Early Primary Care Provider Follow-up and Readmission After High-Risk Surgery

Introduction: Minority communities have had limited access to advances in genomic medicine. Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, partnered to assess the feasibility of offering genomic screening to Latino patients receiving care at a community-based health center. We examined primary care provider (PCP) experiences reporting genomic screening results and integrating those results into patient care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other members of the health care team charged with supporting patients who received positive genomic screening results. Interviews were recorded, transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results indicating a genetic variant that warranted clinical management. PCPs felt genomic screening was valuable to patients and their families, and that genomic research should strive to include underrepresented minorities. Providers identified multiple challenges integrating genomic sequencing into patient care, including difficulties maintaining patient contact over time; arranging follow-up medical care; and managing results in an environment with limited genetics expertise. Providers also reflected on the ethics of offering genomic sequencing to patients who may not be able to pursue diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing advances in precision medicine to community-based health centers serving under-resourced populations. By proactively considering patient support needs, and identifying financial assistance programs and patient-referral mechanisms to support patients who may need specialized medical care, PCPs and other health care providers can help to ensure that precision medicine lives up to its full potential as a tool for improving patient care.

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Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter

Journal of Academic Ophthalmology ◽

10.1055/s-0041-1726288 ◽

2021 ◽

Vol 13 (01) ◽

pp. e51-e56

Author(s):

Lauren Hennein ◽

Kimberly A. Spaulding ◽

Veronika Karlegan ◽

Ogonna N. Nnamani Silva ◽

Alejandra G. de Alba Campomanes

Keyword(s):

High School ◽

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

Nonprofit Organization ◽

County Hospital ◽

Categorical Variables ◽

Homeless Shelter ◽

High School Diploma

Abstract Objective Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter. Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection. Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one (p = 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present (p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates (p = 0.79). Conclusion Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.

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Abstract TP356: Post-Acute Stroke Experience Survey- Development and Pilot Testing

Stroke ◽

10.1161/str.51.suppl_1.tp356 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jane A Anderson ◽

Barbara Kimmel ◽

Kirt Martin ◽

Anette Ovalle ◽

Chizoba Ifeorah ◽

...

Keyword(s):

Primary Care ◽

Health Insurance ◽

Care Provider ◽

Primary Care Provider ◽

Claims Data ◽

Stroke Care ◽

Insurance Status ◽

Stroke Survivors ◽

Health Insurance Status

Background: Administrative claims data show variability in post-acute stroke care. Stroke survivors without health insurance are not included in claims data statistics. The PASES survey was developed and tested to describe stroke care experience of underserved survivors participating in V-STOP a telehealth self-management program. Methods: Semi-structured interviews were completed to elicit feedback from survivors on experiences during their stroke event, emergency and hospital care, and after discharge. Items on PASES were established based on participants’ responses and survey was piloted in a sample of underserved survivors (N=95). Descriptive statistics and Chi-square analysis were applied to describe stroke survivors’ experiences and differences based on health insurance status. Results: The sample was 45% female, mean age 57, 18% Black and 60% Hispanic. Most (60%) had an annual income of less than $25,000 and 44% had no insurance. Only 25% reported calling 911. However (60%) report presenting to a hospital within 2 hours of stroke symptoms recognition. Nearly half (42%) reported not knowing whether they received a “clot dissolving” medication. Fifty-four percent did not receive rehabilitation after discharge. Eighty-percent reported seeing a healthcare provider after discharge. Most (61%) saw a primary care provider and 22% saw a neurologist. However, only 24% reported seeing a provider within one month of hospital discharge. No significant differences were identified between insured vs. uninsured with respect to race, ethnicity, income, calling 911, receiving inpatient rehab, seeing a provider after discharge and follow up with primary care provider vs. neurologist. Significant differences were identified between insured vs. uninsured with respect to presenting to a hospital within 2 hours of stroke symptoms (35 vs 18 [p=0.023]) and in receiving no rehab after discharge (27 vs 12 [p=0.02]). Conclusion: Results suggest low utilization of EMS, delayed presentation to hospital, limited access to rehabilitation after discharge and limited access to timely follow-up with stroke specialist among underserved stroke survivors. Health insurance status may influence delayed hospital presentation and access to rehabilitation services.

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How Do We Support Follow-up With the Primary Care Provider After an Emergency Department Visit for Asthma?

PEDIATRICS ◽

10.1542/peds.2009-1284 ◽

2009 ◽

Vol 124 (4) ◽

pp. 1206-1207 ◽

Cited By ~ 3

Author(s):

M. E. Mansour

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Department Visit ◽

Care Provider ◽

Primary Care Provider

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Community Primary Care Provider Preferences for Emergency Department Follow-up Recommendations

Pediatric Emergency Care ◽

10.1097/pec.0000000000001068 ◽

2017 ◽

Vol 33 (10) ◽

pp. 690-693

Author(s):

Marissa A. Hendrickson ◽

Eta Obeya ◽

Andrew R. Wey ◽

Philippe R. Gaillard

Keyword(s):

Primary Care ◽

Emergency Department ◽

Care Provider ◽

Primary Care Provider

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Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up

Journal of Hospital Medicine ◽

10.1002/jhm.666 ◽

2010 ◽

Vol 5 (7) ◽

pp. 392-397 ◽

Cited By ~ 137

Author(s):

Gregory J. Misky ◽

Heidi L. Wald ◽

Eric A. Coleman

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider

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Using CBPR to Decrease Health Disparities in a Suburban Latino Neighborhood

Hispanic Health Care International ◽

10.1177/1540415317727569 ◽

2017 ◽

Vol 15 (3) ◽

pp. 121-129 ◽

Cited By ~ 5

Author(s):

Maren J. Coffman ◽

Brisa Urquieta de Hernandez ◽

Heather A. Smith ◽

Andrew McWilliams ◽

Yhenneko J. Taylor ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

High Risk ◽

Social Services ◽

Care Provider ◽

Primary Care Provider ◽

Access To Health Care ◽

Care Delivery ◽

Research Network ◽

Community Based

Introduction: This project tested the feasibility of using a community-based participatory research (CBPR) approach to deliver health and social resources in two high-risk, suburban neighborhoods. Method: An established research network was used to engage stakeholders to design and deliver a neighborhood-based intervention targeting a Latino immigrant population. The intervention provided screenings for hypertension, diabetes, and depression; primary care provider visits; and information about navigating health care delivery systems and related community-based resources. Participants ( N = 216) were consented for participation and their subsequent use of health and social services were measured at baseline and 1 year post intervention. Results: At baseline, 5.1% of participants had health insurance, 16.7% had a primary care provider, and 38.4% had a chronic illness. SF-12 scores showed a majority of participants with low perceived health status (56%) and high risk for clinical depression (33%). Self-reported use of primary care services increased from 33.8% at baseline to 48% 1 year after the intervention, and 62% reported use of social services. Conclusion: Neighborhood-based interventions informed by a CBPR approach are effective in both identifying community members who lack access to health care–related services and connecting them into needed primary care and social services.

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“She knows me best”: a qualitative study of patient and caregiver views on the role of the primary care physician follow-up post-hospital discharge in individuals admitted with chronic obstructive pulmonary disease or congestive heart failure

BMC Family Practice ◽

10.1186/s12875-021-01524-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sarah Griffiths ◽

Gaibrie Stephen ◽

Tara Kiran ◽

Karen Okrainec

Keyword(s):

Heart Failure ◽

Chronic Obstructive Pulmonary Disease ◽

Primary Care ◽

Hospital Discharge ◽

Care Provider ◽

Primary Care Provider ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge. Methods A qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a randomized controlled study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes. Results Interviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care. Conclusions Patients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity.

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