Enhancing Primary Care Research Articles

Enhancing Primary Care by Investing in Interprofessional Education: The SPLICE Project.

The System-transforming, Patient centered Longitudinal Interprofessional Community-based Education (SPLICE) Initiative was a Health Resources and Services Administration (HRSA) funded project designed to educate and train health professions learners in team-based primary care within a clinical environment. The SPLICE project team developed multiple learning activities including case studies and simulations that integrated the IPEC Core Competencies within clinical scenarios. The interprofessional aspects were also modeled by faculty facilitators from different professions. Each activity was thoroughly evaluated by the learners using mixed methods processes including data from retrospective pretest-posttest self-assessments, open-ended surveys, and focus groups. Faculty, staff, and learners invested countless hours of volunteer time due to the enthusiasm and passion for the work supported with HRSA funding to implement and evaluate the SPLICE initiative. Outcomes include the development of an enhanced primary care simulation template; the creation of 21 unique primary care simulations that integrated the IPEC competencies; improved confidence and competence in over 700 learners; over 110 faculty trained in simulation and debriefing skills; clinical skills training for Federally Qualified Health Center (FQHC) staff; improved quality improvement processes at a local FQHC; and a high rate of retention of the graduates in primary care. This project demonstrated a significant return on the investment beyond the initial HRSA funding.

Enhancing Primary Care: The Role of Occupationnal Therapy in Chronic Pain Self-Management

Enhancing Primary Care: The Role of Occupationnal Therapy in Chronic Pain Self-Management

Time trends in maternal hypertensive disorder incidence in Brazil, Russian Federation, India, China, and South Africa (BRICS): an age-period-cohort analysis for the GBD 2021

ObjectivesMaternal hypertensive disorder (MHD) is a leading cause of significant maternal and fetal mortality and morbidity. The BRICS nations are crucial in the global MHD landscape, given their large populations and varied healthcare infrastructures. This investigation evaluates the incidence trends of MHD in BRICS countries from 1992 to 2021.Study design and methodsData on the number, all-age rate, age-standardized rate (ASR), and the relative change of MHD incidence from this study were sourced from the Global Burden of Disease (GBD) 2021 public dataset to investigate temporal trends in MHD incidence over three decades globally and in BRICS countries. The age-period-cohort (APC) model was used to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks.ResultsA 15.87% increase in global MHD cases, alongside a 13.40% decrease in age-standardized incidence rates from 1992 to 2021. MHD incidence rates are declining across various BRICS age groups, except in China and Russian Federation, where most groups exhibit increasing trends. Annual net drift in MHD incidence ranges from − 4.25% in India to 2.38% in China. A shift in the age distribution of MHD cases from younger to older within the childbearing age range is observed in all BRICS nations. Countries exhibit similar age-effect patterns, with decreasing risk with increasing age, and varying period and cohort effects, indicative of differential control measures and temporal incidence trends.ConclusionsGlobal and BRICS-specific reductions in MHD incidence vary in magnitude. Customized preventive strategies, leveraging existing resources, are advisable for BRICS nations to address pregnancy complications. Enhancing primary healthcare and maternal care quality, particularly for older mothers, is imperative.

Enhancing Primary Care and Mental Health Integration for Women Veterans with Complex Healthcare Needs Using Evidence-Based Quality Improvement

BackgroundWomen Veterans with co-morbid medical and mental health conditions face persistent barriers accessing high-quality health care. Evidence-based quality improvement (EBQI) offers a systematic approach to implementing new care models that can address care gaps for women Veterans.ObjectiveThis study examines factors associated with the successful deployment of EBQI within integrated health systems to improve primary care for women Veterans with complex mental health needs.DesignFollowing a 12-site (8 EBQI, 4 control) cluster randomized study to evaluate EBQI effectiveness, we conducted an in-depth case study analysis of one women’s health clinic that used EBQI to improve integrated primary care–mental health services for women Veterans.ParticipantsOur study sample included providers, program managers, and clinic staff at a women Veteran’s health clinic that, at the time of the study, had one Primary Care and Mental Health Integration team and one women’s health primary care provider serving 800 women. We analyzed interviews conducted 12 months, 24 months, and 4 years post-implementation and call summaries between the clinic and support team.Main MeasuresWe conducted qualitative thematic analysis of interview and call summary data to identify EBQI elements, clinic characteristics, and reported challenges and successes within project development and execution.Key ResultsThe clinic harnessed core EBQI elements (multi-level stakeholder engagement, data-driven progress-monitoring, PDSA cycles, sharing results) to accomplish pre-defined project goals, strengthen inter-disciplinary partnerships, and bolster team confidence. Clinic characteristics that facilitated implementation success included prior QI experience and an organizational culture responsive to innovation, while lack of pre-existing guidelines and limited access to centralized databases posed implementation challenges.ConclusionsSuccessful practice transformation emerges through the interaction of evidence-based methods and site-specific characteristics. Examining how clinic characteristics support or impede EBQI adaptation can facilitate efforts to improve care within integrated health systems.

Enhancing Primary Care and Community Health: A NAPCRG Report on 2 Conferences.

Enhancing Primary Care and Community Health: A NAPCRG Report on 2 Conferences.

Enhancing Primary Care for Nursing Home Patients with an Artificial Intelligence-Aided Rational Drug Use Web Assistant.

Polypharmacy can result in drug-drug interactions, severe side-effects, drug-disease interactions, inappropriate medication use in the elderly, and escalating costs. This study aims to evaluate nursing home residents' medication regimens using a rational drug use web assistant developed by researchers to mitigate unnecessary medication usage. This analytical, cross-sectional study included data from nursing home residents recently recorded in a training family health center. Sociodemographic information, medical conditions, and prescribed medications of all patients in the nursing home (n = 99) were documented. Medications were assessed using an artificial intelligence-aided rational drug use web assistant. Instances of inappropriate drug use and calculations of contraindicated drug costs were also recorded. The study revealed that 88.9% (n = 88) of patients experienced polypharmacy, with a mean value of 6.96 ± 2.94 drugs per patient. Potential risky drug-drug interactions were present in 89.9% (n = 89) of patients, contraindicated drug-drug interactions in 20.2% (n = 20), and potentially inappropriate drug use in 86.9% (n = 86). Plans to discontinue 83 medications were estimated to reduce total direct medication costs by 9.1% per month. After the assessment with the rational drug use web assistant, the number of drugs that patients needed to use and polypharmacy decreased significantly. This study concludes that the rational drug use web assistant application, which is more cost-effective than the traditional manual method, assisted by artificial intelligence, and integrated into healthcare services, may offer substantial benefits to family physicians and their geriatric patients.

Enhancing Primary Care Learning in a Referral Hospital Setting: Introducing Veterinary Clinical Demonstrators.

With the majority of veterinary graduates entering primary care practice (PCP), there is increasing recognition of the importance of preparing students to practice across a broad spectrum of care (SoC). The traditional model of veterinary training, focused on the referral hospital environment, can make this challenging. In 2018, Bristol Veterinary School recruited five primary care (PC) veterinary surgeons as veterinary clinical demonstrators (VCDs) who collaborated with rotation-specific specialists to help enhance student focus upon day-one skills and to emphasize SoC relevance of the referral caseload. To evaluate the initiative, two separate online surveys were disseminated to clinical staff and final year veterinary students. The survey was completed by 57 students and 42 staff members. Participants agreed that VCDs helped students feel prepared for a first job in primary care practice (students 94.7%; staff 92.7%); helped students to focus on the primary care relevance of referral cases (students 96.5%; staff 70.8%); helped students develop clinical reasoning skills (students 100%; staff 69.3%), practical skills (students 82.4%; staff 72.5%), and professional attributes (students 59.6%; staff 71.4%). Thematic analysis of free-text comments revealed the benefits and challenges associated with implementing the role. The data gathered helped to guide the role's ongoing development and to provide recommendations for others who may be looking to implement similar educational initiatives to help prepare graduates to practice across a spectrum of care.

Enhancing Primary Care Payments Without Adding Financial Risk.

The delivery of primary healthcare in the USA is threatened on multiple fronts. To preserve and strengthen this critical part of the healthcare delivery system, a rapid and broadly accepted change in the basic payment strategy is needed. This paper describes the changes in the delivery of primary health services that demand additional population-based funding and the need to provide sufficient funding to sustain direct provider-patient interaction. We additionally describe the merits of a hybrid payment model that continues to include some level of fee-for-service payment and point to the pitfalls of imposing substantial financial risk on primary care practices, particularly small- and medium-sized primary care practices lacking the financial reserves to sustain monetary losses.

100 Million Mouths Campaign: Creating a Pilot Program to Advance Oral Health Equity.

More individuals access primary care compared with oral health services. Enhancing primary care training to include oral health content can therefore improve access to care for millions of individuals and improve health equity. We developed the 100 Million Mouths Campaign (100MMC), which aims to create 50 state oral health education champions (OHECs) who will work with primary care training programs to integrate oral health into their curricula. In 2020-2021, we recruited and trained OHECs from 6 pilot states (Alabama, Delaware, Iowa, Hawaii, Missouri, and Tennessee) with representation from varied disciplines and specialties. The training program consisted of 4-hour workshops over 2 days followed by monthly meetings. We conducted internal and external evaluations to assess the program's implementation through postworkshop surveys, identifying process and outcome measures for engagement of primary care programs, and through focus groups and key informant interviews with the OHECs. The results of the postworkshop survey indicated that all 6 OHECs found the sessions helpful in planning next steps as a statewide OHEC. Each OHEC was also successful in engaging 3 primary care training programs within their state and incorporating oral health curricular content through various modalities, including lectures, clinical practice, and case presentations. During the year-end interviews, the OHECs reported that they would overwhelmingly recommend this program to future state OHECs. The 100MMC pilot program was implemented successfully, and the newly trained OHECs have the potential to improve access to oral health within their communities. Future program expansion needs to prioritize diversity within the OHEC community and focus on program sustainability.

HepCare Plus: Enhancing Primary Care Identification and Treatment of Hepatitis C Virus in High-Risk Individuals.

Hepatitis C Virus (HCV) disproportionately affects people who inject drugs, migrants, prisoners and the homeless. An integrated, peer-led model of care involving primary and secondary care is required to enhance the identification and treatment of HCV in these marginalised groups. HepCare Plus builds on the network and achievements of HepCare Europe (a co-funded Third Health Programme of the European Union/Health Service Executive project). It further identifies those not accessing care and facilitates prompt assessment and treatment of those diagnosed with HCV, with the aid of a peer support worker (PSW) and a community HCV nurse specialist. Of 109 individuals identified and assessed for HCV treatment, 100 commenced HCV treatment. Despite interruptions to treatment (COVID-19 pandemic and national health service cyberattack) there was a high-level of treatment completion with PSW engagement (98%, n = 98). Eighty (73%) individuals were previously aware of a positive HCV status, highlighting the ongoing need to address barriers preventing marginalised groups from engaging with care. HepCare Plus reiterates the defining role of peer-led community interventions in HCV treatment engagement and the need for continuous open-ended HCV care. It provides a sustainable framework to meaningfully combat HCV and achieve the United Nations Sustainable Development Goal of HCV elimination by 2030.

Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction.

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care.

Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative

BackgroundGaps in identification, medical management and appropriate referral for patients with chronic kidney disease (CKD) are evident.ObjectiveWe designed and implemented an interactive educational intervention (accredited workshop) to improve primary care...

Primary Care's Effects on Costs in the US Veterans Health Administration, 2016-2019: an Observational Cohort Study.

Enhancing primary care is a promising strategy for improving the efficiency of health care. Previous studies of primary care's effects on health expenditures have mostly relied on ecological analyses comparing region-wide expenditures rather than spending for individual patients. To compare overall medical expenditures for individual patients enrolled vs. those not enrolled in primary care in the Veterans Health Administration (VHA). Cohort study with stratification for clinical risk and multivariable linear regression models adjusted for clinical and demographic confounders of expenditures. In total, 6,009,973 VHA patients in fiscal year (FY) 2019-5,410,034 enrolled with a primary care provider (PCP) and 599,939 without a PCP-and similar numbers in FYs 2016-2018. Total annual cost per patient to the VHA (including VHA payments to non-VHA providers) stratified by a composite health risk score previously shown to predict VHA expenditures, and multivariate models additionally adjusted for VHA regional differences, patients' demographic characteristics, non-VHA insurance coverage, and driving time to the nearest VHA facility. Sensitivity analyses explored different modeling strategies and risk adjusters, as well as the inclusion of expenditures by the Medicare program that covers virtually all elderly VHA patients for care not paid for by the VHA. Within each health-risk decile, non-PCP patients had higher outpatient, inpatient, and total costs than those with a PCP. After adjustment for health risk and other factors, lack of a PCP was associated 27.4% higher VHA expenditures, $3274 per patient annually (p < .0001). Sensitivity analyses using different risk adjusters and including Medicare's spending for VHA patients yielded similar results. In the VHA system, primary care is associated with substantial cost savings. Investments in primary care in other settings might also be cost-effective.

Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey

Objectives:Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences.Methods:We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs.Results:Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7).Conclusions:Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.

Enhancing primary care services for diverse sexual and gender minority populations: a developmental study protocol

IntroductionCompared with heterosexual, cisgender populations, sexual and gender minority (SGM) people are more likely to suffer from serious health conditions and insufficient access to health services. Primary care is at...

Enhancing primary care support for informal carers: A scoping study with professional stakeholders.

Informal carers (i.e. people who provide unpaid care to family and/or friends) are crucial in supporting people with long‐term conditions. Caring negatively impacts on carers’ health and experiences of health services. Internationally and nationally, policies, legislation, professional guidance and research advocate for health and care services to do more to support carers. This study explored the views of health and social care providers, commissioners and policy makers about the role and scope for strengthening health service support for carers. Twenty‐four semi‐structured interviews, with 25 participants were conducted, audio‐recorded, transcribed verbatim and analysed by thematic analysis. Three main themes emerged: (a) identifying carers, (b) carer support, and (c) assessing and addressing carer needs. Primary care, and other services, were seen as not doing enough for carers but having an important role in identifying and supporting carers. Two issues with carer identification were described, first people not self‐identifying as carers and second most services not being proactive in identifying carers. Participants thought that carer needs should be supported by primary care in collaboration with other health services, social care and the voluntary sector. Concerns were raised about primary care, which is under enormous strain, being asked to take on yet another task. There was a clear message that it was only useful to involve primary care in identifying carers and their needs, if benefit could be achieved through direct benefits such as better provision of support to the carer or indirect benefit such as better recognition of the carer role. This study highlights that more could be done to address carers’ needs through primary care in close collaboration with other health and care services. The findings indicate the need for pilots and experiments to develop the evidence base. Given the crucial importance of carers, such studies should be a high priority.

Enhancing primary health care providers’ capacity in screening and referral of women with fistula

Aims: To describe PHC providers’ perspectives on the intervention and differences between intervention and comparison districts in PHC providers’ fistula-related capacity.&#x0D; Methods: At intervention endline, structured interviews were conducted across 50 PHCs in intervention (n=22) and comparison (n=28) districts with 100 providers on their knowledge of fistula screening, counseling and referral, perceived access barriers and experience implementing the intervention.&#x0D; Results: More than a third of trained providers used the job aid to screen for OF, while 25% used the hotline at least once. Half thought the transportation voucher was the most important intervention component, while 70% selected community agents. Awareness of emergency obstetric care as a prevention strategy was significantly higher in intervention than comparison district (56% v. 16%; p &lt;0.001). A higher proportion of providers in intervention sites recognize and refer women with fistula symptoms (38% v. 26%).&#x0D; Conclusions: Strengthening PHC provider capacity can improve screening and referral of fistula patients in marginalized areas, reducing barriers to repair.

A6635 Enhancing primary care service and preventing excessive alcohol intake to reduce regional disparity in hypertension control—results from the screening of 47000 adults in Emin, China

Objectives: Hypertension (HT) is the leading preventable cause of cardiovascular disease but poorly controlled in Xinjiang. More focused efforts could be deployed to accelerate the control rate with a better understanding local distribution of HT and related factors. Methods: We conducted a blood pressure (BP) screening project covered a third of adult population during 2014–2016 in Emin County, northern Xinjing, China. HT was defined as systolic BP ≥140 mmHg, and/or diastolic BP ≥90 mmHg and/or taking anti-HT drugs. We compared the prevalence, awareness, treatment, and control rates of HT and related factors among different regions (agricultural, stock-raising or urban) and by ethnic groups (Han, Kazakh, Uygur and Mongolian). Results: Totally 47040 adults completed screening process, 48.5% were women. The overall age-adjusted rates of prevalence, awareness, treatment, and control of HT were 26.5%, 64.6%, 44.5%, and 15.3%, respectively. HT prevalence rate was higher in urban (28.2%) than in other regions, and in Kazakh (30.3%) than in other ethnic groups. The lowest awareness and treatment rates were observed in rural region or in Kazakh population, while the lowest control rate was presented in stock-raising region (13.8%) or in Kazakh ethnic group (12.6%). After adjusting for age, gender, ethnic group and regions, compared to normal weight, non-smoker and non-drinkers, obesity, smoking and alcohol drinking were significantly related to increased prevalence of HTN by 53%, 1.6 and 4.4 folds, respectively. Conclusion: The disparities in HTN control among regions and ethnic groups suggested inadequate screening and treatment by primary health care, especially in agricultural and stock-raising regions. Control of alcohol drinking, smoking and obesity should be at high priority of health promotion. Even though the curre

SnoChillie Browser and Web Services: Enhancing Primary Care &amp; Emergency Services in New Zealand

An introduction: (comprising context and problem statement) New Zealand’s largest primary care network is in the transition from Read Version 2 to SNOMED CT signaling the end of an era for the former. Now a patient’s diagnosis and clinical activity are being entered into SNOMED CT to facilitate the interchange of standardized patient information between health professionals as a seamless process.Simultaneously Valentia Technologies (VTL) has developed “SnoChillie Browser” which provides a standardized approach to facilitate accurate health records embracing all clinical terminology for documentation and reporting.Key features of SnoChillie Browser: “Post Coordination” which is a hierarchical system that channels the diagnosis to a precise description based on the International Health Terminology Standards Development Organization (IHTDSO) hierarchy.Mapping: between other terminologies e.g. International Classification of Diseases 10 (ICD 10), Logical Observation Identifiers Names and Codes (LOINC), Clinical Term Version 3 etc.Aim and theory of change: SnoChillie Browser provides an easier online access for health professionals to facilitate clinical decision support, care coordination and optimize medication requirements.The theory of change involves developing and exposing Web Application Programming Interface (API) so that it is accessible within the public domain of New Zealand healthcare.Targeted population and stakeholders: SnoChillie API is targeted at stakeholders engaged in the development of Electronic Health Record (EHR) systems and primary users of SnoChillie Browsers are General Practitioners, Nurses, and Medical Care Assistants.Timeline:- July 2015: Research and Development initiated- May 2016: First release of SnoChillie BrowserHighlights: (innovation, impact, and outcomes) SNOMED CT Release Format 2 is being implemented in New Zealand for the first time by VTL and is available for use by the Web developer community with comprehensive documentation to facilitate its application.SnoChillie will also enable all health professionals to exchange their patient care information to multidisciplinary teams effortlessly to optimize patient health and wellbeing.Comments on sustainability: VTL has worked in partnership with relevant stakeholders:To manage the Terminology Services; to ensure that SNOMED CT International Release database is updated accordingly and to provide guidance regarding utilization of VTL’s SnoChillie Web API to all developers without importing database.Comments on transferability: VTL swiftly adopted the IHTSDO Workbench and assisted the New Zealand Ministry of Health to pilot and integrate SNOMED CT in the following areas:-- Emergency care- TeleHealth- Phone Triage- Electronic Patient Care reporting- Health Information Exchange- Electronic Patient reporting Form- Patient Management System.Discussion :(comprising key findings) SNOMED CT is a unique terminology product to help EHRs better connect and exchange health information which enables comparison, exchange, and reuse throughout the health system e.g. by General Practitioners &amp; Nurses.VTL “Post coordination” is a refinement to the former and provides a highly organized pathway to deliver a descriptive diagnosis.Conclusion &amp; lessons learned: Working in collaboration with all stakeholders has greatly facilitated the process and success of SNOMED CT and hence VTL SnoChillie. Health care organizations within New Zealand should be encouraged and provided incentives to begin adopting SNOMED CT and SnoChillie to drive their decision-support applications.

Enhancing primary care clerkships with virtual patients

Background: Virtual patients, computer-assisted patient scenarios, have been used in different medical disciplines over several years. Researchers have already gained knowledge on how it helps foster clinical thinking, fills knowledge gaps and enables patient management. Nonetheless, despite these advances in knowledge, the use of virtual patients in Family Medicine education remains limited. Objectives: We point out the current knowledge, benefits and potential ways of using virtual patients in the Family Medicine setting. Discussion: Virtual patients can be used as a preparation tool for clinical clerkships as well as learning about patient treatment not usually encountered in every day practice. Regardless of the means of implementation, students benefit from acquiring skills through multifaceted virtual patients. We firmly believe that, when intelligently applied, virtual patients can enhance and improve future Family Medicine education.