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Showing results for tags 'Primary care'.
Found 194 results
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Content ArticleZiebland et al. consider what might be learned from the unintended, apparently unanticipated, consequences of the use of digital health (including alternatives to face to face consultations, electronic medical records, use of apps and online monitoring) in primary care.
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Content ArticleClinical guidelines advise GPs in England which patients need urgent referral for suspected cancer. This study in BMJ Quality & Safety used linked primary care, secondary care and cancer registration data to assess: how often GPs follow the guidelines on cancer referral whether certain patients are less likely to be referred how many patients were diagnosed with cancer within one year of non-referral. The study included patients who presented for the first time with blood in the urine, breast lump, difficulty swallowing, iron-deficiency anaemia and post-menopausal or rectal bleeding during 2014–2015. The authors found that the majority of patients presenting with common possible cancer symptoms were not being referred by GPs in line with clinical guidelines. They also found that a significant number of these patients went on to develop cancer within a year, and suggest that improvement is needed in the cancer diagnosis process.
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Content ArticleThe authors of this research study, published in BMJ Quality & Safety looked at the issues of hazardous prescribing and inadequate monitoring in patients with mental health issues being managed in primary care. They identified a lack of data in this area, despite most patients with mental illness receiving treatment in a primary care setting. The study found that: 9.4% of patients ‘at risk’ triggered at least one indicator for potentially hazardous prescribing. The risk was greatest for patients aged 35–44, females and those receiving more than 10 repeat prescriptions. 90.2% of patients ‘at risk’ triggered at least one indicator for inadequate monitoring. The risk was particularly high in people under the age of 25, females and those with one or no repeat prescription. The authors of the study hope their findings will support providers to reduce risk and improve care for patients who receive mental health treatment in primary care.
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Content ArticleIn this editorial for BMJ Quality & Safety, Dr Tamasine Grimes makes the case for greater patient involvement in managing medication, particularly at points of transition in care. She comments on a recent report on the effects of MARQUIS2, an evidence-based toolkit trialled in North American hospitals to help manage complex medication. The report found that interventions that involved patients in managing their medication had a significant effect in decreasing medication discrepancies, while purely system-level interventions did not.
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Content ArticleThis study, published in the European Journal of General Practice, explores the type and nature of patient safety incidents in French primary care settings during the first wave of the Covid-19 pandemic. Its findings suggest that constraints of the first wave of the pandemic contributed towards patient safety incidents during non-Covid-19 care, with the authors suggesting a national primary care emergency response plan to support practitioners could have mitigated many of the non-Covid-19 related patient safety incidents during this period.
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Content ArticleThe Remote by Default research study, a collaboration between the Universities of Oxford and Plymouth and the Nuffield Trust, has been exploring how technology can be harnessed to support excellent primary care. Using workshops, interviews, and focus groups of clinicians, service users, and other stakeholders, they have begun to map the multiple interacting influences on the choice of consultation modality.
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Content ArticleGP practices are usually run separately from hospitals. In some places in England and Wales, the NHS organisations responsible for managing hospitals are now also running local GP practices. It is difficult in some areas for practices, which are small organisations, to recruit GPs and keep going. It is also desirable to coordinate GP services with hospital care. For these reasons, it may help if the organisations managing hospitals also run GP practices.
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News Article
GPs’ survey finds race discrimination in NHS treatment of primary care
Patient Safety Learning posted a news article in News
A survey of an area’s GPs and other primary care staff found those from a minority ethnic background feel they are less involved in decision making and less respected by their colleagues, according to results shared with HSJ. The survey, instigated by GPs in Doncaster, South Yorkshire, also found more staff from a minority ethnic background said they had experienced some form of bullying or harassment, including “instances of physical violence”. The work is thought to be unusual in primary care — annual “workforce race equality standard” surveys are required by NHS England for NHS trusts and, in the past year, clinical commissioning groups, but not in primary care. The survey in October was instigated by Doncaster Primary Care BAME Network and facilitated by Doncaster clinical commissioning group. It was sent to GPs and practice staff, community pharmacy staff, and other “healthcare professionals” in primary care. There were 136 respondents. The report of the results said minority ethnic staff felt they were less able to make decisions to improve the work of primary care, less involved in decisions regarding their area of work and less respected by their colleagues compared with their white colleagues. Read full story (paywalled) Source: HSJ, 9 March 2021 -
Content ArticleDiagnosis is one of the most important tasks performed by primary care doctors and the World Health Organization (WHO) has highlighted diagnostic errors in primary care as a high-priority patient safety problem. In this narrative review in BMJ Quality & Safety, the authors discuss the global significance, burden and contributory factors related to diagnostic errors in primary care.
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Content Article
UCL Partners: Proactive care frameworks
Patient Safety Learning posted an article in Care pathways
UCL Partners have developed a series of proactive care frameworks to restore routine care by prioritising patients at highest risk of deterioration, with pathways that mobilise the wider workforce and digital/tech, to optimise remote care and self-care, while reducing GP workload. The frameworks include atrial fibrillation, high blood pressure, high cholesterol, type 2 diabetes, asthma and COPD. -
Content ArticleA sub-group of rare but serious patient safety incidents, known as ‘never events,’ is judged to be ‘avoidable.’ There is growing interest in this concept in international care settings, including UK primary care. However, issues have been raised regarding the well-intentioned coupling of ‘preventable harm’ with zero tolerance ‘never events,’ especially around the lack of evidence for such harm ever being totally preventable. Bowie et al. consider whether the ideal of reducing preventable harm to ‘never’ is better for patient safety than, for example, the goal of managing risk materialising into harm to ‘as low as reasonably practicable,’ which is well-established in other complex socio-technical systems and is demonstrably achievable. They reflect on the ‘never event’ concept in the primary care context specifically, although the issues and the polarised opinion highlighted are widely applicable. Recent developments to validate primary care ‘never event’ lists are summarised and alternative safety management strategies considered, e.g. Safety-I and Safety-II.
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Content ArticleThe Royal College of General Practitioners has updated its guidance on online consultations. The resource gives a useful set of questions to consider when using online consultations, such as which provider is used, the standard of patient care, and ensuring equitable access.
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Content ArticlePatients with respiratory disease deserve a correct diagnosis and guideline driven care that is standardised, patient focussed and delivered by a healthcare professional with suitable training and experience in a site and timeframe to meet their needs. Sadly, patient groups such as the BLF and Asthma UK have recognised that this is often not the case. The Respiratory Service Framework (RSF) attempts to demonstrate what that excellence is – and how it may be delivered at a population level. Developed by the PCRS Service Development Committee, the Respiratory Service Framework helps those looking to design a patient focussed respiratory service working across all sectors of out of hospital care to see the ideal components for a given population of patients. It has been designed to be applicable and helpful to those delivery care at a PCN or ICS level.
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Content ArticleMost primary care clinicians are well aware that the climate crisis is a health crisis and of the immediate and significant health co-benefits of climate action, such as through reduced air pollution. However, when it comes to taking action, in our experience many clinicians do not make the link with clinical practice. This is perhaps a result of extrapolating from actions to reduce one’s personal carbon footprint in areas like energy, waste, and transport. Yet, the majority of general practice’s carbon footprint results from clinical activity. In this article, Aarti Bansal and Grant Blashki focus on clinical practice and outline six practical steps that primary care can take towards sustainable healthcare that align with evidence-informed and person-centred practice.
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Content ArticleThe Royal College of General Practitioners have put together guidance for those working in primary care.
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Content ArticleAsaf Bitton, is Executive Director of Ariadne Labs and a global expert on primary care policy and delivery. In this interview with the Institute for Healthcare Improvement (IHI), Bitton talks about both the losses and the opportunities presented by COVID-19 and the rapid expansion of telehealth.
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Content ArticlePhysicians and patients have concerns associated with a shift toward virtual medicine. This interview with a Dr Paul Hyman, a primary care physician, highlights how the loss of physical touch and in-person communication could negatively affect care and the patient/physician relationship.
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Content ArticleThe Royal College of General Practitioners has put together useful resources for GPs during the coronavirus pandemic.
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Content ArticleIn this study, Avery et al. estimated the incidence of avoidable significant harm in primary care in England, and describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents. The study found there is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care.
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Content ArticleThis cross-sectional survey in the British Journal of General Practice looks at the availability and use of emergency admission risk stratification (EARS) tools across the UK and aims to identify factors that influence their implementation. The authors identified 39 different EARS tools in use. They found that the most important factors in encouraging general practices to use EARS tools were: promotion by NHS commissioners involvement of clinical leaders engagement of practice managers. High workloads and information governance were significant barriers to their use. The authors highlight the need to align policy and practice with research evidence.
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Content ArticleThis article, published in the British Medical Journal, is intended for primary care clinicians and relates to the patient who has a delayed recovery from an episode of COVID-19 that was managed in the community or in a standard hospital ward. Broadly, such patients can be divided into those who may have serious sequelae (such as thromboembolic complications) and those with a non-specific clinical picture, often dominated by fatigue and breathlessness.
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Content ArticlePatient safety is a quality indicator for primary care and it should be based on individual needs, and not differ among different social groups. Nevertheless, the attention on social disparities in patient safety has been mainly directed towards the hospital care, often overlooking the primary care setting. This paper, published in the International Journal for Equity in Health, aims to synthesise social disparities in patient safety in the primary care setting. The results of this systematic review suggest that vulnerable social groups are likely to experience adverse patient safety events in primary care. Enhancing family doctors’ awareness of these inequities is a necessary first step to tackle them and improve patient safety for all patients. Future research should focus on social disparities in patient safety using socioeconomic indicators, such as income and education.
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Content ArticleThis Royal College of General Practitioners (RCGP) report calls on the four governments of the UK to each produce a comprehensive plan to support GPs in managing the longer-term effects of COVID-19 in the community.
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Content Article
Diagnostic Errors: Technical Series on Safer Primary Care (2016)
Patient-Safety-Learning posted an article in WHO
This document from the World Health Organization raises awareness about strategies that could reduce diagnostic errors in primary care. It highlights the importance of examining diagnostic errors, identifies the most common types of diagnostic error in primary care and describes potential solutions. -
Content ArticleNHS National Services Scotland has produced this video for Primary Care staff to aid safe donning, doffing and disposal of personal protective equipment during the COVID-19 pandemic.
