Initial and Follow-Up Evaluations of Integrated Psychological Services for Anxiety and Depression in a Safety Net Primary Care Clinic

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

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Food security is related to adult type 2 diabetes control over time in a United States safety net primary care clinic population

Nutrition and Diabetes ◽

10.1038/nutd.2017.18 ◽

2017 ◽

Vol 7 (5) ◽

pp. e277-e277 ◽

Cited By ~ 9

Author(s):

M U Shalowitz ◽

J S Eng ◽

C O McKinney ◽

J Krohn ◽

B Lapin ◽

...

Keyword(s):

United States ◽

Type 2 Diabetes ◽

Primary Care ◽

Primary Care Clinic ◽

Safety Net ◽

Adult Type ◽

Care Clinic ◽

Clinic Population ◽

Over Time

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A collaborative care team to integrate behavioral health care and treatment of poorly-controlled type 2 diabetes in an urban safety net primary care clinic

General Hospital Psychiatry ◽

10.1016/j.genhosppsych.2016.10.005 ◽

2017 ◽

Vol 44 ◽

pp. 10-15 ◽

Cited By ~ 18

Author(s):

Lydia A. Chwastiak ◽

Sara L. Jackson ◽

Joan Russo ◽

Pamela DeKeyser ◽

Meghan Kiefer ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Health Care ◽

Collaborative Care ◽

Primary Care Clinic ◽

Behavioral Health Care ◽

Safety Net ◽

Care Clinic ◽

Urban Safety

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Implementation of a brief screening tool to identify needs of cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23075 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23075-e23075 ◽

Cited By ~ 1

Author(s):

Allison L. McDonough ◽

Yvonne Y. Lei ◽

Dana Haggett ◽

Rachel Jimenez ◽

Katherine T. Johnston ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Primary Care Clinic ◽

Qualitative Assessment ◽

Plain Language ◽

Convenience Sample ◽

Care Clinic

e23075 Background: Innovation in health care delivery is needed to improve care for cancer survivors. We report a pragmatic study intended to evaluate our experience with adopting screening guidelines from the National Comprehensive Cancer Network (NCCN) to the routine care of breast cancer survivors in primary care and oncology follow up. Methods: We adapted the NCCN recommended screening questions into a plain language self-administered 1 page intake questionnaire. The tool was administered to a convenience sample of female breast cancer survivors in routine follow-up at an oncology or primary care clinic from September through December 2018. Domains included symptoms, lifestyle concerns, and financial issues. Frequency of concerns was assessed as “never”, “rarely”, “sometimes”, “very frequently” and “always”. We dichotomized results and evaluated feasibility of administration, prevalence of reported symptoms and qualitative assessment of burden as well as utility of the tool among participating clinicians. Results: 165 out of 169 patients offered the questionnaire participated (98%). Office staff provided the questionnaire at routine visits without notable impact on clinic flow. Most commonly endorsed concerns (sometimes or more) were: desire to improve fitness or nutrition (80%), worry about cancer recurrence (72%), and problems with sleep (57%). A majority also reported feeling nervous or worried (55%) and aches or pains in limbs or joints (55%). Several issues known to be underreported in clinic visits were endorsed including lack of satisfaction with sexual function (30% sometimes or more, 12% very often or always) and difficulty remembering things (47% sometimes or more, 13% very often or always). Among 7 participating clinicians, the tool was deemed useful and not burdensome. Several noted that it led to discussing issues that may not otherwise have been addressed. Suggestions included systematically identifying resources and strategies to address common issues and incorporating the tool into the electronic health record to increase utility. Conclusions: Screening for individual needs among survivors is feasible and efficient and may identify prevalent issues that otherwise can be missed in routine survivorship care.

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377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings

SLEEP ◽

10.1093/sleep/zsab072.376 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A150-A150

Author(s):

Cassandra Godzik ◽

Adam Sorscher

Keyword(s):

Primary Care ◽

Primary Care Clinic ◽

Primary Care Providers ◽

Sleep Medicine ◽

Quality Metrics ◽

Care Providers ◽

National Guidelines ◽

Daytime Functioning ◽

Care Clinic

Abstract Introduction Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia. Methods We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months. Results Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%). Conclusion Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting. Support (if any) Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553

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Injury Prevention Education in the Waiting Room of an Underserved Pediatric Primary Care Clinic

Clinical Pediatrics ◽

10.1177/0009922818806315 ◽

2018 ◽

Vol 58 (1) ◽

pp. 73-78 ◽

Cited By ~ 1

Author(s):

Nikita Habermehl ◽

Elizabeth Diekroger ◽

Rina Lazebnik ◽

Grace Kim

Keyword(s):

Primary Care ◽

Injury Prevention ◽

Primary Care Clinic ◽

The United States ◽

Childhood Mortality ◽

Pediatric Primary Care ◽

Waiting Room ◽

Care Clinic ◽

Prevention Education

Unintentional injuries are the leading cause of childhood mortality in the United States. Study aims included educating families about injury prevention and improving satisfaction with the waiting room experience. Two hundred caregivers with young children in the waiting room of an underserved pediatric primary care clinic participated in brief individual education sessions and received a toolkit containing small safety items and content highlighting age-appropriate safety topics. Participants completed 2 follow-up surveys, and most caregivers (94%) reported learning new information about injury prevention and thought that the intervention resulted in a better waiting room experience (91%). Of those who completed the 2-week follow-up survey (84%), 93.5% made changes at home and 42.7% bought new safety equipment. Injury prevention education can be effectively provided in the waiting room of a pediatric primary care clinic by improving reported caregiver safety knowledge and behaviors as well as satisfaction with the waiting room experience.

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Depression Among Patients With Diabetes Attending a Safety-Net Primary Care Clinic: Relationship With Disease Control

Psychosomatics ◽

10.1016/j.psym.2014.01.008 ◽

2014 ◽

Vol 55 (6) ◽

pp. 548-554 ◽

Cited By ~ 1

Author(s):

Erik R. Vanderlip ◽

Wayne Katon ◽

Joan Russo ◽

Dan Lessler ◽

Paul Ciechanowski

Keyword(s):

Primary Care ◽

Disease Control ◽

Primary Care Clinic ◽

Safety Net ◽

Care Clinic ◽

Patients With Diabetes

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Improving access in a VA primary care clinic using an innovative Panel Retention Tool: a quality improvement report

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010398 ◽

2020 ◽

Vol 29 (11) ◽

pp. 947-955

Author(s):

Andrew T Harris ◽

Catherine Hoover ◽

Brendan Cmolik ◽

Mariel Zaun ◽

Corinna Falck-Ytter ◽

...

Keyword(s):

Primary Care ◽

Primary Care Clinic ◽

Control Limit ◽

Health Administration ◽

Care Clinic ◽

Loss To Follow Up ◽

Primary Care Teams ◽

Future Care ◽

Lost To Follow Up

BackgroundLoss to follow-up is an under-recognised problem in primary care. Continuity with a primary care provider improves morbidity and mortality in the Veterans Health Administration. We sought to reduce the percentage of patients lost to follow-up at the Northeast Ohio Veterans Affairs Healthcare System from October 2017 to March 2019.MethodsThe Panel Retention Tool (PRT) was developed and tested with primary care teams using multiple Plan, Do, Study and Act cycles to identify and schedule lost to follow-up patients. Baseline data on loss to follow-up, defined as the percentage of panelled patients not seen in primary care in the past year, was collected over 6 months during tool development. Outcomes were tracked from implementation through spread and sustainment (12 months) across 14 primary care clinics.ResultsOf the 96 170 panelled patients at the beginning of the study period, 2715 (2.8%) were found to be inactive and removed from provider panels, improving panel reliability. Among the remaining, 1856 (1.9%) patients without scheduled follow-up were scheduled for future care, and 1239 (1.3%) without recent prior care completed encounters during the study period. The percentage of patients lost to follow-up decreased from 10.1% (lower control limit (LCL) 9.8%–upper control limit (UCL) 10.4%) at baseline to 6.4% (LCL 6.2%–UCL 6.7%) postintervention and patients without planned future care decreased from 21.7% (LCL 21.3%–UCL 22.1%) to 17.1% (LCL 16.7%–UCL 17.5%).ConclusionsThe PRT allowed primary care teams in an integrated health system to identify and schedule lost to follow-up patients. Ease of use, adaptability and encouraging outcomes facilitated spread. This has the potential to contribute to more appropriate utilisation of healthcare resources and improved access to primary care.

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