Reporting and learning from patient safety incidents in general practice: a practical guide. Royal College of General Practitioners.

The purpose of this guide is to: • maximise opportunities to learn from patient safety incidents in your practice, and to share learning via organisational or national reporting systems; and, • outline a process for learning from patient safety incidents in your practice

Health inequalities, physician citizens and professional medical associations: an Australian case study

<p>Abstract</p> <p>Background</p> <p>As socioeconomic health inequalities persist and widen, the health effects of adversity are a constant presence in the daily work of physicians. Gruen and colleagues suggest that, in responding to important population health issues such as this, defining those areas of professional obligation in contrast to professional aspiration should be on the basis of evidence and feasibility. Drawing this line between obligation and aspiration is a part of the work of professional medical colleges and associations, and in doing so they must respond to members as well as a range of other interest groups. Our aim was to explore the usefulness of Gruen's model of physician responsibility in defining how professional medical colleges and associations should lead the profession in responding to socioeconomic health inequalities.</p> <p>Methods</p> <p>We report a case study of how the Royal Australian College of General Practitioners is responding to the issue of health inequalities through its work. We undertook a consultation (80 interviews with stakeholders internal and external to the College and two focus groups with general practitioners) and program and policy review of core programs of College interest and responsibility: general practitioner training and setting of practice standards, as well as its work in public advocacy.</p> <p>Results</p> <p>Some strategies within each of these College program areas were seen as legitimate professional obligations in responding to socioeconomic health inequality. However, other strategies, while potentially professional obligations within Gruen's model, were nevertheless contested. The key difference between these lay in different moral orientations. Actions where agreement existed were based on an ethos of care and compassion. Actions that were contested were based on an ethos of justice and human rights.</p> <p>Conclusion</p> <p>Colleges and professional medical associations have a role in explicitly leading a debate about values, engaging both external stakeholder and practicing member constituencies. This is an important and necessary step in defining an agreed role for the profession in addressing health inequalities.</p

Reporting and learning from patient safety incidents in general practice: a practical guide. Royal College of General Practitioners.

The purpose of this guide is to: • maximise opportunities to learn from patient safety incidents in your practice, and to share learning via organisational or national reporting systems; and, • outline a process for learning from patient safety incidents in your practice

Introducing quality improvement teaching into general practice undergraduate placements

Quality Improvement skills are deemed essential for future clinical practice of doctors by professional regulatory bodies. This paper presents the challenges of a curriculum development initiative to ensure that all medical students have involvement with a quality improvement project during a general practice placement in their fourth year. The curriculum development is described within a 'Plan-Do-Study-Act' framework. The learning is presented as a reflective discussion with conclusions and recommendations on how potential current barriers to implementing authentic participation in quality improvement projects for undergraduate medical students might be met. The key barriers include lack of opportunities within the curriculum structure to allow sufficient time for authentic quality improvement projects and a lack of confidence amongst placement tutors to support medical students with quality improvement projects

Using an online survey of healthcare-seeking behaviour to estimate the magnitude and severity of the 2009 H1N1v influenza epidemic in England

Background : During the 2009 H1N1v influenza epidemic, the total number of symptomatic cases was estimated by combining influenza-like illness (ILI) consultations, virological surveillance and assumptions about healthcare-seeking behaviour. Changes in healthcare-seeking behaviour due to changing scientific information, media coverage and public anxiety, were not included in case estimates. The purpose of the study was to improve estimates of the number of symptomatic H1N1v cases and the case fatality rate (CFR) in England by quantifying healthcare-seeking behaviour using an internet-based survey carried out during the course of the 2009 H1N1v influenza epidemic. Methods : We used an online survey that ran continuously from July 2009 to March 2010 to estimate the proportion of ILI cases that sought healthcare during the 2009 H1N1v influenza epidemic. We used dynamic age- and gender-dependent measures of healthcare-seeking behaviour to re-interpret consultation numbers and estimate the true number of cases of symptomatic ILI in 2009 and the case fatality rate (CFR). Results : There were significant differences between age groups in healthcare usage. From the start to the end of the epidemic, the percentage of individuals with influenza-like symptoms who sought medical attention decreased from 43% to 32% (p < 0.0001). Adjusting official numbers accordingly, we estimate that there were 1.1 million symptomatic cases in England, over 320,000 (40%) more cases than previously estimated and that the autumn epidemic wave was 45% bigger than previously thought. Combining symptomatic case numbers with reported deaths leads to a reduced overall CFR estimate of 17 deaths per 100,000 cases, with the largest reduction in adults. Conclusions : Active surveillance of healthcare-seeking behaviour, which can be achieved using novel data collection methods, is vital for providing accurate real-time estimates of epidemic size and disease severity. The differences in healthcare-seeking between different population groups and changes over time have significant implications for estimates of total case numbers and the case fatality rate

Increasing the knowledge, identification and treatment of osteoporosis through education and shared decision-making with residents living in a retirement village community

Objective: This pilot study explored whether individual goal setting in a retirement village setting could improve strategies to strengthen bones in an ageing population and help prevent osteoporosis. Methods: A two-phased osteoporosis prevention program was developed, piloted and evaluated involving a group education session followed by the development of individualised Bone Plans based upon personal understanding of individual fracture risk and lifestyle factors. Results: A significant improvement in knowledge and understanding of factors to prevent and manage osteoporosis was achieved, and changes in lifestyle behaviours were sustained at six months. Conclusion: Success was due to education by specialist medical and health personnel, flexibility of goal setting, use of group sessions and location of the program within the retirement community setting. The ‘Mind Your Bones’ program is a feasible and acceptable way to translate preventative bone health messages to a large number of people via the retirement village network

Integrated working for enhanced healthcare in English nursing homes

Background: The increasingly complex nature of care home residents’ health status means that this population requires significant multi-disciplinary team input from health services. To address this, a multi-sector and multi-professional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. Study aim: To explore the views and experiences of practitioners, social care officers and carers involved in the enhanced healthcare in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of healthcare to older residents. Method: A qualitative constructivist methodology was adopted. The study had two stages. Stage one explored the experiences of the programme enhanced healthcare workforce through group, dyad and individual interviews with 45 participants. Stage two involved two workshops with 28 participants to develop stage one findings (data was collected during February - March 2016). Thematic and content analysis were applied. Findings: The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organisational and professional boundaries that support effective decision making and problem solving