, though not a substitute for periodic in-person visits. It was more acceptable for English speakers and with a usual provider. CONCLUSION: New models of care delivery that recognize patient and family resilience and resourcefulness, emphasize provider continuity, and combine virtual and in-person care may support self-management for individuals with MCC and social needs.

Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes.

BACKGROUND: Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients' perspectives of their medications from hospital to two months after discharge. METHODS: Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted. RESULTS: Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence. CONCLUSIONS: The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients' difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients' needs, increase their safety, and standardize physicians', pharmacists', and nurses' roles and responsibilities.

The Needs of Patients With Chronic Disease in Transitional Care From Hospital to Home in Sudan: A Qualitative Study.

The growing burden of chronic non-communicable diseases demands improved post-discharge care. The Sudanese healthcare system faces challenges in providing coordinated care for patients with chronic conditions after hospital discharge. This qualitative study explored the experiences of patients with chronic disease in transitional care from hospital to home to identify improvement targets. Purposive sampling was used to interview 17 participants from different hospitals in Khartoum, Sudan. Audio recordings were transcribed and analyzed using principles of content analysis to identify themes and the relationship between them. Thematic analysis revealed 4 main themes describing the perceived needs of the patients. These were (1) feeling well-informed about post-discharge care goals and plans; (2) feeling cared for during hospital admission and follow-up visits; (3) feeling safe during the transitional care process; and (4) having access to follow-up services. This study highlights the importance of improving hospital patient education through effective communication to facilitate care transitions.

Enabling patient-physician continuity in Swedish primary care: the importance of a named GP.

BACKGROUND: Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity. AIM: To examine if patients who were registered with a named GP at the onset of their first chronic disease had higher continuity at subsequent visits than patients who were only registered at a practice. DESIGN & SETTING: Registry-based observational study in Region Skåne, Sweden. The study population included 66,063 patients registered at the same practice at least 1 year before the first chronic condition onset in 2009-2015. METHOD: We compared patients registered with a named GP with patients only registered at a practice over a four-year follow-up period. The primary outcome was the Usual Provider of Care (UPC) index, for all visits and for visits related to the chronic disease. Secondary outcomes were the number of GP, nurse and out-of-hours visits, ED visits, hospital admissions, and mortality. We used linear regression models, adjusted for patient characteristics (using entropy balancing weights) and for practice-level fixed effects. RESULTS: Patients with a named GP at onset had 3-4 percentage points higher UPC, but the difference decreased and was not statistically significant after adjusting for patient and practice characteristics. Patients with a named GP made more visits, though not for the chronic condition. There were no statistically significant differences for the other outcomes. CONCLUSION: Registration with a GP at onset does not imply higher continuity at visits and is not linked to other relevant outcomes for patients diagnosed with their first chronic condition.

The Impact of Primary Care Clinic and Family Physician Continuity on Patient Health Outcomes: A Retrospective Analysis From Alberta, Canada.

PURPOSE: Continuity of care is broadly associated with better patient health outcomes. The relative contributions of continuity with an individual physician and with a practice, however, have not generally been distinguished. This retrospective observational study examined the impact of continuity of care for patients seen at their main clinic but by different family physicians. METHODS: We analyzed linked health administrative data from 2015-2018 from Alberta, Canada to explore the association of physician and clinic continuity with rates of emergency department (ED) visits and hospitalizations across varying levels of patient complexity. Physician continuity was calculated using the known provider of care index and clinic continuity with an analogous measure. We developed zero-inflated negative binomial models to assess the association of each with all-cause ED visits and hospitalizations. RESULTS: High physician continuity was associated with lower ED use across all levels of patient complexity and with fewer hospitalizations for highly complex patients. Broadly, no (0%) clinic continuity was associated with increased use and complete (100%) clinic continuity with decreased use, with the largest effect seen for the most complex patients. Levels of clinic continuity between 1% and 50% were generally associated with slightly higher use, and levels of 51% to 99% with slightly lower use. CONCLUSIONS: The best health care outcomes (measured by ED visits and hospitalizations) are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable. The effect of partial clinic continuity appears complex and requires additional research. These results provide some reassurance for part-time and shared practices, and guidance for primary care workforce policy makers.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland.

BACKGROUND: Handovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. METHODS: After ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. MAIN FINDINGS: A total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. CONCLUSIONS: Surgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.