Primary Care Organizations Research Articles

Conceptualizing success factors for patient engagement in patient medical homes: a cross-sectional survey.

Background:Patient engagement is a priority for health care quality improvement and health system design, but many organizations struggle to engage patients meaningfully. We describe patient engagement activities and success factors that influence organizational decision-making in Ontario’s patient medical homes.Methods:From March to May 2018, we conducted an online survey focused on practice-level patient engagement that targeted primary care organization leaders at all Ontario family health teams, community health centres, nurse practitioner–led clinics and Aboriginal Health Access Centres. We asked questions from the Measuring Organizational Readiness for Engagement (MORE) and Public and Patient Engagement Evaluation Tool (PPEET) questionnaires. We used factor and mediation analysis to identify organizational conditions and activities that are associated with the outcomes of patient engagement, affecting board decisions, program-level decisions and the formation of collaborative partnerships.Results:We achieved a 53% response rate (n = 149/283); after removing missing data, our final sample size was 141 respondents. Most respondents perceived that their organization’s patient engagement activities and resources were insufficient. Processes that had a direct effect on outcomes (β = 0.7, p < 0.0001) included planning, training and supporting employees; identifying, recruiting and supporting relevant patients; and using leaders. Structures — including an organizational mission and vision for patient engagement, and policies, procedures, job positions, training programs and organizational culture that reflect that mission — indirectly affected outcomes, mediated by the aforementioned processes (β = 0.7, p < 0.0001).Interpretation:Based on the perceptions of primary care leaders, organizational structures and processes are related to successful patient engagement. Organizations that seek to improve patient engagement should assess their commitment and follow-through with associated resources and activities.

Implementation of Integrated Primary Care for Patients with Diabetes and Hypertension: A Case from Slovenia.

Introduction:Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care.Methods:This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients.Results:The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented.Discussion:The implementation of the integrated care of patients with diabetes and/or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified.Conclusion:Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved.

Epidemiological features of glaucoma prevalence among the population of the Russian Federation

PURPOSE. To study the epidemiological features of glaucoma prevalence among the population of the Russian Federation and to assess the organization of primary specialized medical care for patients with this pathology.MATERIALS AND METHODS. The subject of this study was the population of the Russian Federation diagnosed with glaucoma. In order to assess the epidemiological features of glaucoma prevalence and to assess the organization of primary specialized medical care for patients with this pathology, according to the federal statistical reporting forms (Forms No. 12, No. 30), the following indicators were calculated: overall and primary incidence of glaucoma in the general population; proportion of patients with glaucoma who are registered with ophthalmologists; availability of ophthalmologists (individuals) per 100 thousand population; proportion of patients with glaucoma diagnosis established during preventive examinations; total number of registered patients with blindness and visual impairment. Statistical processing of the material involved methods of descriptive statistics; calculation of average and relative values with a preliminary assessment of the distribution of indicators for normality. Spearman rank correlation method was used to determine the correlation between quantitative variables.RESULTS. The studied data was used to calculate the following average values: total and primary glaucoma incidence among the population of the Russian Federation — 78.2 (55.8–105.3) cases per 100 thousand population; the proportion of patients with dispensary registered glaucoma — 80% (74.4–85.8%). The performed correlation analysis established a moderate direct statistically significant relationship between the indicators of total and primary glaucoma incidence among the population (rank correlation coefficient: r=0.72 at p&lt;0.05). In its turn, the correlation between the indicators of glaucoma incidence among the population and the availability of ophthalmologists for the population has not been established (r=0.14, p&gt;0.05). It was found that the indicators of dispensary observation of glaucoma patients do not depend on the indicators of total glaucoma incidence (r=0.16) and availability of ophthalmologists for the population (r=0.13). There is a weak inverse correlation between the proportion of glaucoma cases detected during preventive examinations and the indicator of primary glaucoma incidence among the population (r=-0.28; p&lt;0.05). Also, the correlation analysis did not establish a relationship between the indicator of total glaucoma incidence among the population and the total number of registered patients with blindness and low vision (r=-0.008).CONCLUSION. The incidence rate of glaucoma in specific administrative territories should be assessed by comparison with the average values among the whole population, which are represented by the median and quarterly ranges. The incidence rate of glaucoma in the general population is not statistically related to the level of availability of ophthalmologists for the population. The proportion of follow-up observation of glaucoma patients does not depend on the availability of ophthalmologists and the level of glaucoma incidence. The incidence of blindness and low vision does not statistically correlate with the incidence of glaucoma in the population.

Evolvement of the primary care landscape – from generalist to specialist

IntroductionNumerous forces drive the evolution and need for transformation of primary care. Decisionmakers in Europe argue that primary care cannot remain in status quo. One key policy issue during the previous decade, especially in Northern and central Europe, has been organization of primary care and introducing new organizational models to improve patient experience and achieve greater efficiency and value from health and social care delivery systems. The aim of this study to describe how primary care services are evolving and changing, stimulating new models for service provision by 1) describing the degree specialisation of Norwegian nursing homes and home care services and 2) analysing whether structural factors like population size and/or centrality is associated with degree of specialisation.MethodsCross-sectional study using an online survey. All of Norway’s 422 municipalities were invited to answer the survey during the period February to April 2019.ResultsIn total, we got complete responses from 277 municipalities. Having specialised primary care services for particular patient groups were highly prevalent, e.g. units in nursing homes for dementia care (89%) and rehabilitation (81%), and homecare teams for e.g. dementia care (79%) and reablement (76%). Over two-thirds (69%) of our sample were categorised as having high-level of specialisation in homecare services and 60% had high-level of specialisation in nursing home services. Significantly more of the lager, most central municipalities had high levels of specialisation compared to medium-sized or small, less central municipalities.DiscussionsSpecialisation of primary care and regional differences can be both advantageous and necessary, but it may also negatively impact fundamentals such as equity, accessibility, continuity, coordination and comprehensiveness of care.ConclusionsOur study indicates that primary care is changing. It has evolved from generalist services for older adults to a differentiated and specialised service which serve patient-groups where different age-groups are represented. There are also indications of different service models emerging, where some provide more specialised services, while others are generalists.Lessons learnedDue to continuing political and social changes, both in individual countries as well as globally, it is essential to uncover trends and discuss their intended effects and unintended consequences to be able to plan for a sustainable, high-quality primary care service in the future.LimitationsThe study is based on municipal managerial employees’ knowledge and perception of the provision of their primary healthcare services – the respondents may not have had sufficient knowledge about the full extent of services provided since they are not ‘hands-on in the field’. Our pre-defined categories in the survey did not cover the entire array of services provided in primary care.Suggestions for future researchLongitudinal studies of the development of primary care in order to gain more detailed knowledge about how international and national trends and reforms transform the care landscape. Furthermore, identify and characterise typologies of primary care provision models and how the different models impact on the quality of care delivered.

Primary Health Care and Hospital Management During COVID-19: Lessons from Lombardy.

The pandemic due to SARS-CoV-2 tested the resilience of health systems worldwide. The outcome of the pandemic is impacted by health management choices made over the course of the disaster, which in turn are strongly dependent on the underlying healthcare system – as mirrored by the fact that regional pandemic experiences differ considerably: In Italy (a country most impacted by the COVID-19 outbreak), infection and mortality rates vary vastly between regions, with Lombardy – a comparatively well-equipped region with regard to hospitals and centers of scientific excellence – being amongst the worst-affected areas. Within this article, we focus on the challenges within primary health care and hospital organization, cooperation between primary and specialist care, and access to health care services: In Lombardy, neglected primary health care with a comparatively low availability of general practitioners (GPs) per inhabitant, the initial prioritization of hospitals during the pandemic while neglecting primary health care in terms of personal protective equipment (PPE), the lack of testing resources, and a failure to achieve coordinated support contributed to a quick overburdening of hospitals, where the dissolution of traditional departments into “macro-areas” may favor nosocomial infections during an ongoing pandemic. Neither specialized medicine nor privatization, but rather flexible public healthcare services working in consistent cooperation with GPs, show better efficiency in containing viral spread and managing patients. Strengthening the primary health care sector with regard to human and technical resources and supporting the coordination between the different levels of health care providers help to avoid overcrowded hospitals, while protecting patients and health care workers during large-scale health emergencies. Overall, further in-depth analysis of structural determinants is needed in order to develop more-resilient and integrative health care systems.

Intuition and rationality in intrapreneurship and innovation outputs: The case of health professionals in primary health care

The aim of this article is to explore the role of cognitive styles and intrapreneurship in health professionals’ innovation outputs, as well the mediated effect of intrapreneurship between cognitive styles and innovation output. This study used the survey method of data collection, through a self-administered questionnaire. Partial least square structural equation modelling method was used to analyse the result of the sample of 209 professionals of primary health care providers in Northern Portugal. Our findings reveal that cognitive style plays a significant role in intrapreneurship and innovation outputs, which are mediated by intrapreneurship. In particular, health care professionals with the rational cognitive style are likely to be more of a intrapreneur and innovative as compared to those with a intuitive cognitive style. Promoting intrapreneurship is crucial for successful innovation outputs. This study reveals that an understanding of the cognitive style of the health care professionals can help managers allocate appropriate individuals to different healthcare tasks. Our primary contribution to theory has been to highlight the importance of cognitive styles in intrapreneurship and innovation within the context of primary health care organizations.

THE ASSESSMENT OF THE RESEARCH POTENTIAL OF THE AMBULATORY-POLYCLINICAL INSTITUTIONS OF THE MOSCOW HEALTHCARE SYSTEM

Scientific research and their inclusion in the health care system is an important part of modern medical science. To study the readiness of primary care physicians as well as administration staff to introduce a research component into the national health care system, "The Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department" conducted an online survey of two groups of respondents - physicians of primary care settings (n = 593) and heads of outpatient clinics in Moscow (n = 168) in 2021. The results of the study show the insufficient involvement of primary care doctors in research activities in their working places: more than half do not consider scientific activities as a priority, motivating it by the lack of conditions, practical skills, age and health status as well as high level of employment, although they do not reject it in the future. Heads of Moscow primary health care settings demonstrate similar answers. According to their opinion, research activities are poorly represented in organizations of this type, and most likely the situation will not be changed in the near future; about half do not have sufficient information about the number of employees engaged in scientific work and are rarely familiar with their topics (often extensive, represented by various fields of medicine); about one third of managers reported participating in research projects of Moscow City Department of Health. The study made it possible to identify barriers that prevent the introduction of research components into the activities of Moscow primary health care organizations, which should be taken into account when making managerial decisions.

Organization of primary medical care for patients with osteoporosis

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

Organization of primary health care in pandemics

Background: The world is experiencing one of the greatest public health emergencies in history with the global spread of COVID-19. Health systems, including Primary Health Care (PHC) services, are pillars of pandemic coping strategies. Objective: To systematic review of the literature that analyzes the effectiveness of PHC organization strategies in the context of epidemics. Methods: We performed a rapid systematic literature review on MEDLINE (via PubMed), EMBASE and LILACS (via VHL), in order to analyze empirical studies on the effectiveness of PHC organization strategies in the context of epidemics to improve access and reduce morbidity and mortality. There was no assessment of risk of bias, and the synthesis was narrative. PROSPERO CRD42020178310.Results: We selected seven articles, which studied the responses to different epidemic–s in different parts of the world. In terms of access, the studies suggest positive results with the adoption of adjustments of work processes of the teams and the structure of the services, combined with diversification of actions (including call center), adequate provision of inputs and personal protective equipment, adequate action plans and communication strategies, and effective integration with public health services and other levels of care. No study analyzed population morbidity and mortality. The included studies suggest also that community-oriented PHC is more effective in crisis scenarios, indicating the necessity of strengthening of the Family Health Strategy in the Brazilian context. Conclusion: PHC can be effective in coping with public health emergencies. Action plans should be built with broad participation by the actors involved in coping with the epidemic. Emphasis is placed on the importance of empowering the link between the healthcare service and its registered population.

Why women choose to to seek facility-level obstetrical care in rural Guatemala: A qualitative study

ObjectiveThe majority of indigenous Guatemalan women give birth at home with traditional birth attendants (TBAs), and maternal mortality rates are high (Ministerio de Salud, 2017). Our objective was to better understand decision-making around whether to remain in the home or to seek facility-level care for obstetric complications. MethodsThis study was a qualitative analysis using semi-structured interviews in a Maya population in the Western Highlands of Guatemala who received prenatal care between April 2017 and December 2018. We used qualitative interviews with women who were identified as medically high-risk and needing facility-level care, offered assistance with acquiring such care, and yet declined this option. Women interviewed were connected to a primary care organization called Maya Health Alliance, through care with TBAs involved in a program utilizing a smartphone-based decision support application to identify maternal and neonatal complications of pregnancy. Interviews were analyzed using Dedoose (www.dedoose.com). Deductive and inductive analysis was performed. ResultsBarriers to care included a disagreement between the respondent and TBA about indications for facility care, fear of hospital care, concerns about the quality of hospital care, logistical obstacles, and lack of control; and they were more often described by respondents who had previous healthcare experiences. Therapeutic misalignment occurred more with conditions perceived to be less severe. Participants described a balancing of fears and apprehensions against concerns of low quality and disrespectful maternity care, and in the setting of emergent conditions, disregarded barriers that were often described as inhibiting non-urgent obstetric care. ConclusionsThe decision to engage in medical care in this population of Maya women involves a weighing of the perception of seriousness of the medical complication against fears of facility level care and concerns of a poor quality of care.

An Ecological Model to Frame the Delivery of Pediatric Preventive Care.

* Abbreviation: FV — : fluoride varnish Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, and identify social determinants of health and protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary on the basis of the features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery. Screening and surveillance are important activities in child health promotion and disease prevention.1–5 The American Academy of Pediatrics recommends a wide range of specific preventive services to allow for early implementation of effective interventions to maximize development and quality of life.3 The need is clear; >17% of children are at risk for developmental delay,6 and screening can facilitate entry into critical services. Unfortunately, nearly 40% of pediatricians do not routinely screen … Address correspondence to Corina Graif, Department of Sociology and Criminology, Population Research Institute, Pennsylvania State University, 816 Oswald Tower, University Park, PA 16802. E-mail: corina.graif{at}psu.edu

The National Health Insurance System of Indonesia and primary care physicians' job satisfaction: a prospective qualitative study.

The implementation of the National Health Insurance System (NHIS) in Indonesia has been changing the primary care physician (PCP) work condition and their job satisfaction. This research aimed to explore the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. We conducted an exploratory qualitative study within two areas in Central Java, Indonesia, using semi-structured in-depth interviews with 34 PCPs and 19 triangulation sources. We conducted both inductive and deductive analyses by the NVivo 11. Most PCPs felt dissatisfied with the following aspects of the NHIS: referral system, NHIS health services standard, NHIS programmes, performance evaluation and pay-for-performance, relationship with patient and workloads. PCPs felt constrained with the referral regulation and non-specialist diagnoses, which led to dissatisfaction with performance evaluation and the pay-for-performance implementation. Furthermore, an increase in workload and conflict with patients resulted from patients' misunderstanding the NHIS health service procedures. However, PCPs felt satisfied with the chronic disease management programme and patients' appreciation. This study presents the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. There is a need for additional discussion among all stakeholders (Ministry of Health, Social Security Agency for Health/SSAH, primary health care and physician's professional organizations about the non-specialist diagnoses list, performance evaluation and pay-for-performance). The government and SSAH need to improve the communication and socialization of the NHIS procedures/regulations.

Strategic directions for the competitiveness of primary health care organizations

The article analyzes the impact of the pandemic COVID-19 in 2020 on the state of competition in the medical services market and the competitiveness of primary care organizations, and identifies prospects for the development of the medical services market. The SWOT-analysis and analysis of complaints and statements of citizens on the quality of medical services made it possible to comprehensively assess the strengths and weaknesses of organizations, external opportunities and threats, specify the positions of medical organizations in the medical services market and determine strategic directions for the development and ensuring the competitiveness of primary medical organizations. The results of the study allowed the authors to propose strategic directions for ensuring the competitiveness of the primary medical organization, namely, the creation of mechanisms for material and intangible incentives for medical personnel; improving the quality of health services; modernization of the medical diagnostic base of the primary medical organization.

Impact of a Pharmacy-Led Transitions of Care Program Within a Primary Care-Based Accountable Care Organization.

To assess the impact of pharmacist-led transitions of care program on 30-day readmission rates in the accountable care organization (ACO) primary care setting. Retrospective cohort study. Two primary care provider (PCP) offices with an ACO in South Florida. Adult Medicare patients who completed a post-discharge follow-up visit at two primary care offices within an ACO from July to December 2017. To supplement postdischarge visits with a PCP, the pharmacy services were also provided two days per week with a PCP. The comparator groups were patients who only saw a PCP or those who saw a PCP and pharmacist. The primary outcome was hospital readmission or emergency department visit within 30 days. A total of 190 subjects were included. There were 113 patients in the PCP group and 77 patients in the PCP/pharmacist group. There was a reduction in the primary outcome when comparing the PCP-only versus PCP/pharmacist groups (6.2% versus 3.9%; P = 0.74). Involving pharmacists in patient transitions of care in the primary care setting may be beneficial as previous studies have demonstrated. Further studies evaluating pharmacy services in emerging health care models are needed in order to most effectively utilize the expertise of the pharmacy team.

Motivation of nursing personnel in a primary care medical organization (primary healthcare)

The aim of the study the theoretical and methodological foundations of motivation in the professional activity of nurses and its impact on improving the efficiency of the polyclinic and the degree of patient satisfaction with the organization of primary health care. Results: the role and importance of labor stimulation in increasing the efficiency of the organization’s activities were considered, an analysis and assessment of the motivation of the labor activity of nurses was carried out, the main directions of improving the motivation of the labor of nurses and the efficiency of the polyclinic were developed. Conclusion: a properly developed effective functioning of the system of motivation and stimulation of labor in outpatient clinics will increase labor productivity, which will positively affect the performance of a medical institution and increase the level of team cohesion.

Decreasing primary care use and blood pressure monitoring during COVID-19.

Among a group of primary care accountable care organizations, patients with hypertension were 50% less likely to have a blood pressure recorded in April compared with February.

A double-edged sword: The effects of social network ties on job satisfaction in primary care organizations.

Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited. We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of social support), and related those ties to workers' job satisfaction. We surveyed 456 clinicians and staff at 23 primary care practices about their social networks and workplace attitudes. We used multivariable linear regression to estimate the relationship between an individual's job satisfaction and two network properties: (a) eigenvector centrality (a measure of the importance of an individual in a network) and (b) ego network density (a measure of the cohesiveness of an individual's network). We examined this relationship for both instrumental and expressive ties. Individuals who were more central in the expressive network were less satisfied in their job, b = -0.40 (0.19), p < .05, whereas individuals who had denser instrumental networks were more satisfied in their job, b = 0.49 (0.21), p < .05. Workplace relationships affect worker well-being. Centrality in an expressive network may require greater emotional labor, increasing workers' risk for job dissatisfaction. On the other hand, a dense instrumental network may promote job satisfaction by strengthening workers' access to full information, supporting competence and confidence. Efforts to increase job satisfaction should consider both the positive and negative effects of social networks on workers' sense of well-being.

Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala

Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo’ Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo’ (ie, “egg” in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu’ Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization’s infant and young child feeding indicators. The results of the Saqmolo’ Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.

Retrospective analysis of referrals to the North East of England intermediate oral surgery service

AbstractIntroductionThe intermediate oral surgery service in North East England was introduced in 2009 following changes in the primary care contract in 2005 allowing primary care organisations to locally commission services to meet population need. The aim of this service introduction was to reduce pressures on secondary care and improve efficiency and costs of oral surgery service provision. Where there are geographical variations in the number of referrals received to intermediate oral surgery services in North East England, this study aimed to identify the reasons for these.Materials and methodsA retrospective analysis of referrals to the National Health Service (NHS) Intermediate North East of England Oral Surgery Service was completed. Analysis of 48,286 referrals from 2009 to 2019 was assessed from two NHS specialist oral surgery providers. Primary care practice referrals were located to practice postcode; the sum of referrals from each postcode accumulated over this period. Referral variations were compared with NHS primary care contract sizes, distance to specialist provider and Index of Multiple Deprivation of provider location to identify correlations.ResultsData indicate a significant range in primary care referral frequency over the 10‐year period. Referrals from primary care providers ranged from 1 to 2334 over the 10‐year period. No correlation is seen between distance to provider (r2 = 0.058), contract size (r2 = 0.087), deprivation levels (r2 = 0.01) and the referral rate.ConclusionThe large variation in referral rate provides data for commissioners of dental services including managed clinical networks (MCNs) to outline high referring primary care practices and plan for future service development.

Weight Can't Wait: A Guide to Discussing Obesity and Organizing Treatment in the Primary Care Setting.

The objective of this study was to develop a simple and practical guide for discussing and managing obesity in primary care settings. This study convened representatives from 12 primary care and obesity specialty organizations for a series of roundtable meetings to discuss the key components of obesity treatment in primary care. Attendees identified the need for a guide for primary care providers that outlined the key steps for discussing obesity with patients and managing their care while recognizing the significant time constraints on such provider/patient encounters. Prevailing themes from the roundtable sessions suggested that the key components of addressing obesity in primary care settings are obtaining patient permission, addressing weight bias, providing a diagnosis, and emphasizing shared decision-making. A modified "6A" framework with the steps "Ask," "Assess," "Advise," "Agree," "Assist," and "Arrange" was deemed appropriate to organize the process of weight management in primary care. An algorithm was developed to provide a script for the patient/provider encounter. The expert panel developed a short, accessible, practical, and informative guide for obesity management by primary care clinicians. Efforts are under way to disseminate the guide to primary care providers through the 11 participating organizations that have endorsed it.