Capsule Commentary on Levine et al., Characteristics and Disparities of Primary Care Practices in the United States

Introduction: An estimated 2.4 million people in the United States live with hepatitis C. Though there are effective treatments for chronic hepatitis C, many infected individuals remain untreated because 40% to 50% of individuals with chronic hepatitis C are unaware of their hepatitis C status. In 2013, the United States Preventive Services Task Force (USPSTF) recommended that adults born between 1945 and 1965 should be offered one-time hepatitis C screening. The purpose of this study is to describe rates of birth cohort hepatitis C screening across primary care practices in the WWAMI region Practice and Research Network (WPRN). Methods: Cross-sectional observational study of adult patients born between 1945 and 1965 who also had a primary care visit at 1 of 9 participating health systems (22 primary care clinics) between July 31, 2013 and September 30, 2015. Data extracted from the electronic health record systems at each clinic were used to calculate the proportion of birth cohort eligible patients with evidence of hepatitis C screening as well as proportions of screened patients with positive hepatitis C screening test results. Results: Of the 32 139 eligible patients, only 10.9% had evidence of hepatitis C screening in the electronic health record data (range 1.2%-49.1% across organizations). Among the 4 WPRN sites that were able to report data by race and ethnicity, the rate of hepatitis C screening was higher among African Americans (39.9%) and American Indians/Alaska Natives (23.2%) compared with Caucasians (10.7%; P < .001). Discussion: Rates of birth cohort hepatitis C screening are low in primary care practices. Future research to develop and test interventions to increase rates of birth cohort hepatitis C screening in primary care settings are needed.

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Characteristics and Disparities among Primary Care Practices in the United States

Journal of General Internal Medicine ◽

10.1007/s11606-017-4239-z ◽

2017 ◽

Vol 33 (4) ◽

pp. 481-486 ◽

Cited By ~ 11

Author(s):

David Michael Levine ◽

Jeffrey A. Linder ◽

Bruce E. Landon

Keyword(s):

United States ◽

Primary Care ◽

The United States ◽

Care Practices ◽

Primary Care Practices

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The Role of Primary Care Practices in Screening for Patient Social Needs in the United States and Other High‐Income Countries

Health Services Research ◽

10.1111/1475-6773.13416 ◽

2020 ◽

Vol 55 (S1) ◽

pp. 63-64

Author(s):

R. Tikkanen ◽

A. Shah ◽

E. Schneider

Keyword(s):

United States ◽

Primary Care ◽

The United States ◽

High Income ◽

Social Needs ◽

Care Practices ◽

Primary Care Practices

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Uninsured Children With Psychosocial Problems: Primary Care Management

PEDIATRICS ◽

10.1542/peds.106.s3.930 ◽

2000 ◽

Vol 106 (Supplement_3) ◽

pp. 930-936 ◽

Cited By ~ 1

Author(s):

Thomas K. McInerny ◽

Peter G. Szilagyi ◽

George E. Childs ◽

Richard C. Wasserman ◽

Kelly J. Kelleher

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Professionals ◽

Mental Health Problems ◽

Psychosocial Problems ◽

The United States ◽

Behavior Study ◽

Care Practices ◽

Uninsured Children ◽

Primary Care Practices

Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of psychosocial problems (19%) and severe psychosocial problems (2%). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified psychosocial and mental health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.psychosocial problems, uninsured children, pediatrics, family medicine, primary care.

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Understanding primary care-oncology relationships within a changing healthcare environment

BMC Family Practice ◽

10.1186/s12875-019-1056-y ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Jennifer Tsui ◽

Jenna Howard ◽

Denalee O’Malley ◽

William L. Miller ◽

Shawna V. Hudson ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Care Transitions ◽

Formal System ◽

The United States ◽

Comparative Case Study ◽

Health Care Environment ◽

Optimal Care ◽

Care Practices ◽

Primary Care Practices

Abstract Background Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment. Methods Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond. Conclusions With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.

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Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care

Medical Care Research and Review ◽

10.1177/1077558720945913 ◽

2020 ◽

pp. 107755872094591

Author(s):

Hannah T. Neprash ◽

Laura Barrie Smith ◽

Bethany Sheridan ◽

Ira Moscovice ◽

Shailendra Prasad ◽

...

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Rural Areas ◽

Urban Areas ◽

The United States ◽

Rural Primary Care ◽

Rural And Urban ◽

Clinical Autonomy ◽

Care Practices ◽

Primary Care Practices

The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

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Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky

American Journal of Medical Quality ◽

10.1177/1062860616638154 ◽

2016 ◽

Vol 32 (2) ◽

pp. 178-185 ◽

Cited By ~ 1

Author(s):

Selam Wubu ◽

Laura Lee Hall ◽

Paula Straub ◽

Matthew J. Bair ◽

Jill A. Marsteller ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Pain Management ◽

Primary Care Physicians ◽

The United States ◽

Care Organization ◽

Chronic Pain Management ◽

Accountable Care ◽

Care Practices ◽

Primary Care Practices

Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

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Lost in Translation: Anthropological Reflections on Cancer Survivorship in Primary Care

Practicing Anthropology ◽

10.17730/0888-4552.40.3.27 ◽

2018 ◽

Vol 40 (3) ◽

pp. 27-30

Author(s):

Ellen B. Rubinstein

Keyword(s):

United States ◽

Primary Care ◽

Cancer Survivors ◽

Biomedical Research ◽

Ground Level ◽

The United States ◽

Institute Of Medicine ◽

Stakeholder Interests ◽

Primary Care Practices ◽

Lost In Translation

Abstract In 2006, the Institute of Medicine released a report detailing how cancer survivors in the United States were “lost in transition” from specialty to primary care. Here, I address a different problem: that of being “lost in translation.” Interviews with cancer survivors in community-based primary care practices across the United States revealed a fundamental disconnect between survivorship rhetoric and patients' perspectives on what was clinically, emotionally, and physically relevant to them. In reflecting on this disconnect, I ask how anthropologists can negotiate top-down stakeholder interests with ground-level understandings in biomedical research settings, where clinicians and biomedical scientists often dictate the terms of research. I argue that anthropology has a valuable role to play in teasing out the complexities of clinical and identity categories in biomedical research.

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