The effect of an educational intervention on primary care providers' knowledge, confidence and frequency of patient counselling on strength training and bone density

Abstract Background Primary care providers’ (PCPs’) lack of knowledge about and use of pre-exposure prophylaxis (PrEP) represent important barriers to its effective implementation on a national scale. To address these barriers, a collaboration of infectious diseases clinicians, patient advocates, and continuing medical education (CME) specialists developed and tested an educational intervention for PCPs to increase their knowledge about best practices for providing PrEP-related care. Methods An interactive, online CME-accredited simulation prompted PCPs to make clinical decisions about a hypothetical case of a 44-year-old African-American man seeking treatment for rectal gonorrhea who thus had indications for PrEP. The intervention included real-time educational feedback on clinical decisions and an opportunity to revisit suboptimal care decisions after feedback. PCPs were recruited via email and links on CME/patient advocacy websites and public health listservs. Outcomes included proportions of learners selecting correct answers prior to and after receiving feedback on their decisions. Results During October 2017–April 2018, 234 PCPs (88% physicians, 7% NP, 5% PA) completed the simulation for a total of 4,701 unique clinical decisions. Less than half (45%) of PCPs elicited a comprehensive sexual health history to begin the visit, which improved to 83% after feedback. Two-thirds (67%) of PCPs sought permission before asking about sexual behaviors, which increased to 82% after feedback. Nearly one-quarter of PCPs (24%) needed corrective action to nonjudgmentally ask about condom use. Almost all PCPs (91%) identified that PrEP was appropriate for the case patient on their first attempt. However, only 54% of PCPs initially selected all recommended baseline laboratory tests for PrEP; 75% did so after feedback. Of providers recommending PrEP, 29% selected regimens not FDA approved for this indication. Conclusion Many PCPs participating in an online simulation enacted clinical decisions that were inconsistent with best practices for providing PrEP-related care, but hypothetical care decisions improved after real-time educational feedback. Future studies to test the impact of this educational intervention on clinical practices are warranted. Disclosures D. Evans, Project Inform: Employee, Educational grant. A. McCord, Project Inform: Employee, Educational grant. D. Krakower, Gilead Sciences: Grant Investigator, Research grant.

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Managing dental emergencies: A descriptive study of the effects of a multimodal educational intervention for primary care providers at six months

BMC Medical Education ◽

10.1186/1472-6920-12-103 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 7

Author(s):

Tony Skapetis ◽

Tania Gerzina ◽

Wendy Hu

Keyword(s):

Primary Care ◽

Educational Intervention ◽

Primary Care Providers ◽

Descriptive Study ◽

Care Providers

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Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative

BMJ Open ◽

10.1136/bmjopen-2020-046068 ◽

2021 ◽

Vol 11 (11) ◽

pp. e046068

Author(s):

Michelle D Smekal ◽

Aminu K Bello ◽

Maoliosa Donald ◽

Deenaz Zaidi ◽

Kerry McBrien ◽

...

Keyword(s):

Primary Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Educational Intervention ◽

Primary Care Providers ◽

System Level ◽

Future Research ◽

Care Providers ◽

Post Intervention ◽

Interactive Workshop

BackgroundGaps in identification, medical management and appropriate referral for patients with chronic kidney disease (CKD) are evident.ObjectiveWe designed and implemented an interactive educational intervention (accredited workshop) to improve primary care providers’ awareness of tools to support guideline-concordant CKD management.DesignWe used the Kern method to design the educational intervention and targeted the accredited workshops to primary care team members (physicians, nurses and allied health) in Alberta, Canada. We conducted anonymous pre-workshop and post-workshop surveys to identify practice-specific barriers to care, identify potential solutions, and evaluate provider confidence pre-intervention and post-intervention. We used non-parametric statistics to analyse Likert-type survey data and descriptive content analysis to categorise responses to open-ended survey questions.ResultsWe delivered 12 workshops to 114 providers from September 2017 through March 2019. Significant improvements (p<0.001) in confidence to appropriately identify, manage and refer patients with CKD were observed. Participants identified several patient-level, provider-level, and system-level barriers and potential solutions to care for patients with CKD; the majority of these barriers were addressed in the interactive workshop.ConclusionsThe Kern model was an effective methodology to design and implement an educational intervention to improve providers’ confidence in managing patients with CKD in primary care. Future research is needed to determine if these perceived knowledge and confidence improvements affect patient outcomes and whether improvements are sustained long term.

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1276. Changes in Primary Care Pre-exposure Prophylaxis prescribing in a Large Healthcare System after the Implementation of an HIV Screening Alert and Educational Intervention

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1139 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S460-S460

Author(s):

Thomas Ludden ◽

Lindsay Shade ◽

Jeremy Thomas ◽

Sveta Mohanan ◽

Michael Leonard ◽

...

Keyword(s):

Primary Care ◽

Healthcare System ◽

Educational Intervention ◽

Insurance Coverage ◽

Primary Care Providers ◽

Hiv Screening ◽

Care Providers ◽

Number Of Patients ◽

One Year ◽

Exposure Prophylaxis

Abstract Background The number of providers that prescribe pre-exposure prophylaxis (PrEP) for HIV remains low. Primary care providers (PCPs) are less knowledgeable than HIV providers (HIVPs) with regards to PrEP: fewer PCPs had heard of PrEP (76% vs. 98%), knew about prescribing PrEP (28% vs. 76%), or ever had prescribed it (17% vs. 64%). PCPs limited knowledge about PrEP and questions about insurance coverage were identified as barriers to prescribing PrEP. Additional information on changes in prescribing PrEP in primary care within a large healthcare system is limited. Methods 12 practices were part of a systemwide implementation of an HIV screening Electronic Medical Record (EMR) alert in October 2017 for patients ages 18–64. The 12 primary care practices were also included as part of an educational intervention regarding HIV prevention presented in the first quarter of 2018. As part of the educational intervention, information on prescribing PrEP was included along with resources for linkage-to-care and insurance coverage. The number of PrEP prescriptions were summarized for all 12 practices one year prior to the EMR alert and one-year post-EMR alert. Paired T-test statistics were used to test the number of patients prescribed PrEP by each practice pre- and post-EMR alert. The same analysis was conducted one-year pre- and post- the educational intervention. Results Across the 12 practices, 62 PrEP prescriptions were written one year prior to the implementation of the EMR alert (M=5.2, SD=7.3) and 88 post-EMR alert (M=7.3, SD=6.4), a 42% increase (P = 0.02). There were no differences in PrEP prescriptions one-year pre- and post- the educational intervention (n = 69). Conclusion While the number of PrEP prescriptions written showed significant increase after the implementation of the EMR alert, the overall number of prescriptions in primary care are still relatively low. While there has been national attention to increase PrEP prescribing through initiatives with local health departments, efforts to increase PrEP uptake require additional interventions above and beyond education interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP. Disclosures All authors: No reported disclosures.

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Antimicrobial Resistance Education in the Primary Care Setting

Journal of Doctoral Nursing Practice ◽

10.1891/2380-9418.9.2.217 ◽

2016 ◽

Vol 9 (2) ◽

pp. 217-225

Author(s):

Jenna Oesterle ◽

Meghan Sternemann ◽

Tiffany Sande ◽

Christina Aplin-Kalisz ◽

Diane Towers

Keyword(s):

Primary Care ◽

Antimicrobial Resistance ◽

Educational Intervention ◽

Treatment Guidelines ◽

Primary Care Providers ◽

National Committee ◽

Antibiotic Prescribing ◽

Care Providers ◽

Prescribing Practices ◽

Convenience Sample

Background:Antimicrobial resistance has become a problem of epidemic proportions; however, patients believe antibiotics can treat any infection (National Committee for Quality Assurance [NCQA], 2011). Judicious prescribing practices are known to decrease antimicrobial resistance in the community (Centers for Disease Control [CDC], 2012).Purpose:Primary care providers (PCPs) are in a position to change current prescribing practices and patient beliefs regarding antimicrobials. This project focused on a PCP-facilitated educational intervention.Design/Methods:A quasi-experimental chart review performed over 3 months. PCPs were educated on CDC treatment guidelines for acute bronchitis, sinusitis, pharyngitis, and the educational pamphlet. The PCPs provided a brief educational session with the pamphlet to patients presenting with upper respiratory infections (URIs).Sample:A convenience sample of patients 18–64 years old presenting with URI symptoms; data were collected on antibiotic prescriptions, patient demographics, comorbid diagnoses, and discharge diagnosis.Results:Antibiotic prescribing rates for patient’s pre- to postintervention decreased significantly from 77.9% to 61.6% (1,N= 163) = 0.02,p< .05. Improved adherence to guidelines from pre- to postintervention for bronchitis was demonstrated yet no statistically significant improvement for pharyngitis and sinusitis.Conclusion:A PCP-facilitated educational intervention demonstrated an effective method to reduce antibiotic prescriptions for URIs in primary care.

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The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽

10.1027/0227-5910/a000511 ◽

2018 ◽

Vol 39 (5) ◽

pp. 397-405 ◽

Cited By ~ 3

Author(s):

Steven Vannoy ◽

Mijung Park ◽

Meredith R. Maroney ◽

Jürgen Unützer ◽

Ester Carolina Apesoa-Varano ◽

...

Keyword(s):

Primary Care ◽

Low Socioeconomic Status ◽

Thematic Analysis ◽

Older Men ◽

Primary Care Providers ◽

Depression Treatment ◽

Care Providers ◽

Low Socioeconomic ◽

Self Image ◽

The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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