Increased access rate to a primary health-care centre by introducing a structured patient sorting system developed to make the most efficient use of the personnel: a pilot study

Thorn, Jörgen; Maun, Andy; Bornhöft, Lena; Kornbakk, Malena; Wedham, Sofia; Zaffar, Mona; Thanner, Cathrine

doi:10.1258/hsmr.2010.010005

Cited by 14 publications

(23 citation statements)

References 4 publications

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“…In a primary care setting access to the practice increased by almost 30% and over 80% of patients triaged to a non-physician provider did not need to follow-up with a physician. 20 Similarly, using a structured questionnaire as support for medical decision making for viral respiratory infection showed that military medics could reduce the need for physician referrals by 37%. 21 …”

Section: Discussionmentioning

confidence: 99%

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses

Friedland

Tarima

Erbe

et al. 2016

JAMA Otolaryngol Head Neck Surg

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Importance Vestibular patients are often complex, require additional clinic visit time, and utilize greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders allowing for more efficient allocation of resources and use of providers. Objective To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire. Design, Setting and Participants Retrospective review of 414 new vestibular patient intake questionnaires and medical records with performance of logistic regression analyses and development of predictive models. Intervention Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness. Main Outcome Measures Predictors for the diagnosis of BPPV, Meniere disease, and vestibular migraine. Results Ear-related disorders accounted for 48% of all diagnoses while neurologic conditions accounted for 37% of diagnoses. Three disorders – benign paroxysmal positional vertigo (BPPV), Meniere disease and vestibular migraine – comprised 69% of all diagnoses. The diagnosis of BPPV could be predicted from four variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Meniere disease could be predicted from five variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from four variables with a sensitivity of 76% and specificity of 59%. Conclusions A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable shorter questionnaires or screening algorithms.

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Section: Discussionmentioning

confidence: 99%

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses

Friedland

Tarima

Erbe

et al. 2016

JAMA Otolaryngol Head Neck Surg

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“…As a result of this process nurses triaged all patients to the appropriate primary care professionals according to the symptoms described (Figure 2 ) in contrast to the earlier routine where most patients were initially sent to a General Practitioner. A special sorting manual was developed for this purpose in order to standardize the procedure and physiotherapists, psychologists and occupational therapists started to treat patients with certain conditions triaged directly to them by the nurses without a referral from a general practitioner [ 15 ]. Follow-up studies showed that the structured patient-sorting system seemed to satisfy the patient’s wish and need for quick access to a psychologist and that long-term healthcare consumption decreased for patients initially seeing physiotherapists [ 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

“…It originated from the idea to develop a new organizational model that combines the aims the of the Advanced Access model which has shown to reduce delays through reduction of unplanned and irrational scheduling and the Manchester Triage model which has proven reduction of waiting times and quality improvements in emergency departments [ 13 , 14 ]. The specific alterations of the daily processes and the quantitative results of this project have been published in an earlier article and included a 13% increase of the access rate mainly through the elimination of bottlenecks and the more efficient use of physiotherapists, psychologists and occupational therapists [ 15 ]. Both personnel and patients indicated an improvement in the possibility to book patient appointments.…”

Section: Introductionmentioning

confidence: 99%

Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members’ conceptions

et al. 2014

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BackgroundPrimary healthcare meets increased demands from an aging population concerning quality and availability while concurrently dealing with a growing shortage of general practitioners and imperfect efficiency in healthcare processes. Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results. By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently. The aim of this study was to explore staff members’ conceptions of the structured patient-sorting system in order to gain an inside perspective on this project.MethodsIn this qualitative study 16 interviews were conducted over a period of two years and data was analysed using a phenomenographic approach to identify the various conceptions of the eleven participants.ResultsThree categories of description were identified: The system was conceptualized as 1) a framework for the development of patient-centred processes that were clear and consistent, 2) a promotor of professional development and a shared ideal of cooperative practice and 3) a common denominator and catalyst in conflict management.In an overall perspective the system was conceived as being an appropriate platform for promoting transformation into an effective patient-centred primary healthcare team in which organizational development was perceived as a continuous participative process demanding the commitment of all team members.ConclusionsThis study demonstrates that the introduction of a structured patient-sorting system makes it possible for several important change processes to take place concurrently: improvement of healthcare processes, empowerment of professionals and team development. It therefore indicates the importance of an appropriate, contextualized framework to support multiple concomitant quality improvement processes. Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.

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“…The informants in this study were recruited from the patients who had been triaged directly to a psychologist's assessment between July 2010 and July 2011 through the primary-care triage (Thorn et al , 2010) at the PHCC mentioned above ( n = 142). Of these, 94 patients met the inclusion criteria; a nurse had booked the patient to a psychologist's assessment and the patient had not been booked to another professional for the same symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…With the intention of increasing the accessibility to health care at the correct professional level, a structured patient-sorting system called ‘Primary Care Triage’ was introduced at the PHCC in 2008. Following an instruction manual, patients are sorted by a nurse to the appropriate professional category (GP, physiotherapist, district nurse, psychologist) on the basis of symptoms (Thorn et al , 2010). …”

Section: Introductionmentioning

confidence: 99%

Patients’ experience of being triaged directly to a psychologist in primary care: a qualitative study

Dahlöf

Simonsson

Thorn

et al. 2013

Prim Health Care Res Dev

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BackgroundIn a primary health-care centre (PHCC) situated in a segregated area with low socio-economic status, ‘primary care triage’ has increased efficiency and accessibility. In the primary-care triage, the nurse sorts the patient to the appropriate PHCC profession according to described symptoms.AimThe aim of this study was to examine the patients’ experience of being triaged directly to a psychologist for assessment.MethodInterviews were conducted with 20 patients and then analysed using qualitative content analysis.FindingsThe results show that patients contacting the PHCC for mental health issues often are active agents with their own intent to see a psychologist, not a doctor, as a first-hand choice when contacting the PHCC. Seeking help for mental health issues is described as a sensitive issue that demands building up strength before contacting. The quick access to the preferred health-care professional is appreciated. The nurse was perceived as a caring facilitator rather than a decision maker. It is the patient's wish rather than the symptoms that directs the sorting. The patients’ expectations when meeting the psychologist were wide and diverse. The structured assessment sometimes collided and sometimes united with these expectations, yielding different outcome satisfaction. The results could be seen in line with the present goal to increase patients’ choice in the health-care system. The improved accessibility to the psychologist seems to meet community expectations. The results also indicate a need for providing more prior information about the assessment and potential outcomes.

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Increased access rate to a primary health-care centre by introducing a structured patient sorting system developed to make the most efficient use of the personnel: a pilot study

Cited by 14 publications

References 4 publications

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses

Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members’ conceptions

Patients’ experience of being triaged directly to a psychologist in primary care: a qualitative study

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