Care of Transgender Patients: A General Practice Quality Improvement Approach.
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ABSTRACT:
SUBMITTER: Boyd I
PROVIDER: S-EPMC8775415 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The Scottish Patient Safety Programme in Primary Care (SPSP-PC) aims to improve the medicines reconciliation process in primary care to help reduce the number of adverse events causing avoidable harm. [1] The aim of this project is to improve the process for handling Immediate Discharge Documents (IDDs) in a single practice and develop a protocol using the care bundle approach. The care bundle consisted of: 1. Medicines reconciled and repeat prescription updated 2. Follow up documented 3. Diagnosis coded 4. Were all actions completed? A baseline audit was performed followed by three PDSA cycles. Interventions included: education at each cycle, decision that all Doctors would use the Medicines Reconciliation Polypharmacy LES template and constructing an electronic checklist for the care bundle. Compliance with the care bundle rose from 20% in the baseline measurement to 100% in PDSA cycles two and three. In conclusion, a protocol was developed for the processing of IDDs utilizing the care bundle approach with an electronic checklist, resulting in an improvement in the practice management of IDDs.
| S-EPMC4645813 | biostudies-other
Project description:BackgroundPractice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards positive change.MethodsWe conducted semi-structured interviews with four practice facilitators who worked with 84 primary care practices in Eastern Ontario, Canada over a period of five years (2007-2012). The transcripts were analyzed independently by three members of the research team using an open coding technique. A qualitative data analysis using immersion/crystallization technique was applied to interpret the interview transcripts.ResultsCommon barriers identified by the facilitators included accessibility to the practice (e.g., difficulty scheduling meetings, short meetings), organizational behaviour (team organization, team conflicts, etc.), challenges with practice engagement (e.g., lack of interest, lack of trust), resistance to change, and competing priorities. To help practices move towards positive change the facilitators had to tailor their approach, integrate themselves, be persistent with practices, and exhibit flexibility.ConclusionsThe consensus on redesigning and transforming primary care in North America and around the world is rapidly growing. Practice facilitation has been pivotal in materializing the transformation in the way primary care practices deliver care. This study provides an exclusive insight into facilitator approaches which will assist the design and implementation of small- and large-scale facilitation interventions.
| S-EPMC3931473 | biostudies-literature
Project description:An improvement culture is required in the NHS. Staff members who move from one place of work to another are often best placed to see alternative methods of working that at times are more efficient - locum general practitioners (GPs) tend to be in this category. A tool was developed specifically to obtain quality improvement suggestions to the general practice from the locum GP and vice versa in a time efficient manner. A pilot study was performed in one general practice in Tayside (Grove Health Centre) in December 2013 to assess if this was possible. During this month a general practice partner provided feedback to the locum GP by completing a drop down tick box survey while reviewing three cases dealt with by the locum. The locum GP was emailed after their session with a one question survey enquiring about improvement suggestions for that practice. Five different locum GPs provided clinical cover during the month studied - of these, one opted out from the study. The other four locums performed their clinical session and completed the survey. Feedback from the practice to locums included specific clinical guidance, suggestions for improving documentation, and ways to optimise referrals; of note, unique feedback was given to each locum and this was generated using this tool. Themes from the locum suggestions to the practice included more physical resources (such as cameras in each room), different ways of handling prescriptions, and a suggestion about identifying complex patients. As a direct result of this pilot a locum box has been implemented in this practice and plans are to rerun this tool periodically. The authors would recommend utilising this tool periodically in other general practices as it has the potential to identify improvement suggestions unique for that particular practice.
| S-EPMC4645914 | biostudies-literature
Project description:BackgroundHealthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)'s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread.ObjectiveTo describe EBQI as an approach for promoting VA's PACT and to assess initial implementation of planned EBQI elements.DesignDescriptive.ParticipantsRegional and local interdisciplinary clinical leaders, patient representatives, Quality Council Coordinators, practicing primary care clinicians and staff, and researchers from six demonstration site practices in three local healthcare systems in one VA region.InterventionEBQI promotes bottom-up local innovation and spread within top-down organizational priorities. EBQI innovations are supported by a research-clinical partnership, use continuous quality improvement methods, and are developed in regional demonstration sites.ApproachWe developed a logic model for EBQI for PACT (EBQI-PACT) with inputs, outputs, and expected outcomes. We describe implementation of logic model outputs over 18 months, using qualitative data from 84 key stakeholders (104 interviews from two waves) and review of study documents.ResultsNearly all implementation elements of the EBQI-PACT logic model were fully or partially implemented. Elements not fully achieved included patient engagement in Quality Councils (4/6) and consistent local primary care practice interdisciplinary leadership (4/6). Fourteen of 15 regionally approved innovation projects have been completed, three have undergone initial spread, five are prepared to spread, and two have completed toolkits that have been pretested in two to three sites and are now ready for external spread.DiscussionEBQI-PACT has been feasible to implement in three participating healthcare systems in one VA region. Further development of methods for engaging patients in care design and for promoting interdisciplinary leadership is needed.
| S-EPMC4070240 | biostudies-literature
Project description:ObjectiveTo codesign an electronic chronic disease quality improvement tool for use in general practice.DesignService design employing codesign strategies.SettingGeneral practice.ParticipantsSeventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne.InterventionsCodesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform.ResultsParticipants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners.ConclusionStudy participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.
| S-EPMC7751202 | biostudies-literature
Project description:BackgroundCancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives.MethodsWe used a qualitative approach and interviewed 18 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives.ResultsIn a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities.ConclusionsThe tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation.
| S-EPMC8597279 | biostudies-literature
Project description:Background: General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for GP-led community-based dementia care, as advocated in the Irish National Dementia Strategy (INDS). However, there is a paucity of research exploring GPs' views on dementia care since publication of the INDS. The aim of this qualitative study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice, explored from the perspective of Irish GPs. Methods: Semi-structured interviews were conducted with GPs. GPs who completed the "Dementia in Primary Care" CPD module at University College Cork in Ireland were purposively recruited. Interviews were audio-recorded, transcribed, and analyzed by thematic analysis. Results: 12 interviews were conducted with 7 female and 5 male participants. Experience in General Practice ranged from 3 to 32 years. Most GPs practiced in mixed urban-rural settings (n = 9) and had nursing home commitments (n = 8). The average interview length was 45 minutes. Six major themes emerged from the data set, including resourcing primary care, addressing disparities in secondary care, community-centered care as patient-centered care, linking a dementia network, universal access to care, and raising public awareness. Conclusion: GPs find dementia care to be a complex and challenging aspect of primary care. While education and training is advocated by GPs, service delivery must be reconfigured. This will necessitate adequate financial resourcing and the restructuring of community-based dementia care services.
| S-EPMC7724029 | biostudies-literature
Project description:Prescribing errors are a well recognised cause of adverse incidents and have a direct effect on patients.[1] This impacts on the doctor-family relationship and results in breakdown of trust and communication.[2] This quality improvement project was carried out in the paediatric ward of a district general hospital in Northern Ireland. A retrospective analysis of paediatric prescribing errors between January and December 2013 identified two errors that were felt to be secondary to under-reporting. A baseline audit was subsequently performed that highlighted 32 errors across 12 drug charts. A driver diagram identified three components contributing to prescribing errors and relevant tests of change were developed. The three primary drivers included: education and communication, practical prescribing changes, and medicine reconciliation. Seven interventions were implemented sequentially over a six month period and their effectiveness assessed by a prospective drug chart audit. Ten drug charts were selected at random by the staff nurse allocated to medications on the day of audit. The charts were audited using a predesigned proforma and the total number of errors counted. These were subcategorised and results displayed in graphical format after each intervention. Seven audit cycles were completed in total after each intervention was put into practice. The number of errors (including percentage change following each intervention) is as follows: intervention 1: 32 (+19%); Intervention 2: 31 (+15%); Intervention 3: 17 (-37%); Intervention 4: 12 (-56%); Intervention 5: 15 (-44%); Intervention 6: 7 (-74%); Intervention 7: 10 (-63%). In conclusion, permanent and successful measures are needed to reduce prescribing errors in order to minimise the impact of staff changeover and knowledge deficits.
| S-EPMC4693030 | biostudies-literature
Project description:Pediatric cardiac arrests carry significant morbidity and mortality. With increasing rates of return of spontaneous circulation, it is vital to optimize recovery conditions to decrease morbidity.MethodsWe evaluated all patients who presented to a large quaternary pediatric intensive care unit with return of spontaneous circulation. We compared patient-specific postcardiac arrest care preimplementation and postimplementation of a standardized postcardiac arrest resuscitation pathway. We implemented evidence-based best practices using the Translating Research into Practice framework and Plan-Do-Study-Act cycles. Our primary aim was to increase the percent of postcardiac arrest care events meeting guideline targets for blood pressure and temperature within the first 12 hours by 50% within 18 months.ResultsEighty-one events occurred in the preintervention group (August 1, 2016-April 30, 2018) and 64 in the postintervention group (May 1, 2018-December 1, 2019). The percent of postcardiac arrest events meeting guideline targets for the entirety of their postarrest period improved from 10.9% for goal mean arterial blood pressure to 26.3%, P = 0.03, and increased from 23.4% for temperature to 71.9%, P < 0.0001.ConclusionsImplementing a postcardiac arrest standardized care plan improved adherence to evidence-based postcardiac arrest care metrics, specifically preventing hypotension and hyperthermia. Future multicenter research is needed to link guideline adherence to patient outcomes.
| S-EPMC7952102 | biostudies-literature
Project description:Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process.The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester-a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010-2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team.The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational CoPs in the context of primary care may thus be problematic.In cases when manipulated emergence of new CoPs is problematic, boundary issues could be addressed by adopting a developmental perspective on CoPs, which provides an alternative to the analytical and instrumental perspectives previously described in the CoP literature. This perspective implies a pragmatic, situational approach to mapping existing CoPs and their characteristics and potentially modifying them in the process of service improvement through the combination of internal and external facilitation.
| S-EPMC3514317 | biostudies-literature