Search

Objective: To identify elements of data that have been shown to contribute to continuity of information between primary care providers and medical specialists providing care to adult asthma patients., Design: Systematic review of the literature followed by a 2-round modified Delphi consensus process., Setting: Province of Ontario., Participants: Eight expert panelists, including 3 practising family physicians, a medical specialist knowledgeable in the treatment of asthma, a family physician previously involved in provincial initiatives related to primary care reform, an e-health technologist, a developer of evidence-based guidelines, and an operations and programs specialist., Methods: We completed a systematic literature review to identify important components of consultation reports. We then engaged an 8-member panel in a 2-round modified Delphi consensus process, which led to the identification of components deemed essential to good continuity of information., Main Findings: After 2 rounds, expert panelists reached consensus on 15 components, referred to here as minimum essential elements, of consultation reports generated by medical specialists in response to referring primary care providers' consultation requests., Conclusion: The expert panelists considered inclusion of the minimum essential elements in consultation reports essential to achieving good continuity of information. We assembled these elements in a suggested format for a consultation report. The format can be easily modified by practitioners caring for patients with other chronic diseases.

Objective: To identify elements of data that have been shown to contribute to continuity of information between primary care providers and medical specialists providing care to adult asthma patients., Design: Systematic review of the literature followed by a 2-round modified Delphi consensus process., Setting: Province of Ontario., Participants: Eight expert panelists, including 3 practising family physicians, a medical specialist knowledgeable in the treatment of asthma, a family physician previously involved in provincial initiatives related to primary care reform, an e-health technologist, a developer of evidence-based guidelines, and an operations and programs specialist., Method: We completed a systematic literature review to develop a list of items or data elements related to patient information transfer in chronic care. We engaged an 8-member expert panel in a 2-round modified Delphi process to assess the importance of the 74 data elements identified in the literature review and to identify any additional important elements., Main Findings: The expert panelists reached consensus on 24 components of information, referred to here as minimum essential elements of a referral document, needed for consultations on adult asthma patients., Conclusion: The 24 minimum essential elements of information that should be transferred during referral of asthma patients from primary care providers to experts in asthma care were generated by primary care physicians and thought essential for achieving continuity in information transfer. We assembled these elements into a suggested format for a referral document. The format can be easily modified by practitioners caring for patients with other chronic diseases.

Objective: To develop and validate a questionnaire based on agency theory to measure continuity of care in a community-based diabetes control program in Shanghai, China., Study Design and Setting: Continuity of care was conceptualized in relation to two domains: information transfer and goal alignment. The questionnaire combined scales adopted from two validated questionnaires: the Primary Care Assessment Survey and the Summary of Diabetes Self-care Activities Measure. Patient interviews were conducted with 156 diabetes patients in the intervention group and 182 in the control group in two community health settings in Shanghai, China. The questionnaire was validated in terms of Likert-scaling assumptions, data completeness, score distribution, construct validity, and sensitivity., Results: All scales consistently showed strong measurement properties in item reliability and validity. Requirements of data completeness and distribution were achieved in all scales. Principal components analysis of six scales provided a satisfactory explanation of the hypothesized scale-domain construction., Conclusions: The validation results suggested that the scales in our continuity of care questionnaire are consistent with the concept of continuity of care based on agency theory.

Objective: The aim of the study was to evaluate a community-based diabetes management program in Shanghai, China and to examine the association between continuity of care and clinical outcomes., Study Design and Setting: The diabetes management program was implemented in downtown Shanghai. One hundred fifty-six patients participated in the intervention group and 182 patients were in the control group. Participants were elders without severe diabetic complications. Patient weight, body mass index, blood pressures, and fasting blood glucose were collected from outpatient records at baseline and the end of the study in both groups. Fructosamine level was measured to monitor glycemic control for patients in the intervention group. Continuity of care was measured based on our broad definition., Results: Improved patient health outcomes were observed in the diabetes management program: patients in the intervention group significantly reduced their weight, systolic blood pressure, and fasting blood glucose compared with those in the control group (P<0.05). In hierarchical regression models, continuity of care scales had a significant association with weight loss and fasting blood glucose reduction., Conclusion: This study suggested that continuity based on broad terms can act as an important management tool to improve the quality of primary care in similar urban settings.