Comprehensive Primary Care Delivery Research Articles

Do HIV Care Outcomes Differ by Provider Type?

We compared HIV care outcomes by HIV provider type to inform efforts to strengthen the HIV provider workforce. U.S. We analyzed data from CDC's Medical Monitoring Project collected during 6/2019-5/2021 from 6,323 adults receiving HIV medical care. Provider types were infectious disease physicians only (ID physicians), non-ID physicians only (non-ID physicians), nurse practitioners only (NPs), physician assistants only (PAs), and ID physicians plus NPs and/or PAs (mixed providers). We measured patient characteristics, social determinants of health (SDOH), and clinical outcomes including retention in care; antiretroviral therapy prescription; antiretroviral therapy adherence; viral suppression; gonorrhea, chlamydia, and syphilis testing; satisfaction with HIV care; and HIV provider trust. Compared with patients of ID physicians, higher percentages of patients of other provider types had characteristics and SDOH associated with poor health outcomes and received HIV care at Ryan White HIV/AIDS Program-funded facilities. After accounting for these differences, most outcomes were not meaningfully different, however higher percentages of patients of non-ID physicians, NPs, and mixed providers were retained in care (6.5, 5.6, and 12.7 percentage points, respectively) and had STI testing in the past 12 months, if sexually active (6.9, 7.4, and 13.5 percentage points, respectively). Most HIV outcomes were equivalent across provider types. However, patients of non-ID physicians, NPs, and mixed providers were more likely to be retained in care and have recommended STI testing. Increasing delivery of comprehensive primary care by ID physicians and including primary care providers in ID practices could improve HIV primary care outcomes.

Team Primary Care: Training for Transformation in Canada

To address the growing crisis in primary care access and sustainability in Canada, Team Primary Care brings together 65+ health professional organizations to enhance the capacity of interprofessional, comprehensive primary care through improved training for practitioners, supports for teams and tools for planners and employers.
 Team Primary Care targets the primary care workforce including family physicians, primary care nurse practitioners, family practice nurses, pharmacists, physician assistants, mental health practitioners, traditional Indigenous Healers, and others. The project focuses on those involved in the training of the primary care workforce, including funders, accreditors, learning organizations, health professional associations and government.
 Team Primary Care endeavours to enhance interprofessional comprehensive primary care training; improve labour market integration for Indigenous and internationally educated practitioners, maximizing their utilization; create enabling environments for diverse, healthy, and resilient team members to practice at their optimal scope and capacity; and demonstrate, spread and scale leading integrated primary care workforce planning practices, tools, and resources.
 To date, Team Primary Care has launched eight primary care practitioner specific curricular development projects in parallel with workplace integrated learning demonstration projects, offered team-based training for primary care teams using cross cutting tools and supports to enhance interprofessional, equitable and inclusive, culturally safe care aimed at improving access to care and provider well-being. By March 2023 we anticipate an additional 12 curricular projects and 20+ demonstration projects will be ready for implementation. Unique to this project is its integrative approach and intentional change strategy that has been embedded in its design. In addition, an extensive process, outcome, and meta evaluation will have been carried out throughout the length of the project. Between now and March 2023, the aim is for the project to enhance primary care capacity enabling more Canadians to have access to an integrated primary care workforce that is inclusive of a broader range of practitioners working in teams that embed the principles of interprofessionalism, equity, diversity, inclusion, accessibility, psychological health and safety, reconciliation, and social accountability through enhanced and aligned training.
 The integrative and inclusive approach taken by Team Primary Care provides a unique country-wide case study of how to rapidly use education as a vehicle to quickly catalyze practice reform in primary care. Shifting the mental model towards team-based care inclusive of a broad range of primacy care practitioners committed to the delivery of comprehensive primary care was a major focus of the communication plan used. The cross-cutting tools developed are transferable to teams included but not limited to primary care and for both the Canadian context and beyond.
 The development of a sustainable interprofessional primary care training table is envisioned with a repository of team training tools and resources for use by a prepared primary care workforce prepared to scale and spread team-based care across the healthcare system. This case study will offer learned lessons on how education can be a critical enabler for primary care system reform.

Enhanced Primary Care for People With Serious Mental Illness: A Propensity Weighted Cohort Study.

Objective: People with serious mental illness (SMI) have high rates of cardiometabolic illness, receive low quality care, and experience poor outcomes. Nevertheless, studies of existing integrated care models have not consistently shown improvements in cardiometabolic health for people with SMI. This study assessed the effect of a novel model of enhanced primary care for people with SMI on cardiometabolic outcomes. Enhanced primary care is a model of integrated care wherein comprehensive primary care delivery is adapted to the needs of people with SMI in coordination with behavioral care. Methods: We conducted a propensity-weighted cohort study comparing 234 patients with SMI receiving enhanced primary care to 4,934 patients with SMI receiving usual primary care using electronic health data from a large academic medical system covering the years 2014–2018. The propensity-weighted models controlled for baseline differences in outcome measures and patient characteristics between groups. Results: Compared to usual primary care, enhanced primary care increased hemoglobin A1c (HbA1c) screening by 18 percentage points (95% confidence interval , 10 to 25), low-density lipoprotein (LDL) screening by 16 percentage points (CI, 8.8 to 24), and blood pressure screening by 7.8 percentage points (CI, 5.8 to 9.9). Enhanced primary care reduced HbA1c by 0.27 percentage points (CI, −0.47 to −0.060) and systolic blood pressure by 3.9 mm Hg (CI, −5.2 to −2.5) compared to usual primary care. We did not find evidence that enhanced primary care consistently affected glucose screening, LDL values, or diastolic blood pressure. Conclusions: Enhanced primary care can achieve clinically meaningful improvements in cardiometabolic health compared to usual primary care.

The influence of training experiences on career intentions of the future GP workforce: a qualitative study of new GPs in England.

BackgroundThe capacity of the UK GP workforce has not kept pace with increasing primary care workloads. Although many doctors successfully complete GP specialty training programmes, some do not progress to work in NHS general practice.AimThis article explores the training experiences and perceptions of newly qualified GPs to understand how their education, training, and early experiences of work influence their career plans.Design and settingA qualitative study of doctors in their final year of GP training (ST3) and within 5 years of completion of GP training (F5).MethodParticipants across England were recruited through training programmes, First5 groups, and publicity using social media and networks. Open narrative interviews were conducted with individuals and focus groups. Audiorecorded interviews were transcribed, and a thematic analysis was supported by NVivo and situational analysis mapping techniques.ResultsFifteen participants engaged in individual interviews and 10 focus groups were carried out with a total of 63 participants. Most doctors reported that training programmes had prepared them to deal confidently with most aspects of routine clinical GP work. However, they felt underprepared for the additional roles of running a practice and in their understanding of wider NHS organisational structures. Doctors wished to avoid unacceptably heavy workloads and voiced concerns about the longer-term sustainability of general practice.ConclusionStrategies to attract and retain enough GPs to support delivery of comprehensive primary care should consider how doctors’ early career experiences influence their career intentions. A coherent plan is needed to improve their preparation and increase confidence that they can achieve a professionally satisfying, effective, and sustainable career in NHS general practice.

Primary care attributes and care for depression among low-income African American women.

We examined the association between attributes of primary care providers and care for depression, from a patients' perspective, among a sample of predominantly low-income African American women. Computer-assisted telephone interviews were conducted among a population-based sample of 1202 women residing in Washington, DC. Respondents whose primary care physicians provided more comprehensive medical services were more likely to be asked about and treated for depressive symptoms than women whose providers were less medically comprehensive. Women who rated their providers as having more respect for them also were more likely to be asked about and treated for depression. More comprehensive primary care delivery and a physician-patient relationship focused on mutual respect are associated with greater rates of physician inquiry about and treatment for depression among vulnerable women.

Health Education: A “Primary” Component to the Delivery of Comprehensive Primary Care

Forty-three million Americans lack access to primary health care services. Barriers such as a lack of insurance or financial resources, lack of transportation or child care, and cultural and language differences prevent many Americans from obtaining the health care they need. Delivery of high quality, comprehensive primary care designed with community input can help vulnerable persons overcome these barriers. A comprehensive primary care model should include health education components targeted to the identified needs of the population, presented in a culturally appropriate manner, and delivered via multiple strategies. The provision of enabling services by the primary care provider, specifically, a health center, facilitates client access to health education activities, and ultimately to primary care services. Linkages between the multidisciplinary team of primary care providers and the health education team offer expanded opportunities to assist clients to improve their own health. This article describes the following: (1) characteristics of comprehensive quality primary care, with attention to its health education components, (2) examples of programs that have successfully incorporated health education into the primary care setting, and (3) recommendations for health educators and primary care program administrators to successfully incorporate health education programming into the primary care setting.