Managing type 1 diabetes during the COVID-19 pandemic is a team effort: a qualitative study of the experiences of young people and their parents

ObjectiveTo explore the experiences of young people with type 1 diabetes mellitus (T1DM) and their parents in accessing integrated family-centred care in the Australian Capital Territory during the COVID-19 pandemic.Methods and analysisThis is a pragmatic, qualitative descriptive study for which we conducted semistructured interviews with 11 young people with T1DM aged 12–16 years and 10 of their parents who attended an outpatient diabetes service in Canberra, Australia. Thematic analysis was conducted in accordance with the methods outlined by Braun and Clarke.ResultsThree themes were identified: feeling vulnerable, new ways of accessing care and trust in the interdisciplinary diabetes healthcare team. Participants believed having T1DM made them more vulnerable to poor outcomes if they contracted COVID-19, resulting in avoidance of face-to-face care. Telephone consultations offered a convenient and contact-free way to undertake 3-monthly reviews. The greatest difference between telephone and face-to-face consultations was not having access to the whole interdisciplinary diabetes support team at one appointment, physical examination and haemoglobin A1c testing during telehealth consultations. Participants trusted that clinicians would arrange face-to-face meetings if required. Some felt a video option might be better than telephone, reflecting in part the need for more training in communication skills for remote consultations.ConclusionYoung people with T1DM and their parents require collaborative care and contact with multiple healthcare professionals to facilitate self-management and glycaemic control. While telephone consultations offered convenient, safe, contact-free access to healthcare professionals during the COVID-19 pandemic, the added value of video consultations and facilitating access to the whole interdisciplinary diabetes support team need to be considered in future clinical implementation of telehealth.

Lumos: a statewide linkage programme in Australia integrating general practice data to guide system redesign

ObjectiveWith ageing of the Australian population, more people are living longer and experiencing chronic or complex health conditions. The challenge is to have information that supports the integration of services across the continuum of settings and providers, to deliver person-centred, seamless, efficient and effective healthcare. However, in Australia, data are typically siloed within health settings, precluding a comprehensive view of patient journeys. Here, we describe the establishment of the Lumos programme—the first statewide linked data asset across primary care and other settings in Australia and evaluate its representativeness to the census population.Methods and analysisRecords extracted from general practices throughout New South Wales (NSW), Australia’s most populous state, were linked to patient records from acute and other settings. Innovative privacy and security technologies were employed to facilitate ongoing and regular updates. The marginal demographic distributions of the Lumos cohort were compared with the NSW census population by calculating multiple measures of representation to evaluate its generalisability.ResultsThe first Lumos programme data extraction linked 1.3 million patients’ general practice records to other NSW health system data. This represented 16% of the NSW population. The demographic distribution of patients in Lumos was >95% aligned to that of the NSW population in the calculated measures of representativeness.ConclusionThe Lumos programme delivers an enduring, regularly updated data resource, providing unique insights about statewide, cross-setting healthcare utilisation. General practice patients represented in the Lumos data asset are representative of the NSW population overall. Lumos data can reliably be used to identify at-risk regions and groups, to guide the planning and design of health services and to monitor their impact throughout NSW.

Health professional education and practice in preventing and controlling infections in New Zealand: a review to inform strategies for enhancing practitioner competencies and patient safety

ObjectiveQuality assurance for reducing infections is a key objective of the WHO’s global action plan targeting antimicrobial resistance, yet no studies have employed a multifaceted approach to review health professional education and practice in infection prevention and control (IPC). This study completed such a review.Methods and analysisNew Zealand medical and nursing curricula were analysed for IPC-related teaching and assessment. Clinicians (undergraduate to senior) received peer-expert evaluation while performing procedures demonstrating IPC competencies. Patient and clinician self-evaluation followed. Hospital IPC practice monitoring was also reviewed.ResultsMedical curricula had approximately twice the total IPC-related theory compared with nursing (79.71 vs 41.66 hours), emphasising microbiology. IPC theory in nursing curricula was applied, emphasising health and safety. Junior nursing students were rigorously taught (16.17 hours) and assessed (2.91 hours) in practical IPC competencies, whereas little practical instruction (2.62 hours) and no formal assessment existed for junior medical students. IPC teaching chiefly occurred during medical students’ senior clinical years, and was opportunistic, rotation-specific or in introductory sessions. Senior medical and nursing students were expected to be IPC-proficient but no formal assessment occurred. Peer review generally revealed satisfactory practice, however both professions had lapses with hand hygiene, asepsis and incorrect donning, removal and use of personal protective equipment. Clinician confidence in providing and being peer-reviewed for best IPC practice, and patients’ confidence in receiving best IPC care, was positively associated with clinician experience. Trainee interns, whose confidence in IPC practice was not matched by the same desire for monitoring/feedback as senior colleagues, were the exception.ConclusionMultifaceted approaches to IPC quality assurance have utility in identifying gaps, reducing infection transmission and reassuring staff and patients.

Development of a model to deliver primary health care in Qatar

BackgroundHealthcare providers around the world are seeking to manage the rising burden of chronic conditions against a backdrop of both growing and ageing populations as well as greater expectations of health services. This paper describes the development of an integrated primary care model ‘the family medicine model (FMM)’ to deliver primary healthcare in Qatar to better address some of the healthcare challenges faced.MethodsA developmental approach was adopted in defining an FMM for Qatar that could potentially address health needs of its population, while acknowledging local context and addressing complexities. A literature review was undertaken followed by field visits and setting up of a working group in order to identify, develop and adapt a model suitable for delivery of primary care in Qatar.ResultsKey principles of the proposed model and its component were defined. Components included primary care workforce and practice-based teams, service provision and practice-based services, health information and technology, access to care and information, care management, care coordination, practice management and quality and safety.ConclusionsThe proposed model is an innovative approach which utilises and integrates these components to deliver holistic primary care. It is anticipated that its introduction will help redesign and integrate the way primary healthcare is delivered to the population of Qatar in helping patients manage their own health and reduce the numbers that need to be admitted to secondary care, improving patients’ independence and well-being as well as dramatically reducing the cost to the overall health system.

Prescribing error reporting in primary care: a narrative synthesis systematic review

Prescribing errors can cause avoidable harm to patients. Most prescriptions originate in primary care, where medications tend to be self-administered and errors have the most potential to cause harm. Reporting prescribing errors can identify trends and reduce the risk of the reoccurrence of incidents; however, under-reporting is common. The organisation of care and the movement of prescriptions from general practice to community pharmacy may create difficulties for professionals to effectively report errors.This review aims specifically to identify primary research studies that examine barriers and facilitators to prescription error reporting across primary care. A systematic research of the literature was completed in July 2019. Four databases (PubMed/Medline, Cochrane, CINAHL and Web of Science) were searched for relevant studies. No date or language limits were applied. Eligible studies were critically appraised using the Mixed Methods Appraisal Tool, and data were descriptively and narratively synthesised.Ten articles were included in the final analysis. Seven studies considered prescription errors and error reporting within general practice and three within a community pharmacy setting. Findings from the included studies are presented across five themes, including definition of an error, prescribing error reporting culture, reporting processes, communication and capacity.Healthcare professionals appreciate the value of prescription error reporting, but there are key barriers to implementation, including time, fear of reprisal and organisation separation within primary care.

Enhancing consultation time for primary paediatric care in the outpatient department

ObjectiveTo improve the duration and quality of consultation times during paediatric ambulatory care.Methods and analysisThis, before and after study, compares consultation time and core activities. All the subjects attended the paediatric outpatient department (P-OPD) between 1 July 2013 and 31 October 2013.Initially, consultation time was recorded directly by using observer timing with a stopwatch on 10–12 patients on 3 consecutive days and estimated indirectly after the study. All subjects underwent some or all of the following assessments and interventions (core activities): danger sign detection, illness treatment and referral, growth assessment followed by appropriate dietetic advice, immunisation and parent counselling. We implemented an intervention structure that divided work among staff members and then compared core activities.ResultsDuring the study period, 2204 patients attended the P-OPD over 108 days. Before the study, the average consultation time was less than 5 min (range 3.5–5 min), and the core activities included the treatment and referrals of illnesses and immunisation only. No treatment guidelines existed, and weight record was primarily for calculating the dose of the drug to be prescribed. The protocol did not include growth assessment and maintenance of detailed clinical records.After implementing the core activities through effective utilisation of existing resources, on an average, 20 patients received consultations per day, and the consultation time was approximately 12 min per patient.ConclusionThe P-OPD consultation time increased from 3.5–5 min to approximately 12 min per patient. Using the structured interventions, the range of assessments and interventions, during these consultations, increased without having to hire more staff.

How to implement patient experience surveys and use their findings for service improvement: a qualitative expert consultation study in Australian general practice

ObjectiveTo identify barriers (patient, provider, practice and system levels) to consider when implementing patient experience surveys in Australian general practice and enablers of their systematic use to inform service improvement in clinical practice as well as the broader health system.Methods and analysisAn expert consultation and qualitative content analysis of cross-sectional, open-text survey data. Data were collected from key international and Australian experts in the areas of measurement and quality improvement in general practice.ResultsResponses from 20 participants from six countries were included in the study. Participants discussed the importance of ensuring value and relevance of surveys to stakeholders. Lack of resources, IT infrastructure, capacity building and sustained funding were identified as barriers to implementing surveys. Participants discussed the importance of clearly defining and communicating the purpose of surveys and agreed on the value of using patient experience to inform reflective, team-based learning at the practice level. Opinions differed on the use of patient experience data at the system level, with some questioning its utility or fairness for external performance reporting. Others recommended the aggregation and reporting of these data under certain conditions, including for the purpose of triangulation with other quality and outcome data. The study identified an evidence gap in the assessment and interpretation of patient experience data at the practice and system levels, including the analysis and contextualisation of survey findings at the system level.ConclusionPatient experience surveys have potential for guiding practice level quality improvement, but many barriers to their implementation remain. There is need for greater research and policy efforts to understand how this information can be used at the system level for improving Australian general practice.