scholarly journals Study of choice between accident and emergency departments and general practice centres for out of hours primary care problems

2000 ◽  
Vol 17 (1) ◽  
pp. 18-21 ◽  
Author(s):  
S. F Rajpar
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Emergency Departments ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Care Problems

scholarly journals Prospective analysis of phoned potassium results and what general practitioners do with them: a pilot study

2018 ◽  
Vol 55 (6) ◽  
pp. 710-712
Author(s):  
Jennifer S Johnstone ◽  
Michael J Murphy
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Pilot Study ◽  
Information Management ◽  
Laboratory Information Management System ◽  
Information Management System ◽  
Prospective Analysis ◽  
Out Of Hours ◽  
A Prospective Study ◽  
Laboratory Information Management

Background Communicating abnormal results to requesting clinicians is an essential part of clinical authorisation. Guidance from the Royal College of Pathologists on communication of critical/unexpected results is issued as ‘advice to pathologists’. The 2017 guidelines advise rapid communication of serum potassium results ≤2.5 mmol/L and ≥6.5 mmol/L. Little is known about what happens after the results have been communicated. We wished to establish answers to the following questions: Are phoned results acted on? If so, when? What is the outcome of any action taken? Methods A prospective study of primary care potassium results authorised out of hours was undertaken. Potassium requests from primary care were retrieved from the laboratory information management system. The potassium result was recorded, along with other data. Data were analysed for potassium results that were validated out of hours (18:00 h–08:00 h). Results Over six months, 220 potassium results <3.1 mmol/L and >5.9 mmol/L from primary care were validated out of hours. A subset of these (27) were phoned to the general practice out of hours ‘hub’, and 16 patients referred to hospital out of hours, on account of the potassium results. The remaining potassium results phoned out of hours were acted on subsequently. Conclusions Critical potassium results were phoned urgently and are acted on, although not always out of hours. For potassium results phoned out of hours, the most frequent action was to refer to hospital out of hours. Different actions occurred for similar potassium results, reflecting the fact that actions taken and their urgency depend on the patient, the clinician and the practice policy for handling results.

scholarly journals Daytime use of general practice and use of the Out-of-Hours Primary Care Service for patients with chronic disease: a cohort study

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Lone Flarup ◽  
Grete Moth ◽  
Morten Bondo Christensen ◽  
Mogens Vestergaard ◽  
Frede Olesen ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Chronic Disease ◽  
Care Service ◽  
Primary Care Service ◽  
Out Of Hours

scholarly journals Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linda C. Smit ◽  
Niek J. De Wit ◽  
Meggie L. Nieuwenhuizen ◽  
Marieke J. Schuurmans ◽  
Nienke Bleijenberg
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Patient Outcomes ◽  
Organizational Context ◽  
Care Program ◽  
District Nurse ◽  
Out Of Hours ◽  
Longitudinal Observational Study ◽  
Primary Care Program ◽  
General Practices

Abstract Background The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. Methods A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used. Results A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03). Conclusion Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community.

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