Patients In Primary Care Setting Research Articles

NT-proBNP for risk prediction of cardiovascular events and all-cause mortality: The getABI-study

BackgroundBeside their role in the diagnosis of heart failure in symptomatic patients with dyspnea, natriuretic peptides have been suggested to improve risk prediction of cardiac events and mortality in asymptomatic cohorts. We aimed to evaluate the prognostic value of NT-proBNP for cardiovascular and all-cause mortality above traditional risk factors in a prospective cohort study of unselected elderly patients in a representative primary care setting. MethodsWe followed 6382 patients of the getABI-study for 7 years. Associations of NT-proBNP levels (≤125; 125–300; >300pg/ml for all) with all-cause and cardiovascular mortality were assessed using cox regression analysis. ResultsThe incidence of all-cause and cardiovascular mortality was higher in subjects with higher levels of NT-proBNP (all-cause mortality/cardiovascular mortality: 35.4%/6% for NT-proBNP > 300 pg/ml; 16.2%/40% for NT-proBNP 125–300 pg/ml vs. 11.4%/4% for NT-proBNP ≤ 125 pg/ml. Participants with a NT-proBNP levels > 300pg/ml had increased incidence of hard endpoint (hazard ratio (HR) (95% confidence interval (CI)): 3.62 (3.15–4.17) for all-cause mortality, and 6.38 (4.84–8.41) for cardiovascular mortality). These associations remained after adjustment for traditional risk factors and cardiac medications and diseases (HR = 2.64 (2.26–3.08) for all-cause mortality, and HR = 3.93 (2.90–5.32) for cardiovascular mortality). ConclusionOur results show strong associations of higher NT-proBNP levels with cardiovascular and all-cause mortality in an unselected, large population of elderly patients in the primary care setting independent of traditional risk factors indicating that NT-proBNP can help identifying subjects at high risk for cardiac events.

Physical activity promotion for multimorbid patients in primary care settings: a protocol for a systematic review evaluating health benefits and harms

BackgroundTo date multimorbidity has not received much attention in health policies, even though multiple chronic diseases put high demands on the health care system in industrial nations. Enormous costs of care and a physically, mentally, and socially reduced quality of life are common consequences of multimorbidity. Physical activity (PA) has a positive preventive and therapeutic effect on common non-communicable diseases. The objective of this study will be to evaluate the health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings.MethodsThis is the study protocol for a systematic review. We will search PubMed, MEDLINE (Ovid), Web of Science, CINHAL, and the Cochrane Library (from inception onwards). In addition, clinical trial registers and reference lists of included studies will be searched. We will include randomized controlled trials, quasi-experimental, and non-randomized trials examining the health benefits and harms of PA interventions with or without additional lifestyle interventions for sedentary adult patients with multimorbidity (e.g., two or more chronic non-communicable diseases) in primary care. Eligible control groups will be standard care, placebo, or medications. Two reviewers will independently screen all citations, abstracts data, and full-text articles. The primary outcomes will be health-related quality of life and mortality. Secondary outcomes will include cardiovascular fitness, muscular strength and disease-specific outcomes (e.g., depression score), biomarkers as well as control of metabolic risk factors (e.g., blood pressure, HBA1c, body weight) and any adverse event. The methodological quality of the studies will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., study design, geographical location, or type of intervention). Strength of the body of evidence will be assessed according to the Grading of Recommendations Assessment (GRADE).DiscussionThis review will evaluate the evidence on health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. We anticipate our findings to be of interest to patients, their families, caregivers, and healthcare professionals in selecting and conducting optimal health promotion programs. Possible implications for further research will be discussed.Systematic review registrationOpen Science Framework (registration identifier: osf.io/ka8yu)

Frequency and individual severity of arterial blood pressure changes in children and adolescents with attention-deficit/hyperactivity disorder treated with methylphenidate hydrochloride: a prospective non-interventional study

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a common behavioural disorder in childhood. The psychostimulant methylphenidate hydrochloride (MPH) is one of the major pharmacological options for ADHD. MPH is known to result, on...

ATA2020 Session Summaries (Abstracts)

ATA2020 Session Summaries (Abstracts)

Interventions to Reduce Adverse Drug Event-Related Outcomes in Older Adults: ASystematic Review and Meta-analysis.

Many studies focus on interventions that reduce the processes that lead to adverse drug events (ADEs), such as inappropriate or high-risk prescribing, without assessing whether they result in a reduction in ADEs or associated adverse health outcomes. Our objective was to systematically review interventions to reduce the incidence of ADEs measured by health outcomes in older patients in primary care settings. The review included randomised controlled trials, controlled clinical trials, controlled before and after studies, interrupted time series studies and cohort studies conducted in the community care setting. Older patients (aged ≥ 65years) receiving medical treatment in primary care were included. Interventions wereaimed at reducing adverse health outcomes associated with ADEs in older patients. Risk of bias was assessed using the Cochrane Collaboration's tool. Outcomes were measured by reductions in hospitalisation, emergency department (ED) visits, mortality and improvements in quality of life (QoL), mental health and physical function. Fixed and random-effects models were used to calculate pooled effect estimates comparing interventions and control groups for the outcomes, where feasible. The literature search identified 1566 abstracts, seven of which were included in the systematic review. The interventions for reducing ADEs included prescription or medication reviews by a pharmacist (n = 4), primary care physician (n = 1) or research team (n = 1), and an educational intervention (n = 1) for nursing staff to improve the recognition of potentially harmful medications and corresponding ADEs. Meta-analysis found no statistically significant benefit from any interventions on hospitalisation, ED visits, mortality, QoL or mental health and physical function. No significant benefit was gained from any of the interventions in terms of the outcomes considered. New approaches are required to reduce ADEs in older adults.

Description of frail older people profiles according to four screening tools applied in primary care settings: a cross sectional analysis

BackgroundRegarding the health care of older populations, WHO recommends shifting from disease-driven attention models towards a personalized, integrated and continuous care aimed to the maintenance and enhancement of functional capacities. Impairments in the construct of functional intrinsic capacity have been understood as the condition of frailty or vulnerability. No consensus has been yet reached regarding which tools are the most suitable for screening this kind of patients in primary care settings. Tools based on the measurement of functional performance such as Timed up and go test (TUG), Short Physical Performance battery (SPPB), self-completed questionnaires like Tilburg Frailty Indicator (TFI) and clinical judgement, as the Gerontopole Frailty Scale (GFS) may be adequate. The objective of this work is to describe and compare characteristics of community-dwelling individuals identified as vulnerable or frail by four tools applied in primary care settings.MethodsCross sectional analysis developed in primary care services in two regions of Spain.Community-dwelling independent individuals aged 70 or more willing to participate were recruited and data was collected via face-to-face interviews. Frailty was assessed by TUG, SPPB, TFI and GFST. Also socio-demographic characteristics, lifestyle habits and health status data (comorbidities, polypharmacy, self-perceived health), were collected. Multiple correspondence analysis (MCA) and cluster analysis were used to identify groups of individuals with similar characteristics.ResultsEight hundred sixty-five individuals were recruited, 53% women, with a mean age of 78 years. Four clusters of participants emerge. Cluster 1 (N = 263) contained patients categorized as robust by most of the studied tools, whereas clusters 2 (N = 199), 3 (N = 183) and 4 (N = 220) grouped patients classified as frail or vulnerable by at least one of the tools. Significant differences were found between clusters.ConclusionsThe assessed tools identify different profiles of patients according to their theoretical construct of frailty. There is a group of patients that are identified by TUG and SPPB but not by GFS or TFI. These tools may be useful in primary care settings for the implementation of a function- driven clinical care of older patients.

Neurology eConsults at Penn State Health: What, Why, and How?

eConsults provide a mechanism for specialists to provide guidance to their colleagues to allow them to manage patients in primary care settings. The patient receives access to specialist expertise, avoids the long wait time and high costs associated with an office visit, and maintains relationship continuity with the primary care physician (PCP). The PCP has dynamic access to specialist expertise and an opportunity for attainting a higher comfort level with chronic neurological care comanagement. Patient referrals for specialty care are high, while there has been projected shortage in nonprimary care specialties. The increasing prevalence of neurologic diseases associated with an aging population will likely continue to increase the demand for neurologists.

Diabetes distress in Indonesian patients with type 2 diabetes: a comparison between primary and tertiary care

BackgroundThe number of people living with diabetes mellitus (DM) in Indonesia has continued to increase over the last 6 years. Four previous studies in U.S have found that higher DD scores were associated with worse psychological outcomes, lower health-related quality of life (HRQoL) and increased risk of T2DM complications. In this study, we aimed to firstly compare DD scores in Indonesian T2DM outpatients treated in primary care versus those in tertiary care. Subsequently, we investigated whether socio-demographic characteristics and clinical conditions explain potential differences in DD score across healthcare settings.MethodsA cross-sectional study was conducted on Java island in three primary care (n = 108) and four tertiary care (n = 524) facilities. The participants completed the Bahasa Indonesia version of the Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). Ordinal regression analysis was conducted with the quartile of the summation of the DD score as the dependent variable to investigate how the association between the level of healthcare facilities and DD altered when adding different variables in the model.ResultsThe final adjusted model showed that the level of healthcare facilities was strongly associated with DD (p < .001), with participants in primary care having a 3.68 times (95% CI 2.46–5.55) higher likelihood of being more distressed than the participants in tertiary care. This association was detected after including the socio-demographic characteristics and clinical conditions as model confounders.ConclusionsThis is the first study in Indonesia to compare DD scores within different healthcare facilities. We recommend a regular DD assessment, possibly closely aligned with health-literacy partner programs, especially for T2DM patients in primary care settings.

The Possibility of Correcting Anxiety Symptoms in Cardiac Patients in Primary Care Settings: Results of the Therapeutic Part of a Russian Multicenter Study COMETA

to assess efficacy of correction of anxiety states by anxiolytic drug fabomotizole in ambulatory patients with arterial hypertension(AH) and / or ischemic heart disease (IHD). In the framework of multicenter cross-sectional study withparticipation of patients aged ≥55 years with verified AH / IHD we conducted the therapeutic part of the COMETA program in whichwe included patients with comorbid anxiety state (≥11 points on the Hospital Anxiety and Depression Scale Anxiety [HADS-A]and clinically expressed anxiety state) without clinically expressed depressive symptoms (&lt;11 points on the HADS-Depression).Participants were randomized into main and control groups. Patients in the main group in addition to therapy prescribed becauseof AH / IHD were given a recommendation to take fabomotizole (10 mg thrice a day), patients of control group received standardtherapy. Efficacy of therapy was evaluated by HADS and visual analog scale after 6 and 12 weeks of observation. We included182 and 104 in the main and control groups, respectively. Most patients in main and control groups had AH (97.3 and 95.2 %, respectively,about one third had IHD (36.8 and 30.8 %, respectively). Social-demographic, clinical characteristics, and recommendedfor AH / IHD treatment of participants of both groups were similar. Portion of patients with complete reduction of anxiety symptoms(&lt;8 points on HADS-A) was significantly higher already after 6 weeks of fabomotizole therapy (37.9 and 19.2 %, respectively,p&lt;0.001). Analogous picture was noted by the end of observation (66.9 and 32 %, respectively; p&lt;0.001). Mean estimate of chronicpsychoemotional stress in the main group decreased by 25 % after 6 weeks (from 6.45±2.20 to 5.05±1.96 points; р&lt;0.001) and by40 % after 12 weeks (from 6.45±2.20 to 3.98±1.99 points; р&lt;0.001). In the control group it also decreased but degree of lowering was2 times less than in the main group (11.1 % vs. 25 % after 6 weeks, р=0.016; and 20 % vs. 40 % after 12 weeks, р&lt;0.001, respectively). The use of fabomotizole by patients with AH / IHD provided improvement of psychological status (reduction of anxietysymptoms and lowering of the level of chronic psychoemotional stress).

Vaccination management for elderly patients in primary care settings - documentation and responsibilities during a vaccination campaign.

ObjectiveThe aims of the current analysis were to evaluate the vaccination status and attitudes towards vaccinations of elderly patients and to explore effects of a vaccination campaign.MethodsThe data were raised in primary care settings by a physicians network which collected data during routine care from 697 patients and by the analysis of health insurance claims data from the Kassenärztliche Vereinigung Schleswig-Holstein (KVSH/Association of Statutory Health Insurance Physicians of the federal state of Schleswig-Holstein, Germany), regarding vaccinations in the participating practices before and after a vaccination campaign.ResultsVaccination documentation for tetanus (57.7%), diphtheria (55.7%) and influenza (55.8%) was available for slightly more than half of the study sample. A lower documentation rate was observed for pertussis (33.1%), pneumococcal vaccination (30.3%) and polio (26.3%). Practice assistants were more responsible for determining the vaccination status than physicians. The attitude regarding influenza and pneumococcal vaccine was positive in 72.9% and 56.9% of patients respectively. After the campaign, rates of influenza and pneumococcal vaccine utilization increased by 13.4% and 62.9%, respectively.ConclusionsAttitudes regarding vaccination were generally positive. Documentation was missing for almost half of the elderly population. The delegation of vaccine management to practice assistants could increase the immunization rate. Moreover, it can be assumed that a campaign might be helpful in increasing vaccination awareness and vaccine coverage.

Elucidating factors associated with non-adherence among Type 1 diabetes patients in primary care setting in Southeastern Brazil

AimsTo explore the factors associated with adherence and non-adherence to the pharmacological treatment of patients with T1DM in primary care setting southeast Brazil. MethodsWe conducted a cross-sectional study with 158 patients attending in the primary health care in the city of Franca southeast Brazil and measure adherence to antidiabetic medication. Adherence was measure using Morisky–Green Test modified. ResultsThe majority of patients was adherence to antidiabetic medication (63.2%). More than one third of patients were non-adherent treated pharmacologically and comorbidities most prevalent were hypertension (63.8%), dyslipidemia (43.1%) and depression (32.8%). Depression were strongest predictor OR=2.8 (1.2–6.5) of non-adherence. ConclusionDepression is a factor associated with non-adherence to pharmacological treatment in patients with T1DM, and in clinical practice, screening for depression and intervention as well as pharmaceutical care may improve adherence to pharmacotherapy.

Potentially inappropriate medication use among geriatric patients in primary care setting: A cross-sectional study using the Beers, STOPP, FORTA and MAI criteria.

Inappropriate prescribing is a risk factor for adverse drug reactions and hospitalizations in the elderly and places a considerable burden on the healthcare system. Hence, it is imperative to identify irrational prescribing and implement interventions to improve prescribing appropriateness in geriatric clinical practice. This study aimed to determine: (i) the prevalence of potentially inappropriate medications (PIMs) according to Beers STOPP, FORTA, and the Medication Appropriateness Index (MAI) criteria; (ii) the prevalence of potential prescribing omissions (PPOs) according to START criteria; and (iii) the predictors for PIMs and PPOs. A cross-sectional study was performed among elderly outpatients of 10 primary healthcare centers with specialized geriatric clinics in Kuwait. Four-hundred and seventy-eight patients were selected randomly, 420 (87.9%) agreed to participate. Data about chronic diseases and prescribed medications were obtained from the physicians by accessing the patients’ medical records. Descriptive and multivariable logistic regression were used for data analysis. A total of 2645 medications were prescribed to all patients; mean (SD) number of medicines per patient was 6.3 (3.0). PIMs were present in 53.1%, 55.7%, and 44.3% of respondents, according to Beers, STOPP, and FORTA criteria, respectively. Almost 74% of respondents had one or more inappropriate ratings among their medications in the MAI criteria. According to START criteria, 19.8% of patients had at least one PPO. Respondents taking ≥ 5 medications were found to be using more PIMs according to Beers (OR: 6.3), STOPP (OR: 3.3), FORTA (OR: 6.0) and MAI (OR: 3.9) criteria in comparison to those taking ≤ 4 medications (p<0.001). The MAI revealed a significantly higher number of medications with inappropriate ratings compared to the Beers, STOPP and FORTA criteria (p<0.001). Taking the MAI as reference standard, STOPP criteria had the highest sensitivity (68.6%) and measure of agreement (Kappa index = 0.40) to detect PIMs compared with Beers and FORTA criteria. Inappropriate prescribing is common among the elderly in the primary geriatric clinics. This necessitates further evaluation of its impact on clinical outcomes and warrants efforts to implement interventions to improve prescribing practice in these settings.

The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018.

BackgroundCardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence.ObjectiveThis study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings.MethodsWe will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level.ResultsThe project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019.ConclusionsThe findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities.International Registered Report Identifier (IRRID)DERR1-10.2196/13571

Health advice and education given to overweight patients by primary care doctors and nurses: A scoping literature review.

Health advice for overweight patients in primary care has been a focus of obesity guidelines. Primary care doctors and nurses are well placed to provide evidence based preventive health advice. This literature review addressed two research questions: ‘When do primary care doctors and nurses provide health advice for weight management?’ and ‘What health advice is provided to overweight patients in primary care settings?’The study was conducted in the first half of 2018 and followed Arksey and O'Malley (2005) five stage framework to conduct a comprehensive scoping review. The following databases were searched: Emcare, Ovid, Embase, The Cochrane library, Proquest family health, Health source (nursing academic), Joanna Briggs Institute EBP database, Medline, PubMed, Rural and remote, Proquest (nursing and allied health) and TRIP using search term parameters. Two hundred and forty-eight (248) articles were located and screened by two reviewers.Twenty-three research papers met the criteria and data were analysed using a content analysis method. The results show that primary care doctors and nurses are more likely to give advice as BMI increases and often miss opportunities to discuss weight with overweight patients. Body Mass Index (BMI) is often wrongly categorised as overweight, when in fact it is in the range of obese, or not recorded and when health advice is given, it can be of poor quality. Few studies on this topic included people under 40 years, practice nurses as the focus and those with a BMI of 25–29.9 without a risk factor. A ‘toolkit’ approach to improve advice and adherence to evidence based guidelines should be explored in future research.

Prediction of unplanned hospital admissions in older community dwellers using the 6-item Brief Geriatric Assessment: Results from REPERAGE, an observational prospective population-based cohort study

Background: The 6-item Brief Geriatric Assessment (BGA) provides a priori risk stratification of incident hospital health adverse events, but it has not been used yet to assess the risk of unplanned hospital admission for older patients in primary care. This study aims to examine the association between the a priori risk stratification levels of the 6-item BGA performed by general practitioners (GPs) and incident unplanned hospital admissions in older community patients.Methods: Based on an observational prospective cohort design, 668 participants (mean age 84.7 ± 3.9 years; 64.7% female) were recruited by their GPs during an index primary care visit. The 6-item BGA was completed at baseline and provided an a priori risk stratification in three levels (low, moderate, high). Incident unplanned hospital admissions were recorded during a 6-month follow-up.Results: The incidence of unplanned hospital admissions increased with the risk level of the 6-item BGA stratification, the highest prevalence (35.3%) being reported with the high-risk level (P = 0.001). The risk of unplanned hospital admission at the high-risk level was significant (crude odds ratio (OR) = 5.48, P = 0.001 and fully adjusted OR = 3.71, P = 0.032, crude hazard ratio (HR) = 4.20; P = 0.002 and fully adjusted HR = 2.81; P = 0.035). The Kaplan-Meier’s distributions of incident unplanned hospital admissions differed significantly between the three risk levels (P-value = 0.002). Participants with a high-risk level were more frequently admitted to hospital than those at a low-risk level (P = 0.001). Criteria performances of all risk levels were poor, except the specificity of the high-risk level, which was 98.2%.Conclusions: The a priori 6-item BGA risk stratification was significantly associated with incident unplanned hospital admissions in primary care older patients. However, except for the specificity of the high-risk level, its criteria performances were poor, suggesting that this tool is unsuitable for screening older patients in primary care settings at risk of unplanned hospital admission.

Report on a Program to Improve Vascular Care for Women: Experience in 68,402 Patients Seen in Primary Care Clinics

Background: Lower extremity peripheral artery disease (PAD) affects at least 8.5 million people nationwide, causing 143,000+ hospitalizations and 40,000 amputations annually. Women with PAD have a higher chance of being asymptomatic or present with atypical symptoms. Fewer than half of affected women know they have PAD, and studies illustrate an expected increase in under-diagnoses in these women. Women with PAD are two to three times more likely to experience stroke or myocardial infarction (MI). This is the first report on the clinical feasibility of using a specialized volume plethysmography system (VPS) as operated by a medical aide in the primary care setting to perform PAD testing on female patients. Methods: In 2018, consecutive female patients in primary care settings were evaluated for the presence or absence and severity of PAD. Beforehand, the patients completed a self-administered questionnaire to identify gender, age, PAD symptoms, and atypical cardiovascular factors. Medical aides performed the test as part of routine clinical practice and presented results to primary care physicians who made the diagnosis based upon test findings. Results: Of the 68,402 patients who met the American Heart Association/American College of Cardiology criteria and were tested in the primary care setting, 26,576 or 38.9% had moderate to severe PAD. These patients were frequently asymptomatic, hypertensive, hyperlipidemic, diabetic, and/or had a history of tobacco smoking. Conclusion: VPS is an accurate, reproducible, cost-effective, and clinically feasible in-office or home visit test allowing for detection of PAD in women earlier in the disease process.

Professional interventions to implement guidelines to prevent hazardous alcohol consumption by patients in primary care settings

Professional interventions to implement guidelines to prevent hazardous alcohol consumption by patients in primary care settings

Perceptions regarding the scope of practice of family doctors amongst patients in primary care settings in Nairobi.

BackgroundPrimary care (PC) is the foundation of the Kenyan health care system, providing comprehensive care, health promotion and managing all illnesses across the lifecycle. In the private sector in Nairobi, PC is principally offered by the general practitioners, also known as family doctors (FDs). The majority have no postgraduate training. Little is known about how patients perceive their capability.AimTo assess patients’ perceptions of the scope of practice of FDs working in private sector PC clinics in Nairobi and their awareness of the new category of family physicians (FPs) and the discipline of family medicine.SettingPrivate sector PC clinics in Nairobi.MethodsA descriptive survey using a structured, self-administered questionnaire. Simple random sampling was used to recruit 162 patient participants.ResultsOf the participants, 30% knew the difference between FPs and FDs. There was a high to moderate confidence that FDs could treat common illnesses; provide lifestyle advice; family planning (66%) and childhood immunisations (64%). In adolescents and adults, low confidence was expressed in their ability to manage tuberculosis (58%), human immunodeficiency virus (55%) and cancer (33%). In the elderly, there was low confidence in their ability to manage depression (55%), anxiety (57%), urinary incontinence (57%) and diabetes (59%). There was low confidence in their ability to provide antenatal care (55%) and Pap smears (42%).ConclusionPatients did not perceive that FDs could offer fully comprehensive PC services. These perceptions may be addressed by defining the expected package of care, designing a system that encourages the utilisation of PC and employing FPs.

Implementing and evaluating a primary care service for oral surgery: a case study

BackgroundA primary care oral surgery service was commissioned alongside an electronic referral management system in England, in response to rising demand for Oral Surgery services in secondary care. It is important to ensure that standards of quality and safety are similar to those in existing secondary care services, and that the new service is acceptable to stakeholders. The aim of this study is therefore to conduct an in depth case study to explore safety, quality, acceptability and implementation of the new service.MethodsThis case study draws on multiple sources of evidence to report on the commissioning process, implementation, treatment outcomes and acceptability to patients relating to a new oral surgery service in a primary care setting. A combination of audit data and interviews were analysed.ResultsMost referrals to the new service consisted of tooth extractions of appropriate complexity for the service. There were issues with lack of awareness of the new service in a primary care setting within referring primary care practices and patients at the start of implementation, however over time the service became a fully integrated part of the service landscape. Complications reported following surgery were low.ConclusionPatients liked the convenience of the new service in terms of shorter waiting time and geographical location and their patient reported experience measures and outcomes were similar to those reported in secondary care. Providing appropriate clinical governance was in place, oral surgery could safely be provided in a primary care setting for patients without complex medical needs. Attention needs to be paid to communication with general dental practices around changes to the service pathway during the early implementation period to ensure all patients can receive care in the most appropriate setting.

Effective Patient-Provider Communication For Newly Diagnosed Patients In A Primary Care Setting: A Quantitative Study

Ralston Lockett, BSN, RN - FNP StudentMyra Michelle DeBose, PhD, MSN, MSEd, RN - Faculty AdvisorPrairie View A &amp; M University - College of Nursing - Graduate Program - Houston, TXBackground: There are newly diagnosed patients in primary care settings with depressive symptomsdue to lack of communication from providers. The aim of this proposed study is to assess newlydiagnosed patients who may express depressive symptomology. Establishing a sound relationshipbetween patients and providers is essential for a trusting relationship. Patient-centeredcommunication increases better health outcomes in primary care settings. There is reason to believethat missed opportunities between patient-providers can decrease patient compliance and increasedepression.Research Hypothesis: Newly diagnosed patients that receive effective provider communication willhave a decrease in depressive symptoms as compared to newly diagnosed patients who do not receiveeffective communication.Methodology: This study uses a longitudinal, quasi-experimental research design, conveniencesampling. Up to 80 newly diagnosed patients who did not receive effective communication will beevaluated for approximately six months. The primary setting will be 2 urban area clinics in Houston,Texas. The Center for Epidemiologic Studies Depression Scale (CES-D), will be used within 30 days afterthe initial healthcare provider visit to assess depressive symptoms.Results: Depressive symptoms will be measured using the (CES-D) assessment tool of 20 – items. Thetool assesses how frequently an individual experienced depressive symptoms within a week. Inaddition, a 45 min post visit survey regarding provider communication will be sent after 30 days.Sample analysis will include diagnosis and literacy level. Participants will be asked to identify preferredmethods of communicating with their provider.Significance: There is a correlation between depressive symptoms and lack of effective communicationwith patients in a primary care setting. Poor identification of patient’s mental health status andengagement in plan of care can lead to poor patient health outcomes, increase health care costs, anddisparities to under-privilege communities.