Implementing Whole Person Primary Care.
Ontology highlight
ABSTRACT:
SUBMITTER: Rosenbaum E
PROVIDER: S-EPMC10042571 | biostudies-literature | 2023 Mar-Apr
REPOSITORIES: biostudies-literature
Publications
Implementing Whole Person Primary Care.
Rosenbaum Elena E Gordon Andrea E AE Cresta Jake J Shaughnessy Allen F AF Jonas Wayne B WB
Annals of family medicine 20230301 2
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Project description:Adverse childhood experiences (ACEs) and social determinants of health (SDOH) negatively affect health outcomes. This program was developed to screen for ACEs and SDOH in the primary care setting in families with children 9 months to 5 years of age at well-child checks and provide interventions that support families and build resiliency. Programmatic criteria were identified, referral resources were developed, and a database was implemented, with 246 families enrolled in year 1; 56.9% of caregivers reported 1 or more ACEs for their child, 63% of caregivers reported an SDOH need, and 39.4% of caregivers reported both. The average number of ACEs was 0.94. This program was created to address ACEs and SDOH, to empower families, build resiliency, and provide buffers to mitigate and prevent ACEs. It provides a model that can be implemented in a primary care setting while providing wraparound resources, including integrated mental health resources and referrals, to measure the success of these interventions.
| S-EPMC9315173 | biostudies-literature
Project description:ObjectivePerson-centered care is a key quality indicator and central to promoting integrated and recovery-oriented services. Person-centered care planning (PCCP) is a manualized intervention promoting the collaborative cocreation of a recovery-oriented care service plan on the basis of an individual's most valued life goals. This cluster randomized controlled trial tested the effect of PCCP training on person-centered care delivery in community mental health clinics.MethodsFourteen clinic sites were randomly assigned to receive either PCCP training (N=7; experimental condition) or service planning as usual (N=7; control condition). Data were collected from online surveys, and service plans were completed by 60 provider teams. The Person-Centered Care Planning Assessment Measure was administered via chart review at baseline, 12 months, and 18 months, and surveys were used to measure supervision, implementation leadership, and program type. The main effect was examined with linear mixed-effects regression models, with observations over time.ResultsAnalyses controlling for service user and program characteristics revealed that at 12 months, the group assigned to PCCP training showed significant improvements in delivering person-centered care compared with the control group (b=1.10, SE=0.50, p=0.03). At 18 months, this effect was even more pronounced (b=1.47, SE=0.50, p=0.01), representing a medium-to-large effect size of d=0.71 (95% confidence interval=0.23-1.20).ConclusionsThese findings indicate that training providers in PCCP increases provider competency in delivering person-centered care. Using an objective measure of person-centered care, the authors show that a comprehensive training strategy can target both the philosophical shift and the technical skills needed to promote client recovery.
| S-EPMC8192424 | biostudies-literature
Project description:Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for "Whole Health Veterans Administration," "integrative medicine," "integrative health," "complementary and alternative medicine," and, as they related to the outcomes, of "health outcomes," "cost-effectiveness," "cost reduction," "patient satisfaction," and "physician satisfaction." Additional studies were identified from an initial search and the authors' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.
| S-EPMC8307064 | biostudies-literature
Project description:ObjectiveTo examine the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received.Data/settingWe used patient surveys and time-stamped electronic health record (EHR) data in a large ambulatory care system.DesignLean-based changes to clinical spaces and care team workflows were implemented in one pilot site and then scaled to all primary care departments across the system. Redesigns included standardizing equipment and patient education materials in examination rooms, streamlining call management functions, co-locating physician and medical assistant dyads in a shared workspace, and creating new care team workflows. We used a non-randomized stepped-wedge study design and segmented regression with interrupted time series analysis to examine Lean impacts on patient outcomes.Data collectionWe analyzed patient satisfaction ratings and wait times as documented by the EHR. These longitudinal data were collected for 317 physician-led teams in 46 primary care departments from January 2011 to December 2016.Principal findingsAfter implementation of Lean redesigns, patients reported a 44.8 percent increase in satisfaction with the adequacy of time spent with care providers during office visits (P < .05). They also reported 71.6 percent higher satisfaction with their care provider's ability to listen to their concerns, and a 55.4 percent increase in perceived staff helpfulness at the visit (P < .01). Based on monthly EHR data, the amount of time elapsed between a patient request for a routine appointment and the scheduled visit day decreased from baseline by an average 2 percent per month (P < .01). On the day of the visit, patient wait times to be seen also decreased gradually by an average 1.2 percent per month (P < .05).ConclusionsPatient experiences of care after Lean implementations have not been widely studied in primary care settings. We found that Lean redesign yielded improvements that may strengthen clinical operations while enhancing value for patients.
| S-EPMC8143684 | biostudies-literature
Project description:Little is understood about the use of person-centered care (PCC) for individuals with delirium superimposed on dementia (DSD), especially in the acute care setting. As part of a larger clinical trial, the purpose of the current exploratory study was to describe examples and qualitatively derived themes of nurse-facilitated PCC for hospitalized older adults with dementia and delirium. A total of 750 delirium rounds were analyzed across three diverse acute care sites. Qualitative derived themes of PCC included: (a) Knowing the Patient's Baseline; (b) Knowing the Patient's Interests and Values; (c) Enhancing Sensory Abilities to Communicate; (d) Individualizing Cognitive Stimulation; and (e) Enhancing Behavioral Approaches to Comfort and Sleep. Barriers included failure to see the patient as an individual and lack of time. Principles of PCC were effectively used, demonstrating the potential for PCC to ease the burden of DSD for all members of the health care team. [Journal of Gerontological Nursing, 43(12), 21-28.].
| S-EPMC6329586 | biostudies-literature
Project description:ImportanceTelemedicine is an increasingly used yet understudied vehicle to deliver pediatric primary care. Evidence detailing downstream health care utilization after telemedicine visits is needed.ObjectiveTo compare pediatric primary care conducted via telemedicine (video or telephone) with in-person office visits with regard to physician medication prescribing and imaging and laboratory ordering and downstream follow-up office visits, emergency department (ED) visits, and hospitalizations.Design, setting, and participantsThis cohort study included all patients younger than 18 years who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the Kaiser Permanente Northern California health system, a large integrated health care delivery system offering in-person office visits, video visits, or telephone visits for pediatric primary care.ExposurePediatric primary care in-person visit, telephone visit, or video visit.Main outcome and measuresRates of physician medication prescribing and imaging and laboratory ordering during an index telemedicine or office visit and rates of in-person office visits, ED visits, and hospitalizations within 7 days after the visit, adjusted for patient and clinical characteristics.ResultsOf 782 596 total appointments (51.1% male) among 438 638 patients, telemedicine was used for 332 153 visits (42.4%). After adjustment, there was more medication prescribing for in-person visits (39.8%) compared with video visits (29.5%; adjusted difference, -10.3%; 95% CI, -10.6% to -10.0%) or telephone visits (27.3%; adjusted difference, -12.5%; 95% CI, -12.5% to -12.7%). There was also more laboratory ordering for in-person visits (24.6%) compared with video visits (7.8%; adjusted difference, -16.8%; 95% CI, -17.0% to -16.6%) or telephone visits (8.5%; adjusted difference, -16.2%; 95% CI, -16.3% to -16.0%). There was more imaging ordering for in-person visits (8.5%) compared with video visits (4.0%; adjusted difference, -4.5%; 95% CI, -4.6% to -4.4%) and telephone visits (3.5%; adjusted difference, -5.0%; 95% CI, -5.1% to -4.9%). After adjustment, fewer in-person follow up visits occurred for index visits that were in-person (4.3%) compared with video (14.4%; adjusted difference, 10.1%; 95% CI, 9.9%-10.3%) or telephone (15.1%; adjusted difference, 10.8%; 95% CI, 10.7%-11.0%) visits. The rate of ED visits following an in-person visit was slightly lower (1.75%) compared with after video visits (2.04%; adjusted difference, 0.29%; 95% CI, 0.21%-0.38%) or telephone visits (2.00%; adjusted difference, 0.25%; 95% CI, 0.18%-0.33%). There was no statistically significant difference in the 7-day rate of hospitalizations.Conclusions and relevanceIn this cohort study, telephone and video visits for pediatric primary care were associated with less prescribing and ordering than in-person visits. Telemedicine visits were associated with modestly higher rates of subsequent in-person visits and slightly higher rates of ED visits, and there was no difference in hospitalizations. Telemedicine appears to be a useful vehicle for health care delivery in the pediatric population, although it is not a universal substitute for in-person visits.
| S-EPMC11584922 | biostudies-literature
Project description:The introduction of innovative models of healthcare does not necessarily mean that they become embedded in everyday clinical practice. This study has two aims: first, to analyse deliberate and emergent strategies adopted by healthcare professionals to overcome barriers to normalization of a specific framework of person-centred care (PCC); and secondly, to explore how the recipients of PCC understand these strategies.This paper is based on a qualitative study of the implementation of PCC in a Swedish context. It draws on semi-structured interviews with 18 researchers and 17 practitioners who adopted a model of PCC on four different wards and 20 patients who were cared for in one of these wards. Data from these interviews were first coded inductively and emerging themes are analysed in relation to normalization process theory (NPT).In addition to deliberate strategies, we identify emergent strategies to normalize PCC by (i) creating and sustaining coherence in small but continuously communicating groups (ii) interpreting PCC flexibly when it meets specific local situations and (iii) enforcing teamwork between professional groups. These strategies resulted in patients perceiving PCC as bringing about (i) a sense of ease (ii) appreciation of inter-professional congruity (ii) non-hierarchical communication.NPT is useful to identify and analyse deliberate and emergent strategies relating to mechanisms of normalization. Emergent strategies should be interpreted not as trivial solutions to problems in implementation, but as a possible repertoire of tools, practices and skills developed in situ. As professionals and patients may have different understandings of implementation, it is also crucial to include patients' perceptions to evaluate outcomes.
| S-EPMC5545038 | biostudies-other
Project description:ObjectiveTo identify and describe research conducted on the implementation, validity, and utility of whole-person outcome measures administered during routine inpatient or outpatient care.BackgroundIncorporating information about patients' overall health, health-related quality of life, and global well-being into health care delivery has the potential to increase referral rates, enhance doctor-patient communication, and improve the detection of untreated symptoms. Assessment of these whole-person outcomes during routine clinical care is of broad interest to health care providers and health systems.MethodsWe employed a scoping review design and searched Ovid MEDLINE, APA PsycINFO, and CINAHL for relevant English-language primary studies and systematic reviews published through November 13, 2023. Screening for inclusion and data abstraction were conducted by 1 investigator then checked by another. Study risks of bias and the strength of available evidence were not assessed.ResultsOf 1327 potentially relevant publications, 44 primary studies and 5 systematic reviews met eligibility criteria. Assessment of global well-being was comparatively less researched than overall health or health-related quality of life. Available research provided a range of perspectives on the performance, feasibility, acceptability, implementation, and clinical utility of whole-person outcome measures. No studies reported change in patient health or disease outcomes attributed to whole person outcome assessment (directly or through changes to care delivery).ConclusionsCurrently available evidence provides insights about the performance and implementation of whole-person outcome measures during routine clinical care, but no studies are available that examine the impact of assessing whole-person outcomes on clinical or patient outcomes.
| S-EPMC11548827 | biostudies-literature
Project description:BackgroundOne of the biggest changes to primary care triggered by the COVID-19 pandemic was the rapid integration of virtual care (VC). VC offers benefits to patients and providers but implementation presents challenges.MethodsThis study is a secondary analysis of a 2021 quality improvement (QI) driven environmental scan comprising a survey and 1:1 interviews, at the Department of Family and Community Medicine at the University of Toronto. The scan aimed to understand the current and desired future use of VC at the 14 sites.ResultsThe survey was completed by all sites between July and October 2021 and 1:1 interviews were conducted between October and November 2021 with 12 of the 14 site/QI leads. VC was seen as convenient and flexible, and as enabling continuity of care for patients who could not easily attend in-person. Factors enabling implementation of VC included leadership at both the system and local level; a shared understanding of VC on the part of providers, patients and clinical staff; and technological and administrative readiness. Challenges included the need for triage algorithms; incongruent expectations of VC by patients and providers; technology issues; increased administrative burden; and impacts on medical education. All anticipated that some degree of VC would continue in future.ConclusionsVC offered benefits but it also impacted clinical routines and administrative processes creating new forms of work for clinicians and staff. Patient education is needed to ensure that their expectations of VC align with those of providers. Research and QI efforts are required to optimise the use of VC in primary care.
| S-EPMC11409381 | biostudies-literature
Project description:BackgroundBeyond initial COVID-19 pandemic emergency expansions of telemedicine use, it is unclear how well primary care telemedicine addresses patients' needs.ObjectiveTo compare treatment and follow-up visits (office, emergency department, hospitalization) between primary care video or telephone telemedicine and in-person office visits.DesignRetrospective design based on administrative and electronic health record (EHR) data.SettingLarge, integrated health care delivery system with more than 1300 primary care providers, between April 2021 and December 2021 (including the COVID-19 pandemic Delta wave).Patients1 589 014 adult patients; 26.5% were aged 65 years or older, 54.9% were female, 22.2% were Asian, 7.4% were Black, 22.3% were Hispanic, 46.5% were White, 21.5% lived in neighborhoods with lower socioeconomic status, and 31.8% had a chronic health condition.MeasurementsTreatment outcomes included medication or antibiotic prescribing and laboratory or imaging ordering. Follow-up visits included in-person visits to the primary care office or emergency department or hospitalization within 7 days. Outcomes were adjusted for sociodemographic and clinical characteristics overall and stratified by clinical area (abdominal pain, gastrointestinal concerns, back pain, dermatologic concerns, musculoskeletal pain, routine care, hypertension or diabetes, and mental health).ResultsOf 2 357 598 primary care visits, 50.8% used telemedicine (19.5% video and 31.3% telephone). After adjustment, medications were prescribed in 46.8% of office visits, 38.4% of video visits, and 34.6% of telephone visits. After the visit, 1.3% of in-person visits, 6.2% of video visits, and 7.6% of telephone visits had a 7-day return in-person primary care visit; 1.6% of in-person visits, 1.8% of video visits, and 2.1% of telephone visits were followed by an emergency department visit. Differences in follow-up office visits were largest after index office versus telephone visits for acute pain conditions and smallest for mental health.LimitationsIn the study setting, telemedicine is fully integrated with ongoing EHRs and with clinicians, and the study examines an insured population during the late COVID-19 pandemic period. Observational comparison lacks detailed severity or symptom measures. Follow-up was limited to 7 days. Clinical area categorization uses diagnosis code rather than symptom.ConclusionIn-person return visits were somewhat higher after telemedicine compared with in-person primary care visits but varied by specific clinical condition.Primary funding sourceAgency for Healthcare Research and Quality.
| S-EPMC11382601 | biostudies-literature