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Preview: Family Practice - Advance Access

Family Practice Advance Access





Published: Sat, 17 Feb 2018 00:00:00 GMT

Last Build Date: Fri, 16 Feb 2018 21:44:22 GMT

 



Development of a health assessment instrument for people with intellectual disabilities: a Delphi study

Sat, 17 Feb 2018 00:00:00 GMT

Abstract
Background
People with intellectual disabilities (IDs) experience health inequalities. Applying health assessments is one way of diminishing these inequalities. A health assessment instrument can support general practitioners (GPs) in providing better medical care to people with ID.
Objectives
The aim of this study was to determine which items should be part of a health assessment instrument for people with ID to be used in primary care.
Methods
This Delphi consensus study was conducted among 24 GP experts and 21 ID physicians. We performed three anonymous sequential online questionnaire rounds. We started with 82 ‘general’ items and 14 items concerning physical and additional examinations derived from the international literature and a focus group study among Dutch GPs. We definitely included items if more than 75% of the GP experts agreed on their inclusion.
Results
The participation rate in all rounds was above 88%. The expert groups proposed 10 new items. Consensus was reached on 64 ‘general’ items related to highly prevalent diseases, public health and health promotion. Consensus was also reached on 18 physical and additional examination items.
Conclusions
For the first time, experts in a Delphi study were able to arrive at a selection of items for a health assessment instrument for people with ID. The overall agreement among the GPs and ID physicians was good. Because the experts prefer that patients complete the health assessment questionnaire at home, questions that cover these items must be formulated clearly.



Towards optimal electronic medical record use: perspectives of advanced users

Sat, 10 Feb 2018 00:00:00 GMT

Abstract
Background
While primary health care electronic medical record (EMR) adoption has increased in Canada, the use of advanced EMR features is limited. Realizing the potential benefits of primary health care EMR use is dependent not only on EMR acquisition, but also on its comprehensive use and integration into practice; yet, little is known about the advanced use of EMRs in primary health care.
Objective
To explore the views of advanced primary health care EMR users practising in a team-based environment.
Methods
A descriptive qualitative approach was used to explore the views of primary health care practitioners who were identified as advanced EMR users. Twelve individual semi-structured interviews were held with primary health care practitioners in Southwestern Ontario, Canada. Field notes were created after each interview. Interviews were audio recorded and transcribed verbatim. Researchers independently coded the transcripts and then met to discuss the results of the coding. We used a thematic approach to data analysis.
Results
Three themes emerged from the data analysis: advanced EMR users as individuals with signature characteristics, advanced EMR users as visionaries and advanced EMR users as agents of change. In any one participant, these elements could overlap, illuminating the important interplay between these themes. Taken together, these themes defined advanced use among this group of primary health care practitioners.
Conclusions
To realize the potential benefits of EMR use in improved patient care and outcomes, we need to understand how to support EMR use. This study provides a necessary building block in furthering this understanding.