Quality in primary care
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Quality in primary care · Jan 2011
The SHARE frailty instrument for primary care predicts incident disability in a European population-based sample.
The adoption of a frailty paradigm in primary care would be helpful to identify adults who need priority access to specialised resources. The frailty phenotype by Fried et al is a popular operationalisation of frailty, but it is not easily applicable in routine primary care practice. We recently created and validated a frailty instrument based on the Survey of Health, Ageing and Retirement in Europe (SHARE-FI), in order to provide primary care practitioners with an easy, reliable and freely accessible tool for the assessment and monitoring of frailty in community dwelling adults over the age of 50 years (www.biomedcentral.com/1471-2318/10/57). ⋯ SHARE-FI may contribute to quality in primary care by offering a quick and reliable way to assess and monitor frailty in community dwelling individuals over the age of 50 and prioritize their access to resources, and it serves as a novel tool for audit and research.
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Quality in primary care · Jan 2011
Building high functioning clinical teams through quality improvement initiatives.
Team-based care has consistently been associated with improved clinical outcomes. However, strategies for promoting and sustaining a team-based approach in family medicine practice are more elusive. ⋯ These findings suggest a strategic role for clinical performance feedback linked to team initiated quality improvement initiatives for improving both clinical outcomes and clinical team-based care.
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Quality in primary care · Jan 2011
Pilot study to develop and test a generic peer feedback instrument to review videotaped consultations in primary care.
The ability to consult effectively is key to the delivery of quality patient care. External peer review of consultations has been available to general medical practitioners (GPs) in the west of Scotland for several years. Pharmacists are expected to provide increasingly complex advice for patients. This study describes the development and first steps in the evaluation of a generic tool to be used to inform feedback about both GP and pharmacist consultations with patients. ⋯ The results suggest that the instrument is useful only when applied to practitioners who have been taught how to consult in a patientcentred manner, and have led to the introduction of training in consultation skills for pharmacists throughout Scotland. Potential reliability in providing peer feedback for GP consultations is important in the context of the provision of consistent, meaningful evidence for GP appraisal and revalidation in the UK.
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Quality in primary care · Jan 2011
Reducing variation in general practitioner referral rates through clinical engagement and peer review of referrals: a service improvement project.
General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services. ⋯ This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies.
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Quality in primary care · Jan 2011
Design of a quality and performance improvement project for small primary care practices: reflections on the Center for Practice Innovation.
Small practices often lack the human, financial and technical resources to make necessary practice improvements and infrastructure investments in order to achieve sustainable change that promotes quality and efficiency. ⋯ Small practices today are facing a range of important challenges. The CPI sought to provide successful guidance to small practices with evidence of positive change in some clinical measures, patient satisfaction and practice motivation to implement quality of care and practice management improvements.