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The European Journal of General Practice Dec 2023Increasing numbers of primary care physicians (PCPs) are reducing their working hours. This decline may affect the workforce and the care provided to patients. (Review)
Review
BACKGROUND
Increasing numbers of primary care physicians (PCPs) are reducing their working hours. This decline may affect the workforce and the care provided to patients.
OBJECTIVES
This scoping review aims to determine the impact of PCPs working part-time on quality of patient care.
METHODS
A systematic search was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. Peer-reviewed, original articles with either quantitative, qualitative or mixed methods designs, published after 2000 and written in any language were considered. The search strings combined the two concepts: part-time work and primary care. Studies were included if they examined any effect of PCPs working part-time on quality of patient care.
RESULTS
The initial search resulted in 2,323 unique studies. Abstracts were screened, and information from full texts on the study design, part-time and quality of patient care was extracted. The final dataset included 14 studies utilising data from 1996 onward. The studies suggest that PCPs working part-time may negatively affect patient care, particularly the access and continuity of care domains. Clinical outcomes and patient satisfaction seem mostly unaffected or even improved.
CONCLUSION
There is evidence of both negative and positive effects of PCPs working part-time on quality of patient care. Approaches that mitigate negative effects of part-time work while maintaining positive effects should be implemented.
Topics: Humans; Physicians, Primary Care; Patient Care; Patient Satisfaction
PubMed: 37909317
DOI: 10.1080/13814788.2023.2271167 -
Respiratory Care Jan 2020COPD exacerbations lead to accelerated decline in lung function, poor quality of life, and increased mortality and cost. Emergency department (ED) observation units...
BACKGROUND
COPD exacerbations lead to accelerated decline in lung function, poor quality of life, and increased mortality and cost. Emergency department (ED) observation units provide short-term care to reduce hospitalizations and cost. Strategies to improve outcomes in ED observation units following COPD exacerbations are needed. We sought to reduce 30-d ED revisits for COPD exacerbations managed in ED observation units through implementation of a COPD care bundle. The study setting was an 800-bed, academic, safety-net hospital with 700 annual ED encounters for COPD exacerbations. Among those discharged from ED observation unit, the 30-d all-cause ED revisit rate (ie, the outcome measure) was 49% (baseline period: August 2014 through September 2016).
METHODS
All patients admitted to the ED observation unit with COPD exacerbations were included. A multidisciplinary team implemented the COPD bundle using iterative plan-do-study-act cycles with a goal adherence of 90% (process measure). The bundle, adopted from our inpatient program, was developed using care-delivery failures and unmet subject needs. It included 5 components: appropriate inhaler regimen, 30-d inhaler supply, education on devices available after discharge, standardized discharge instructions, and a scheduled 15-d appointment. We used statistical process-control charts for process and outcome measures. To compare subject characteristics and process features, we sampled consecutive patients from the baseline ( 50) and postbundle ( 83) period over 5-month and 7-month intervals, respectively. Comparisons were made using tests and chi-square tests with < .05 significance.
RESULTS
During baseline and postbundle periods, 410 and 165 subjects were admitted to the ED observation unit, respectively. After iterative plan-do-study-act cycles, bundle adherence reached 90% in 6 months, and the 30-d ED revisit rate declined from 49% to 30% ( = .003) with a system shift on statistical process-control charts. There was no difference in hospitalization rate from ED observation unit (45% vs 51%, = .16). Subject characteristics were similar in the baseline and postbundle periods.
CONCLUSIONS
Reliable adherence to a COPD care bundle reduced 30-d ED revisits among those treated in the ED observation unit.
Topics: Aged; Clinical Observation Units; Clinical Protocols; Emergency Service, Hospital; Female; Hospitalization; Humans; Male; Middle Aged; Patient Care Bundles; Patient Discharge; Patient Readmission; Pulmonary Disease, Chronic Obstructive
PubMed: 31882412
DOI: 10.4187/respcare.07088 -
American Journal of Health-system... Feb 2020Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. Exacerbations- acute worsening of COPD symptoms-can... (Review)
Review
PURPOSE
Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. Exacerbations- acute worsening of COPD symptoms-can be mild to severe in nature. Increased healthcare resource use is common among patients with frequent exacerbations, and exacerbations are a major cause of the high 30-day hospital readmission rates associated with COPD.
SUMMARY
This review provides a concise overview of the literature regarding the impact of COPD exacerbations on both the patient and the healthcare system, the recommendations for pharmacologic management of COPD, and the strategies employed to improve patient care and reduce hospitalizations and readmissions. COPD exacerbations significantly impact patients' health-related quality of life and disease progression; healthcare costs associated with severe exacerbation-related hospitalization range from $7,000 to $39,200. Timely and appropriate maintenance pharmacotherapy, particularly dual bronchodilators for maximizing bronchodilation, can significantly reduce exacerbations in patients with COPD. Additionally, multidisciplinary disease-management programs include pulmonary rehabilitation, follow-up appointments, aftercare, inhaler training, and patient education that can reduce hospitalizations and readmissions for patients with COPD.
CONCLUSION
Maximizing bronchodilation by the appropriate use of maintenance therapy, together with multidisciplinary disease-management and patient education programs, offers opportunities to reduce exacerbations, hospitalizations, and readmissions for patients with COPD.
Topics: Bronchodilator Agents; Hospitalization; Humans; Patient Readmission; Pulmonary Disease, Chronic Obstructive; United States
PubMed: 31930287
DOI: 10.1093/ajhp/zxz306 -
Canadian Family Physician Medecin de... Jan 2022
Topics: Continuity of Patient Care; Humans; Primary Health Care
PubMed: 35063971
DOI: 10.46747/cfp.68017 -
RoFo : Fortschritte Auf Dem Gebiete Der... Mar 2023
Topics: Humans; Patient Care; Health Services
PubMed: 36796381
DOI: 10.1055/a-2007-8293 -
Current Cardiology Reviews 2020The COVID-19 pandemic has emerged as a serious global threat causing a large number of fatalities and putting enormous strain on the health care resources across the... (Review)
Review
The COVID-19 pandemic has emerged as a serious global threat causing a large number of fatalities and putting enormous strain on the health care resources across the world. This has resulted in preferentially triaging the coronavirus infected patients and placing others, especially cardiovascular patients at increased risk for adverse complications. The effective management of cardiac patients in the hospital environment during this COVID-19 pandemic has emerged as a real challenge. We try to address this issue and also highlight the interplay between COVID-19 and cardiovascular diseases. We hereby review the available literature and emerging guidelines about cardiovascular implications related to COVID-19 which will have a bearing on the patient care, health care professionals and cardiac centres.
Topics: Betacoronavirus; COVID-19; Cardiovascular Diseases; Coronavirus Infections; Humans; Pandemics; Patient Care; Pneumonia, Viral; Practice Guidelines as Topic; SARS-CoV-2
PubMed: 32564757
DOI: 10.2174/1573403X16666200621154842 -
Enfermeria Clinica (English Edition) 2023
Topics: Humans; Ageism; Patient Care; Surveys and Questionnaires
PubMed: 36707217
DOI: 10.1016/j.enfcle.2022.12.001 -
Clinical Medicine (London, England) Jul 2019Engagement of physicians with their healthcare community or institution should be a central issue in healthcare because it can be translated into improved patient care,... (Review)
Review
Engagement of physicians with their healthcare community or institution should be a central issue in healthcare because it can be translated into improved patient care, enhanced well-being for physicians as well as safer, more effective and less costly healthcare. To accomplish the mission/goal of meaningful physician engagement, we set about to establish a 'charter' for physician engagement. We defined our concept of meaningful physician engagement and customised the engagement spectrum construct for physician relationship with their healthcare community or institution. While recognising the importance of physician leaders within the hierarchical system for efficacy of organisational management, relying only on physicians in formal executive positions is insufficient for developing physician engagement. There is a need for widespread physician engagement across the organisation. The objective is both an improvement in patient care and in physician well-being.
Topics: British Columbia; Burnout, Professional; Humans; Leadership; Medical Staff; Patient Care; Physicians; Work Engagement
PubMed: 31308103
DOI: 10.7861/clinmedicine.19-4-278 -
RMD Open Oct 2022
Topics: Humans; Patient Care
PubMed: 36270745
DOI: 10.1136/rmdopen-2022-002728 -
Journal of the American Geriatrics... Feb 2021To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care.
OBJECTIVES
To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care.
DESIGN
Cross-sectional, national mail-based survey.
SETTING
American Medical Association Masterfile database.
PARTICIPANTS
U.S. primary care physicians (N = 106), including general internists (n = 44) and geriatricians (n = 62).
MEASUREMENTS
Approaches to assessing and addressing family caregivers' needs and risks; barriers and facilitators to conducting caregiver assessments.
RESULTS
Few respondents reported conducting a formal caregiver assessment using a standardized instrument in the past year (10.5%). Informal, unstructured discussions about caregivers' needs and risks were common and encompassed a range of issues, most frequently caregivers' management of patients' safety (41.0%), ability to provide assistance (40.0%), and need for support (40.0%). To address caregiver needs, most respondents endorsed referring patients to services (e.g., adult day care, home care) (69.8%), assessing the appropriateness of the patient's living situation (67.9%), and referring caregivers to community agencies (63.2%). Lack of time was the most frequently cited barrier to assessing caregivers' needs (81.1%). The most commonly endorsed facilitators were access to better referral options (67.0%) and easier referral mechanisms (65.1%). Practice patterns, barriers, and facilitators to caregiver assessment did not differ by physician type.
CONCLUSIONS
Primary care physicians use informal, unstructured discussions rather than standardized instruments to assess caregivers' needs and risks. There is heterogeneity in the topics discussed and types of referrals made. Findings indicate the lack of translation of caregiver assessment tools from research to practice.
Topics: Aged; Caregivers; Cross-Sectional Studies; Female; Humans; Male; Mental Health; Middle Aged; Needs Assessment; Patient Care; Primary Health Care; Referral and Consultation; Respite Care; Risk Assessment; Sleep Wake Disorders; Social Conditions; Social Support; Stress, Psychological; United States
PubMed: 33217776
DOI: 10.1111/jgs.16945