Quality in primary care
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Quality in primary care · Jan 2014
Considerations for using the 'brown bag' strategy to reconcile medications during routine outpatient office visits.
Among medication reconciliation studies, varying methods are used to determine which medications patients are actually taking. One recommended approach is to ask patients to "brown bag" their medications for routine office visits. ⋯ Most BBs do not bag all their medications for office visits. Chart list accuracy is no better among BBs than NBBs, although patients who 'brown bag' their medications for office visits may prompt providers to conduct a more thorough medication history. Lists generated by semistructured interviewing, regardless of BB status, are more accurate than chart lists. Findings challenge benefits of the 'brown bag' unless coupled with in-depth questioning and processes for transferring information to chart lists.
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Quality in primary care · Jan 2014
Understanding the dementia diagnosis gap in Norfolk and Suffolk: a survey of general practitioners.
The National Health Service (NHS) has announced its new target to increase the 'shockingly low dementia diagnosis rate' in England from the current level of 45% to 66% by end of March 2015. Clinical commissioning groups (CCGs) in England have committed to meeting this target. The Norfolk and Suffolk dementia diagnosis rate (DDR) is below the rate for England in some areas; across the CCGs included in this study, the average DDR was 39.9% with a standard deviation of 5.3. ⋯ Despite GPs' attitudes being more positive than in 2009 about diagnosing dementia, the Norfolk and Suffolk DDR remains low. This may reflect lack of GP confidence in the quality and availability of post-diagnostic support services. This study has identified a need to map the existing post-diagnostic support services for people with dementia and to identify gaps in services. This could lead to the development of a resource which might enable GPs to provide relevant advice to newly diagnosed patients and their carers, facilitate signposting to support services, and give GPs confidence to increase the DDR in their area.
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Individual practice needs to be developed to improve effectiveness, safety and patient experience. Although good systems can support better individual performance, without personal development, individual practice can be a source of error. This, the final article in our series on the science of quality improvement, describes models of competence and practice and the causes of good or poor practice. We show how quality improvement techniques can be used to improve individual practice and how this can be incorporated into the appraisal process for doctors, nurses and other healthcare professionals.
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Quality in primary care · Jan 2014
Engaging with clinical commissioning: the attitudes of general practitioners in East Lancashire.
Clinical commissioning is the centrepiece of government health reforms. Engagement with the reforms is important if they are to bring about improvements in the quality of healthcare. This is important in any healthcare system, not just the UK National Health Service (NHS). This study draws on data from a specially commissioned survey, exploring the extent to which general practitioners (GPs) in East Lancashire are engaged with clinical commissioning. Aim The aim of this study was to assess levels of engagement with clinical commissioning using a Clinical Commissioning Engagement Scale (CCES). ⋯ The findings highlight the potential challenges for CCGs in engaging GPs and in particular responding to perceived problems of capability and capacity. Further research is required to shed light on whether East Lancashire is typical of other CCGs.