Quality in primary care (Qual Prim Care)

Publisher: Radcliffe Medical Press

Journal description

Quality in Primary Care (formerly The Journal of Clinical Governance) is the first European journal devoted solely to the topic of quality in primary healthcare. The journal is concerned with all aspects of quality in primary care and the interfaces between primary and secondary, and primary care and social care.

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Website Quality in Primary Care website
Other titles Quality in primary care (Online), Quality in primary care
ISSN 1479-1072
OCLC 55061615
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Radcliffe Medical Press

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The number of tests ordered in primary care continues to increase influenced by a number of factors not all of which are concerned with diagnosis and management of disease. Liver function tests (LFTs) are a good example of inexpensive tests that are frequently ordered in patients with non-specific symptoms. They remain among the most frequently ordered tests despite their lack of specificity yet the full range of motives behind the decision to order an LFT remains unexplored. To gain an understanding of the family practitioner's (FP) medical and non-medical motives for ordering an LFT and the influence of various social and technical factors on this decision. We interviewed FPs across six practices who were participating in a prospective study of the efficacy of an abnormal LFT to indicate the development of a serious liver disease. Following content analysis of the data from the semi-structured interviews we used the 'attitude-social influence-efficacy' model to categorise the determinants of test ordering behaviour. Factors influencing an FP's decision to order a test were grouped into two broad categories; the first is 'internal' including expectation of efficacy and general attitude towards LFTs. The second group is 'external' and consists of themes of social influence, tests characteristics and defensive medicine. Whilst our sample acknowledged the clinical use of LFTs such as the routine monitoring of medication and liver-specific diagnostic purposes we also found that social and behavioural reasons are strong motivators to order an LFT and may take precedence over clinical factors.
    Quality in primary care 08/2014; 22(4):201-10.
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    ABSTRACT: NHS policy documents continue to make a wide-ranging commitment to patient involvement. The Patient Participation Direct Enhanced Service (PP-DES), launched in 2011, aimed to ensure patients are involved in decisions about the range and quality of services provided and commissioned by their practice through patient reference groups (PRGs). The aim of this exploratory study is to review the impact of the PP-DES (2011-13) on a sample of PRGs and assess how far it has facilitated their involvement in decisions about the services of their general practices. A qualitative methods design, using semi- structured interviews and focus groups, was employed to explore the experiences and views of GP practice staff (n = 24), PRG members (n = 80) at 12 GP practices, and other stakeholders (n = 4). Wide variation in the role and remit of the participating PRGs was found, which broadly ranged from activities to improve practice resources to supporting health promotion activities. The majority of PRG members were unfamiliar with the PP-DES scheme and its aims and purpose. Stakeholders and practice staff felt strongly that the main success of the PP-DES was that it had led to an increase in the number of PRGs being established in the locality. The PP-DES scheme has been a catalyst to establish PRGs. However, the picture was mixed in terms of the PRGs involvement in decisions about the services provided at their general practice as there was wide variation in the PRGs role and remit. The financial incentive alone, provided via the DES scheme, did not secure greater depth of PRG activity and power, however, as social factors were identified as playing an important role in PRGs' level of participation in decision making. Many PRGs have to become more firmly established before they are involved as partners in commissioning decisions at their practice.
    Quality in primary care 08/2014; 22(4):189-99.
  • Quality in primary care 08/2014; 22(4):173-5.
  • Quality in primary care 08/2014; 22(4):171-2.
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    ABSTRACT: The substantial prevalence of bacterial lower urinary tract infections (LUTIs) in out-of-hours (OOH) primary care is a reason for frequent prescription of antibiotics. Insight in guideline adherence in OOH primary care concerning treatment of LUTIs is lacking. To check feasibility of the use of OOH routine data to assess guideline adherence for the treatment of LUTI in OOH primary care, in different regions of Europe. We compared guidelines for diagnosis and treatment of uncomplicated LUTIs in nine European countries, followed by an observational study on available data of guideline adherence. In each region a convenience sample of registration data of at least 100 contacts per OOH primary care setting was collected. Data on adherence (% of contacts) was identified for type of antibiotic and for full treatment adherence (i.e. recommended type and dose and duration). Six countries were able to provide data on treatment of LUTIs. Four of them succeeded to collect data on type, dosage and duration of treatment. Mostly, trimethoprim was the treatment of first choice, sometimes combined with sulfamethoxazol or sulfamethizol. Adherence with the type of antibiotics varied from 25% to 100%. Denmark achieved a full treatment adherence of 40.0%, the Netherlands 72.7%, Norway 38.3%, and Slovenia 22.2%. Guidelines content is similar to a large extent in the participating countries. The use of OOH routine data for analysis of guideline adherence in OOH primary care seems feasible, although some challenges remain. Adherence regarding treatment varies and suggests room for improvement in most countries.
    Quality in primary care 08/2014; 22(4):221-31.
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    ABSTRACT: A recent systematic review suggests that practice facilitation (PF) is a robust intervention for implementing evidence-based preventive care guidelines in primary care, but the ability of PF to improve chronic illness care remains unclear. To examine the specific activities and Chronic Care model (CCM) components that primary care practices implemented and sustained in response to a 12-month PF intervention. The ABC trial tested the effectiveness of PF to improve care for diabetes in 40 small community-based primary care practices that were randomized to "initial" or "delayed" intervention arms. A trained facilitator met with each practice over 12-months. Facilitators used interactive consensus building to help practices implement one or more of quality improvement activities based on the CCM. Facilitators prospectively recorded implementation activities reported by practice teams during monthly meetings and confirmed which of these were sustained at the end of the intervention. 37 practices implemented and sustained a total of 43 unique activities [range 1-15, average 6.5 (SD=2.9)]. The number (%) of practices that implemented 1 or more key activities in each CCM component varied: Patient Self-Management Support: 37 (100%); Clinical Information Systems: 24 (64.9%), Delivery System Design: 14 (37.8%), Decision Support: 13 (35.1%), Community Linkages: 2 (5.4%); Healthcare System Support: 2 (2.7%). The majority of practices (59%) only implemented activities from 1 or 2 CCM components. The number of sustained activities was associated with the number of PF visits, but not with practice characteristics. In spite of the PF intervention, it was difficult for these small practices to implement comprehensive CCM changes. Although practices implemented and sustained a remarkable number and variety of key activities, the majority of these focused on patient self-management support, as opposed to other components of the CCM, such as clinical information systems, decision support, delivery system redesign, and community linkages.
    Quality in primary care 08/2014; 22(4):211-219.
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    ABSTRACT: Among medication reconciliation studies, varying methods are used to determine which medications patients are actually taking. One recommended approach is to ask patients to "brown bag" their medications for routine office visits. To determine if 'brown bag' practices performed during routine office visits improve the accuracy of provider-documented medication lists. This cross-sectional pilot study was conducted in a university affiliated community geriatric clinic. Forty-six cognitively intact elders who managed their own medications enrolled. Participants self-selected into two groups: 'brown-baggers' (BBs) and 'non-brown-baggers' (NBBs). Three medication lists were compared for each patient: provider-documented in patient's chart (chart list); researcher-generated by post-appointment semistructured interview (point-of-care [POC] list); post-appointment semi-structured telephone interview (telephone list, reference standard). Accuracy of chart and POC lists were compared with reference lists among BBs and NBBs. Thirty-three (72%) patients brought some of their medications to scheduled appointments (BBs); of these, 39% bagged all of their medications. Excluding route as a variable, 35% of provider-documented chart lists were complete; only 6.5% were accurate. Some 76% of chart-documented medication lists contained inclusion, omission and/or dosing instruction discrepancies, with no differences between BBs and NBBs. However, POC lists obtained using a semi-structured interview included fewer inclusion and omission discrepancies among BBs than NBBs (42% v 77%, P = 0.05). In subset analyses by medication type, over-the-counter (OTC) medication documentation was more accurate among BBs than NBBs. Overall, chart lists contained two to three times more discrepancies than lists generated at POC. Most BBs do not bag all their medications for office visits. Chart list accuracy is no better among BBs than NBBs, although patients who 'brown bag' their medications for office visits may prompt providers to conduct a more thorough medication history. Lists generated by semistructured interviewing, regardless of BB status, are more accurate than chart lists. Findings challenge benefits of the 'brown bag' unless coupled with in-depth questioning and processes for transferring information to chart lists.
    Quality in primary care 08/2014; 22(4):177-87.
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    ABSTRACT: Treatment fidelity has previously been defined as the degree to which a treatment or intervention is delivered to participants as intended. Underreporting of fidelity in primary care randomised controlled trials (RCTs) of complex interventions reduces our confidence that findings are due to the treatment or intervention being investigated, rather than unknown confounders. We aimed to investigate treatment fidelity (for the purpose of this paper, hereafter referred to as intervention fidelity), of an educational intervention delivered to general practice teams and designed to improve the primary care management of insomnia. We conducted telephone interviews with patients and practitioners participating in the intervention arm of the trial to explore trial fidelity. Qualitative analysis was undertaken using constant comparison and a priori themes (categories): 'adherence to the delivery of the intervention', 'patients received and understood intervention' and 'patient enactment'. If the intervention protocol was not adhered to by the practitioner then patient receipt, understanding and enactment levels were reduced. Recruitment difficulties in terms of the gap between initially being recruited into the study and attending an intervention consultation also reduced the effectiveness of the intervention. Patient attributes such as motivation to learn and engage contributed to the success of the uptake of the intervention. Qualitative methods using brief telephone interviews are an effective way of collecting the depth of data required to assess intervention fidelity. Intervention fidelity monitoring should be an important element of definitive trial design. ClinicalTrials. gov id isrctn 55001433 - www.controlled-trials.com/isrctn55001433.
    Quality in primary care 02/2014; 22(1):25-34.
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    ABSTRACT: This is the fifth in a series of papers about the science of quality improvement. In this paper, we explore the issue of healthcare as a system and how this contributes to our understanding of how to spread improvement.
    Quality in primary care 02/2014; 22(1):7-10.
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    ABSTRACT: Homeopathy is one of the most frequently used areas of complementary and alternative medicine (CAM). Previous research has focused in particular on the pharmacological effectiveness of homeopathy. There is intense discussion among German family medical practitioners as to whether family medicine should adopt elements of homeopathy because of the popularity of this treatment method. For the first time in Germany, patients with chronic conditions were asked about their views on the medical care provided by homeopathic medical practitioners. The survey used questionnaire-based, semi-structured expert interviews, the contents of which were then analysed and summarised. A total of 21 women and five men aged from 29 to 75 years were surveyed. The 'fit' between therapist and patient proved to be particularly important. Both the initial homeopathic consultation and the process of searching for the appropriate medication were seen by patients as confidence-inspiring confirmations of the validity of homeopathic therapy which they considered desirable in this personalised form. The possible adoption by family medicine of elements of homeopathy may be seen as controversial, but this study again indicates the vital importance of successful communication to ensure a sustainable doctor-patient relationship. Advances in this sector not only require continuous efforts in the areas of medical training and professional development, but also touch on basic questions relating to the development of effective medical care, such as those currently being discussed in the context of the 'patient-centred medical home'.
    Quality in primary care 02/2014; 22(1):17-24.
  • Quality in primary care 02/2014; 22(1):3-5.
  • Quality in primary care 02/2014; 22(1):1-2.
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    ABSTRACT: The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date. The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system. The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level, users view key performance indicators based on national standards of diabetes care established by KSeHIN. The national childhood registry (CODeR) accumulates approximately 300 children a year. The adult registry (KHN), implemented in four primary healthcare centres in 2013, has approximately 4000 registered patients, most of whom are not yet meeting national clinical targets. A credit-bearing postgraduate educational programme provides module-based teaching and workplace-based projects. In addition, a new clinical skills centre provides simulator-based training. Over 150 masters students from throughout Kuwait are enrolled and over 400 work-based projects have been completed to date. KSeHIN represents a successful collaboration between multiple stakeholders working across traditional boundaries. It is targeting patient outcomes, system performance and professional development to provide a sustainable transformation in the quality of diabetes healthcare for the growing population of Kuwaitis with diabetes in Kuwait.
    Quality in primary care 02/2014; 22(1):43-51.
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    ABSTRACT: Expanding clinical teaching opportunities is essential for securing a sustainable health workforce. Although Tasmanian general practitioners (GPs) are keen to provide learning opportunities for medical students, they have identifed time pressures due to a need to meet patient service demand and a need for more guidance on effective clinical teaching, as factors impacting their ability to increase clinical supervision. By developing a clinical audit activity, we delivered an educational resource that did not require direct GP supervision yet provided meaningful learning outcomes for students. Through systematically reviewing patient records it was hoped that students would strengthen practicebased quality improvement activities, thus 'giving back' to their placement practice. A clinical audit curriculum was developed for fourth-year medical students at the Launceston Clinical School (n = 46) and implemented during their general practice rotation. This included a lecture and tutorial, and structured activities based on an audit of diabetes care. Preparation and support was provided to GP supervisors and practice staff through ongoing practice visits conducted by school academics. Implementation of the curriculum within general practice was evaluated through focus groups conducted with staff from five training practices (n = 29). Evaluation of student experiences is ongoing. This paper reports on the experiences of general practice supervisors and other practice staff. GPs and practice staff responded positively, indicating that the syllabus provided novel teaching opportunities and a modest contribution to improving patient records and patient care. Major learning opportunities identified included the development of skills working with patient records and practice software, and understanding the importance of accurate and reliable medical records for the optimal delivery of patient care. Conducting clinical audit provides students with novel learning opportunities while also strengthening the capacity of teaching general practices to provide clinical placements. Students learnt about the importance of monitoring professional practice using systematic clinical audit, and the complexities of managing patients within primary care. In so doing, they enhanced the robustness and rigor of patient records within their placement practice.
    Quality in primary care 02/2014; 22(1):35-41.
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    ABSTRACT: The patient perspective is central to quality improvement. This article describes how health services are involving individuals and the public in improving healthcare. It describes the importance and different methods of accessing patient and carer feedback on satisfaction, experience and outcomes, and explores current thinking on individual involvement, engagement in commissioning, and the role of the public in redesigning health services.
    Quality in primary care 02/2014; 22(1):11-5.
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    ABSTRACT: Professional bodies have long overseen the maintenance of standards of training and practice within the different healthcare professions. Organisational regulation of healthcare in England comprises two main elements: regulation of the quality and safety of care offered by healthcare providers, currently undertaken by the Care Quality Commission (CQC); and regulation of the market in healthcare services, currently the responsibility of Monitor and the Department of Health. The eighth in the series, this article considers the expanding roles of newer bodies, particularly in relation to primary care. The cost-effectiveness of these new arrangements is unknown - and possibly unknowable.
    Quality in primary care 01/2014; 22(2):57-61.
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    ABSTRACT: The success of immunisation programmes depends on the quality with which they are administered. The Vaccine Advice for CliniCians Service (VACCSline) is an advice service to support immunisers and promote excellence in immunisation practice, through specialist guidance and local education, covering a catchment population of two million people. All enquiries are recorded onto a database and categorised. Vaccine error is selected when a vaccine has not been prepared or administered according to national recommendations or relevant expert guidance.
    Quality in primary care 01/2014; 22(3):139-46.
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    ABSTRACT: Evaluating quality improvement interventions requires a variety of methods. These range from quantitative methods, such as randomised controlled trials, to quasi-experimental (controlled before-and-after and interrupted time series) and uncontrolled before-and-after studies, including clinical audits, to determine whether improvement interventions have had an effect. Qualitative methods are often also used to understand how or why an intervention was successful and which components of a complex or multifaceted intervention were most effective. Finally, mixed methods designs such as action research or case study methods are widely used to design and evaluate improvement interventions.
    Quality in primary care 01/2014; 22(2):63-70.
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    ABSTRACT: EUprimecare is a study funded by the Seventh Framework Programme of the European Union, aimed at analysing the quality of the different models of primary care in Europe. The objective of this study was to describe and analyse the determinants associated with patient satisfaction in primary care in Europe.
    Quality in primary care 01/2014; 22(3):147-55.