Interventions on frequent attenders in primary care. A systematic literature review.
Ontology highlight
ABSTRACT:
SUBMITTER: Smits FT
PROVIDER: S-EPMC3406646 | biostudies-other | 2008
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:Primary care settings are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions. Despite emerging effectiveness data, few efforts have been made to summarize the collective findings from these delivery approaches. OBJECTIVE:The aim of this study was to review recent literature on the use of technology to deliver, enhance, or support the implementation of alcohol-related interventions in primary care. We focused on addressing questions related to (1) categorization or target of the intervention, (2) descriptive characteristics and context of delivery, (3) reported efficacy, and (4) factors influencing efficacy. METHODS:We conducted a comprehensive search and systematic review of completed studies at the intersection of primary care, technology, and alcohol-related problems published from January 2000 to December 2018 within EBSCO databases, ProQuest Dissertations, and Cochrane Reviews. Of 2307 initial records, 42 were included and coded independently by 2 investigators. RESULTS:Compared with the years of 2000 to 2009, published studies on technology-based alcohol interventions in primary care nearly tripled during the years of 2010 to 2018. Of the 42 included studies, 28 (64%) were randomized controlled trials. Furthermore, studies were rated on risk of bias and found to be predominantly low risk (n=18), followed by moderate risk (n=16), and high risk (n=8). Of the 24 studies with primary or secondary efficacy outcomes related to drinking and drinking-related harms, 17 (71%) reported reduced drinking or harm in all primary and secondary efficacy outcomes. Furthermore, of the 31 studies with direct comparisons with treatment as usual (TAU), 13 (42%) reported that at least half of the primary and secondary efficacy outcomes of the technology-based interventions were superior to TAU. High efficacy was associated with provider involvement and the reported use of an implementation strategy to deliver the technology-based intervention. CONCLUSIONS:Our systematic review has highlighted a pattern of growth in the number of studies evaluating technology-based alcohol interventions in primary care. Although these interventions appear to be largely beneficial in primary care, outcomes may be enhanced by provider involvement and implementation strategy use. This review enables better understanding of the typologies and efficacy of these interventions and informs recommendations for those developing and implementing technology-based alcohol interventions in primary care settings.
| S-EPMC6475823 | biostudies-other
Project description:To our knowledge, there is no available standardized educational curriculum designed to promote the incorporation of skin cancer examinations and procedures into general practice. To explore the contemporary training landscape, we conducted a systematic review of educational interventions designed to support skin cancer diagnostic examinations by primary care providers (PCPs). Our review uniquely encompasses all PCPs, including practicing physicians, residents, and advanced practice practitioners (APPs). The objective of this study is to review and synthesize worldwide data on educational interventions addressing PCP performance of skin cancer diagnostic examinations. A systematic review was performed in MEDLINE, Cochrane, EMBASE, and Scopus for English language articles worldwide published from 2000 onwards. Articles were screened for eligibility, and possibly overlapping datasets were resolved. Data extracted included curriculum content, delivery format, and educational outcomes. This review followed the PRISMA guidelines. A total of 63 studies were selected for data inclusion with one addressing training for resident physicians, 4 for APPs, and the remainder for practicing physicians. Educational interventions included in this review reflect the pre-SARS-CoV-2 pandemic educational environment: half provided live/synchronous instruction of about 5-h duration on average, and a quarter featured interactive components. Less than a quarter of interventions included practice change as a specific reported outcome. Without sustainable practice change, the anticipated long-term benefits of early cancer detection in patients remain limited. Previous and existing educational interventions designed to support skin cancer detection by PCPs demonstrate heterogeneous curriculum content, delivery methods, and educational outcomes. An ideal intervention would teach consensus-derived clinical competencies, provide meaningful learner feedback, and measure outcomes, such as knowledge/competency, confidence/attitudes, and practice change, using validated instruments.
| S-EPMC8763425 | biostudies-literature
Project description:BackgroundLeaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear.ObjectivesTo review the literature on the effectiveness of programmes to support leadership, the relationship between clinical leadership and integrated primary care, and important leadership skills for integrated primary care practice.MethodsWe systematically searched PubMed, CINAHL, Embase, PsycINFO until June 2018 for empirical studies situated in an integrated primarycare setting, regarding clinical leadership, leadership skills, support programmes and integrated-care models. Two researchers independently selected relevant studies and critically appraised studies on methodological quality, summarized data and mapped qualitative data on leadership skills.ResultsOf the 3207 articles identified, 56 were selected based on abstract and title, from which 20 met the inclusion criteria. Selected papers were of mediocre quality. Two non-controlled studies suggested that leadership support programmes helped prepare and guide leaders and positively contributed to implementation of integrated primary care. There was little support that leaders positively influence implementation of integrated care. Leaders' relational and organizational skills as well as process-management and change-management skills were considered important to improve care integration. Physicians seemed to be the most adequate leaders.ConclusionGood quality research on clinical leadership in integrated primary care is scarce. More profound knowledge is needed about leadership skills, required for integrated-care implementation, and leadership support aimed at developing these skills.
| S-EPMC6394325 | biostudies-literature
Project description:INTRODUCTION:Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. METHODS:We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies. Eligible studies used a randomized or pre-post design and assessed depression treatment initiation (i.e., ≥ 1 mental health visit or antidepressant fill) among adults, the majority of whom met criteria for depression. Interventions were classified as simple or complex and sub-classified into intervention strategies that were graded for strength of evidence. RESULTS:Of 9516 articles identified, we included 14 unique studies representing 16 (4 simple and 12 complex) interventions and 8 treatment initiation strategies. We found low to moderate strength of evidence for collaborative/integrated care (3 studies), treatment preference matching (2 studies), and case management (2 studies) strategies. However, there was insufficient evidence to determine the benefit of cultural tailoring (2 studies), motivation (alone, with reminders or with cultural tailoring (5 studies)), education (1 study), and shared decision-making strategies (1 study). Overall, we found moderate strength of evidence for complex interventions (8 of 12 complex interventions demonstrated statistically significant effects on treatment initiation). DISCUSSION:Collaborative/integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation, but none of the strategies had high strength of evidence. While primary care settings can consider using some of these strategies when referring depressed patients to treatment, our review highlights the need for further rigorous research in this area.
| S-EPMC6206350 | biostudies-other
Project description:BackgroundPrimary care in England is facing increasing pressure due to the increasing number and complexity of consultations and the declining number of doctors per head of population. The improvement of primary care efficiency and productivity should be a priority, to ensure that future investments in the medical workforce can cope with the increasingly large and complex demand for care.ObjectivesThis paper presents a systematic literature review of studies that define or measure efficiency in primary care in high-income settings. The review of the existing definitions of primary care efficiency and their limitations will inform future research on the measurement of efficiency in primary care in England and its determinants.MethodsLiterature searches were performed on Embase, Medline, and EconLit in January 2020. The records that passed the screening were reviewed in full text, and data on the study settings, the efficiency definition, and the efficiency analysis were extracted.ResultsOf the 2590 non-duplicate records retrieved from the searches, 38 papers were included in the analysis. The volume of the literature on primary care efficiency has evolved significantly from the 1980s, with the majority of the published studies focussing on European health systems. The setting most often analysed was primary care centres. Output was usually expressed using measures of primary care utilisation, with or without quality adjustments. Reference to the health outcomes achieved was, however, limited. Inputs were more commonly expressed in labour terms, while the exogenous variables related either to the characteristics of the patient population or the organisation of primary care. While all studies included an analysis of technical efficiency, consideration of allocative or cost efficiency or the determinants of productivity (e.g. technological change, skill mix) was rare.ConclusionsThe main limitations that future research on primary care efficiency should address relate to the definition of output. Current approaches to measure the impact on health and the multiple dimensions of output are not sufficient to represent the valued output of primary care. In light of the recent changes in the model of primary care delivery in England, future research should also investigate the impact of technological change on productivity and the scope for substitution across staff roles.
| S-EPMC8337146 | biostudies-literature
Project description:BackgroundThe US Preventive Services Task Force recommends screening for and treating obesity. However, there are many barriers to successfully treating obesity in primary care (PC). Technology-assisted weight loss interventions offer novel ways of improving treatment, but trials are overwhelmingly conducted outside of PC and may not translate well into this setting. We conducted a systematic review of technology-assisted weight loss interventions specifically tested in PC settings.MethodsWe searched the literature from January 2000 to March 2014.Inclusion criteria(1) Randomized controlled trial; (2) trials that utilized the Internet, personal computer, and/or mobile device; and (3) occurred in an ambulatory PC setting. We applied the Cochrane Effective Practice and Organization of Care (EPOC) and Delphi criteria to assess bias and the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) criteria to assess pragmatism (whether trials occurred in the real world versus under ideal circumstances). Given heterogeneity, results were not pooled quantitatively.ResultsSixteen trials met inclusion criteria. Twelve (75 %) interventions achieved weight loss (range: 0.08 kg - 5.4 kg) compared to controls, while 5-45 % of patients lost at least 5 % of baseline weight. Trial duration and attrition ranged from 3-36 months and 6-80 %, respectively. Ten (63 %) studies reported results after at least 1 year of follow-up. Interventions used various forms of personnel, technology modalities, and behavior change elements; trials most frequently utilized medical doctors (MDs) (44 %), web-based applications (63 %), and self-monitoring (81 %), respectively. Interventions that included clinician-guiding software or feedback from personnel appeared to promote more weight loss than fully automated interventions. Only two (13 %) studies used publically available technologies. Many studies had fair pragmatism scores (mean: 2.8/4), despite occurring in primary care.DiscussionCompared to usual care, technology-assisted interventions in the PC setting help patients achieve weight loss, offering evidence-based options to PC providers. However, best practices remain undetermined. Despite occurring in PC, studies often fall short in utilizing pragmatic methodology and rarely provide publically available technology. Longitudinal, pragmatic, interdisciplinary, and open-source interventions are needed.
| S-EPMC4284284 | biostudies-literature
Project description:BACKGROUND:Primary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings. METHODS:The methods were based on our previous review published in 2006. We performed database searches for articles published from 2006 to 2014 and conducted a systematic review with narrative synthesis using the Cochrane Effective Practice and Organisation of Care taxonomy to classify interventions and outcomes. The interventions were mapped to Chronic Care Model elements. The pattern of outcomes related to interventions was summarized by frequency of statistically significant improvements in health care provision and patient outcomes. RESULTS:A total of 9589 journal articles were retrieved from database searches and snowballing. After screening and verification, 165 articles that detailed 157 studies were included. There were few studies with Health Care Organization (1.9% of studies) or Community Resources (0.6% of studies) as the primary intervention element. Self-Management Support interventions (45.8% of studies) most frequently resulted in improvements in patient-level outcomes. Delivery System Design interventions (22.6% of studies) showed benefits in both professional and patient-level outcomes for a narrow range of conditions. Decision Support interventions (21.3% of studies) had impact limited to professional-level outcomes, in particular use of medications. The small number of studies of Clinical Information System interventions (8.9%) showed benefits for both professional- and patient-level outcomes. CONCLUSIONS:The published literature has expanded substantially since 2006. This review confirms that Self-Management Support is the most frequent Chronic Care Model intervention that is associated with statistically significant improvements, predominately for diabetes and hypertension.
| S-EPMC5759778 | biostudies-literature
Project description:ObjectivesTo conduct a systematic review to address the following key questions: (1) what interventions have been successful in improving access for veterans with reduced health care access? (2) Have interventions that have improved health care access led to improvements in process and clinical outcomes?Data sourcesOVID MEDLINE, CINAHL, PsychINFO.Study eligibility criteria, participants, and interventionsEnglish language articles published in peer-reviewed journals from 1990 to June 2010. All interventions designed to improve access to health care for US veterans that reported the impact of the intervention on perceived (e.g., satisfaction with access) or objective (e.g., travel time, wait time) access were included. APPRAISAL AND SYNTHESIS METHODS: Investigators abstracted data on study design, study quality, intervention, and impact of the intervention on access, process outcomes, and clinical outcomes.ResultsNineteen articles (16 unique studies) met the inclusion criteria. While there were a small number of studies in support of any one intervention, all showed a positive impact on either perceived or objective measures of access. Implementation of Community Based Outpatient Clinics (n = 5 articles), use of Telemedicine (n = 5 articles), and Primary Care Mental Health Integration (n = 6 articles) improved access. All 16 unique studies reported process outcomes, most often satisfaction with care and utilization. Four studies reported clinical outcomes; three found no differences.LimitationsIncluded studies were largely of poor to fair methodological quality.Conclusions and implications of key findingsInterventions can improve access to health care for veterans. Increased access was consistently linked to increased primary care utilization. There was a lack of data regarding the link between access and clinical outcomes; however, the limited data suggest that increased access may not improve clinical outcomes. Future research should focus on the quality and appropriateness of care and clinical outcomes.
| S-EPMC3191217 | biostudies-literature
Project description:BackgroundDespite the high prevalence of osteoarthritis and the prominence of primary care in managing this condition, there is no systematic summary of quality indicators applicable for osteoarthritis care in primary care settings.ObjectivesThis systematic review aimed to identify evidence-based quality indicators for monitoring, evaluating and improving the quality of care for adults with osteoarthritis in primary care settings.MethodsOvid MEDLINE and Ovid EMBASE databases and grey literature, including relevant organizational websites, were searched from 2000 to 2015. Two reviewers independently selected studies if (i) the study methodology combined a systematic literature search with assessment of quality indicators by an expert panel and (ii) quality indicators were applicable to assessment of care for adults with osteoarthritis in primary care settings. Included studies were appraised using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A narrative synthesis was used to combine the indicators within themes. Applicable quality indicators were categorized according to Donabedian's 'structure-process-outcome' framework.ResultsThe search revealed 4526 studies, of which 32 studies were reviewed in detail and 4 studies met the inclusion criteria. According to the AIRE domains, all studies were clear on purpose and stakeholder involvement, while formal endorsement and use of indicators in practice were scarcely described. A total of 20 quality indicators were identified from the included studies, many of which overlapped conceptually or in content.ConclusionsThe process of developing quality indicators was methodologically suboptimal in most cases. There is a need to develop specific process, structure and outcome measures for adults with osteoarthritis using appropriate methodology.
| S-EPMC5892173 | biostudies-literature
Project description:PurposeTo decrease cost and improve efficiency, health care organizations have focused on frequent attenders - patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.MethodsThis systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent attendance.ResultsMost studies defined frequent attenders by number of health care visits within a set time period (n=115) and top percentile cutoff (n=42). Based on averages across studies, we propose the following frequent attender definitions: for primary care, either the top 10th percentile or at least 10 visits in 12 months; for emergency room, at least 5 visits in 12 months; and for inpatient hospitalization, at least 4 admissions in 12 months. Common factors correlated with frequent attendance were mental health and chronic disease.ConclusionsWe propose definitions of frequent attenders for three common health care settings: primary care, emergency room, and inpatient. Future studies should include mental health and chronic disease, among other factors, when studying this population. Adoption of these recommendations will allow comparisons across studies such that meta-analyses may better determine interventions for more appropriate health care utilization.
| S-EPMC7398628 | biostudies-literature