The Transition of Primary Care Group Practices to Next Generation Models: Satisfaction of Staff, Clinicians, and Patients

Zink, Therese M.; Kralewski, John E.; Dowd, Bryan E

doi:10.3122/jabfm.2017.01.160118

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…49 Even 2 years after the implementation of CPS on interprofessional teams, PCPs continued to feel solely responsible for most tasks, 15 suggesting that an ethos of physician ownership over patients can be a barrier to achieving interprofessional collaboration. 50 Our findings also echo some Australian pharmacists' perceptions that PCPs deny their skills and dismiss their advice, which researchers interpreted as a demarcation of medical territory and an expression of "medical dominance." 51 On the other hand, PCPs have the opportunity to use their positional power to establish the CPS' collaborative role.…”

Section: Discussionsupporting

confidence: 76%

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

et al. 2021

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Background: With the restructuring of primary care into patient-centered medical homes (PCMH), researchers have described role transformations that accompany the formation of core primary care teamlets (eg, primary care provider, registered nurse care manager, licensed practical nurse, medical support assistant). However, few studies offer insight into how primary care teamlets, once established, integrate additional extended team members, and the factors that influence the quality of their integration.Methods: We examine the process of integrating Clinical Pharmacy Specialists (CPS) into primary care teams in the Veterans Health Administration (VHA). We conducted semi-structured interviews with CPS (n = 6) and clinical team members (n = 16) and performed a thematic analysis of interview transcripts.Results: We characterize 2 ways CPS are integrated into primary care teamlets: in consultative roles and collaborative roles. CPS may be limited to consultative roles by team members' misconceptions about their competencies (ie, if CPS are perceived to handle only medication-related issues like refills) and by primary care providers' opinions about distributing responsibilities for patient care. Over time, teams may correct misconceptions and integrate the CPS in a more collaborative role (ie, CPS helps manage disease states with comprehensive medication management).Conclusions: CPS integrated into collaborative roles may have more opportunities to optimize their contributions to primary care, underscoring the importance of clarifying roles as part of adequately integrating advanced practitioners in interprofessional teams.

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Section: Discussionsupporting

confidence: 76%

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

et al. 2021

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“…13 The personal and professional responses by staff and clinicians to role redefinition can also affect practice transformation; sometimes leading to changes in personnel at a practice. 14 The more successful practices have strong physician facilitation, clearly defined roles and practice guidelines for all levels of staff and strong communication structures (such as team huddles, frequent team meetings) in place.…”

Section: Discussionmentioning

confidence: 99%

Practice Transformation: Using Team-Based Care Training to Improve Diabetes Outcomes

Bilello

Scuderi

Haddad

et al. 2018

J Prim Care Community Health

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Background: One of the key factors of the patient-centered medical home (PCMH) transformation require shifting mental models at the individual level and culture change at the practice level on how clinicians and support staff work together. This culture shift requires a reeducation on the roles and communication strategies within the medical practice. The objective of this project was to implement a team-based care training program based on the AHRQ TeamSTEPPS framework in 6 primary care practices affiliated with a Primary Care Practice Based Research Network to increase communication and performance of the care teams. Methods: Clinicians and staff from these sites received external facilitation by a certified TeamSTEPPS master trainer, who is a physician specializing in diabetes care, over a 1-year period. An analysis of their established diabetes patients’ hemoglobin A1c and low-density lipoprotein cholesterol before the training program and posttraining was performed using the paired t test and verified using the Wilcoxon sign rank test. Results: There was a statistically significant decrease in the mean hemoglobin A1c levels from 7.48% to 7.32% (P < .001) and low-density lipoprotein cholesterol from 92.34 to 88.34 mg/dL (P = .002) for all the practices combined but only 3 practices saw significant improvement individually. Conclusions: Even though the practices participating in this training are PCMHs and are part of a larger primary care network, they have achieved different levels of success, partly due to leadership and buy-in by staff. Practice leaders and team members need to fully embrace team care concepts and continuously monitor teamwork experiences to support effective team-based care.

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“…Furthermore, an increasing number of elderly patients with coronary heart disease are selecting interventional therapy. Many studies have shown that PCI has the advantages of minimal trauma, fast recovery and fewer complications[8,9]. Every year, the rate of the number of patients undergoing PCI increases by 30%-40% in China[10].…”

Section: Introductionmentioning

confidence: 99%

“…Health management enables healthy and less healthy people to develop a good, orderly and healthy lifestyle by promoting health, motivating individual enthusiasm, reducing risk factors, and thus decreasing the incidence of disease. Studies have shown[8] that the period from 2–6 months after discharge is critical for patients to transition from the hospital to a community clinic or to care with family members for continuous treatment or health recovery. If we can strengthen health management during the transition period, it will have important clinical significance for the efficacy of treatment and the prognosis of the discharged patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention: A cluster randomized controlled trial

Zhang

Zhao

et al. 2019

PLoS ONE

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Purpose This study aimed to assess the effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction undergoing percutaneous coronary intervention. Methods We conducted the trial from June 2016 to December 2016. A total of one hundred and fifty patients with acute myocardial infarction after PCI who met the inclusion criteria were randomly divided into an experimental (n = 75) group and a control (n = 75) group. The participants in the experimental group received transitional health management for three months. The two groups of patients were evaluated for treatment adherence, quality of life, clinical indicators, adverse cardiovascular events and statistics regarding readmission rates at baseline and 6 months after discharge. Results Compared with the controls, patients in the intervention group demonstrated better medication adherence, reexamination adherence, healthy lifestyle and clinical indicators (all P<0.05) and lower rates of adverse cardiovascular events and readmission (all P<0.05). Conclusion Transitional health management effectively improved adherence in elderly patients with acute myocardial infarction after PCI, ameliorated clinical indicators, and effectively reduced the incidence of adverse cardiovascular events and readmission rates. Transitional health management was an effective intervention for PCI patients after discharge.

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The Transition of Primary Care Group Practices to Next Generation Models: Satisfaction of Staff, Clinicians, and Patients

Cited by 8 publications

References 19 publications

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

Clinical Pharmacist Integration Into Veterans' Primary Care: Team Members Perspectives

Practice Transformation: Using Team-Based Care Training to Improve Diabetes Outcomes

Effects of transitional health management on adherence and prognosis in elderly patients with acute myocardial infarction in percutaneous coronary intervention: A cluster randomized controlled trial

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