scholarly journals Primary Care Providers’ Acceptance of Pharmacists’ Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease

2019 ◽  
Vol 35 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Leah L. Zullig ◽  
Shelley A. Jazowski ◽  
Clemontina A. Davenport ◽  
Clarissa J. Diamantidis ◽  
Megan M. Oakes ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Medication Management ◽  
Primary Care Providers ◽  
Care Providers ◽  
Diabetic Kidney

Patient Digital Technologies to Support Primary Care across Disorders: Perspectives from Primary Care Providers, Behavioral Health Consultants, and Nurses (Preprint)

2021 ◽  
Author(s):  
Oleg Zaslavsky ◽  
Frances Chu ◽  
Brenna Renn
Keyword(s):  
Primary Care ◽  
Mobile Apps ◽  
Medication Management ◽  
Primary Care Providers ◽  
Health Conditions ◽  
Care Providers ◽  
Health Promoting Behaviors ◽  
Live Video ◽  
Health Promoting ◽  
Clinical Conditions

BACKGROUND Acceptance of digital health technologies among primary care providers and staff for various clinical conditions has not been explored. OBJECTIVE The purpose of this nationwide study was to determine differences between behavioral health consultants (BHCs), primary care providers (PCPs), and nurses in acceptance of mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals to support patient care across clinical conditions. METHODS We surveyed 51 BHCs, 52 PCPs, and 48 nurses embedded in primary care clinics across the United States. We asked respondents to mark technologies they consider appropriate to support patients in: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. RESULTS Respondents were geographically dispersed across the nation, although most (82.9%) practiced in urban and suburban settings. Compared to other personnel, a higher proportion of BHCs endorsed live video. Similarly, a higher proportion of nurses endorsed all other technologies. PCPs had the lowest rates of endorsement across technologies. Within clinical contexts, the highest acceptance rates were 81% and 70% for BHCs and PCPs respectively in live video for common mental health conditions, and 75% for nurses in mobile apps for health-promoting behaviors. The lowest (9%) endorsement rate across providers was in social media for medication management. CONCLUSIONS The survey suggests subtle differences in the way clinicians envision using technologies to support patient care. Future work must attend to provider perceptions to ensure the sustainment of services across conditions and patient populations.

Medications Used Routinely in Primary Care to be Dose-Adjusted or Avoided in People With Chronic Kidney Disease: Results of a Modified Delphi Study

2020 ◽  
Vol 54 (7) ◽  
pp. 625-632 ◽  
Author(s):  
Leena Taji ◽  
Marisa Battistella ◽  
Allan K. Grill ◽  
Jessie Cunningham ◽  
Brenda L. Hemmelgarn ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Delphi Study ◽  
Dose Adjustment ◽  
Sglt2 Inhibitor ◽  
Primary Care Providers ◽  
Delphi Panel ◽  
Care Providers ◽  
Modified Delphi

Background: Chronic kidney disease (CKD) affects up to 18% of those over the age of 65 years. Potentially inappropriate medication prescribing in people with CKD is common. Objectives: Develop a pragmatic list of medications used in primary care that required dose adjustment or avoidance in people with CKD, using a modified Delphi panel approach, followed by a consensus workshop. Methods: We conducted a comprehensive literature search to identify potential medications. A group of 17 experts participated in a 3-round modified Delphi panel to identify medications for inclusion. A subsequent consensus workshop of 8 experts reviewed this list to prioritize medications for the development of point-of-care knowledge translation materials for primary care. Results: After a comprehensive literature review, 59 medications were included for consideration by the Delphi panel, with a further 10 medications added after the initial round. On completion of the 3 Delphi rounds, 66 unique medications remained, 63 requiring dose adjustment and 16 medications requiring avoidance in one or more estimated glomerular filtration rate categories. The consensus workshop prioritized this list further to 24 medications that must be dose-adjusted or avoided, including baclofen, metformin, and digoxin, as well as the newer SGLT2 inhibitor agents. Conclusion and Relevance: We have developed a concise list of 24 medications commonly used in primary care that should be dose-adjusted or avoided in people with CKD to reduce harm. This list incorporates new and frequently prescribed medications and will inform an updated, easy to access source for primary care providers.

scholarly journals Primary Care Providers Believe That Comprehensive Medication Management Improves Their Work-Life

2019 ◽  
Vol 32 (4) ◽  
pp. 462-473 ◽  
Author(s):  
Kylee A. Funk ◽  
Deborah L. Pestka ◽  
Mary T. Roth McClurg ◽  
Jennifer K. Carroll ◽  
Todd D. Sorensen
Keyword(s):  
Primary Care ◽  
Medication Management ◽  
Primary Care Providers ◽  
Work Life ◽  
Care Providers

Comanagement of Diabetic Kidney Disease by the Primary Care Provider and Nephrologist

2013 ◽  
Vol 97 (1) ◽  
pp. 157-173 ◽  
Author(s):  
Brendan T. Bowman ◽  
Amanda Kleiner ◽  
W. Kline Bolton
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Care Provider ◽  
Primary Care Provider ◽  
Diabetic Kidney Disease ◽  
Diabetic Kidney

scholarly journals Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers

2017 ◽  
Vol 133 (1) ◽  
pp. 109-118 ◽  
Author(s):  
Kenneth H. Mayer ◽  
Stephanie Loo ◽  
Phillip M. Crawford ◽  
Heidi M. Crane ◽  
Michael Leo ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Community Health ◽  
Community Health Centers ◽  
Primary Care Providers ◽  
Health Centers ◽  
Research Network ◽  
People Living With Hiv ◽  
Care Providers

Objectives: As the life expectancy of people infected with human immunodeficiency virus (HIV) infection has increased, the spectrum of illness has evolved. We evaluated whether people living with HIV accessing primary care in US community health centers had higher morbidity compared with HIV-uninfected patients receiving care at the same sites. Methods: We compared data from electronic health records for 12 837 HIV-infected and 227 012 HIV-uninfected patients to evaluate the relative prevalence of diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, and malignancies by HIV serostatus. We used multivariable logistic regression to evaluate differences. Participants were patients aged ≥18 who were followed for ≥3 years (from January 2006 to December 2016) in 1 of 17 community health centers belonging to the Community Health Applied Research Network. Results: Nearly two-thirds of HIV-infected and HIV-uninfected patients lived in poverty. Compared with HIV-uninfected patients, HIV-infected patients were significantly more likely to be diagnosed and/or treated for diabetes (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.22-1.41), hypertension (OR = 1.38; 95% CI, 1.31-1.46), dyslipidemia (OR = 2.30; 95% CI, 2.17-2.43), chronic kidney disease (OR = 4.75; 95% CI, 4.23-5.34), lymphomas (OR = 4.02; 95% CI, 2.86-5.67), cancers related to human papillomavirus (OR = 5.05; 95% CI, 3.77-6.78), or other cancers (OR = 1.25; 95% CI, 1.10-1.42). The prevalence of stroke was higher among HIV-infected patients (OR = 1.32; 95% CI, 1.06-1.63) than among HIV-uninfected patients, but the prevalence of myocardial infarction or coronary artery disease did not differ between the 2 groups. Conclusions: As HIV-infected patients live longer, the increasing burden of noncommunicable diseases may complicate their clinical management, requiring primary care providers to be trained in chronic disease management for this population.

scholarly journals Opportunities and Barriers to Medication Safety in Community-Dwelling Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 611-612
Author(s):  
Fatoumata Jallow ◽  
Elisa Stehling ◽  
Zara Sajwani ◽  
Kathryn Daniel ◽  
Yan Xiao
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Medication Safety ◽  
Medication Management ◽  
Primary Care Providers ◽  
Vulnerable Population ◽  
Community Dwelling ◽  
Care Providers ◽  
Essential Information ◽  
Barriers And Enablers

Abstract Community-dwelling multi-morbid older adults are a vulnerable population for medication safety-related threats. We interviewed a sample of these older adults recruited from local retirement communities and from primary care practices to learn their perceptions of barriers and enablers for their medication safety. The present study is part of the Partnership in Resilience for Medication Safety (PROMIS) study. One of the aims of this project is to identify barriers and opportunities to improve older adults' medication safety. These interviews were conducted during COVID-19 pandemic conditions. Results from this qualitative study suggest that trust between these older adults and their healthcare providers is an essential component of medication safety. Overarching themes include disruptions in medication management, caregivers caring for each other, patient safety practices or habits, and medication management literacy. Participants also shared strain due to lack of skills to navigate telemedicine visits, trust in Primary Care Providers (PCPs) and pharmacists to prescribe and dispense safely for them, reliance on PCPs and pharmacists to give essential information about medications without having to be asked. Our interviews illustrated large variations in older adults’ perceived role in medication safety, with some developing expertise in understanding how medications work for them and how long-term medications should be periodically reviewed. The types of information needs and supports from PCPs were likely different. Understanding these barriers and enablers for safe medication management can help us develop medication safety improvements for this vulnerable population.

Transforming the Care of Patients with Diabetic Kidney Disease

2021 ◽  
pp. CJN.18641120
Author(s):  
Frank Brosius, III ◽  
David Cherney ◽  
Patrick Gee ◽  
Raymond Harris ◽  
Alan Kliger ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Health Care Providers ◽  
Diabetic Kidney Disease ◽  
Antihypertensive Agents ◽  
Renin Angiotensin System ◽  
Care Providers ◽  
Diabetic Kidney ◽  
New Therapies ◽  
Risk Of Death ◽  
Ras Inhibitors

Diabetes and its associated complications pose an immediate threat to humankind. Diabetic kidney disease (DKD) is one of the most devastating complications, increasing the risk of death more than 10-fold over that in the general population [1]. Until very recently, the only drugs proven and recommended to slow progression of DKD were angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type 1 receptor blockers (ARBs), which act by inhibiting the renin-angiotensin system (RAS) [2]. Despite their efficacy as kidney and cardiovascular protective therapies and as antihypertensive agents, RAS inhibitors have been grossly underutilized [3]. Moreover, even when RAS inhibitors are used, patients still have a high residual risk of DKD progression [1, 2]. Finally, the kidney-protective effect of RAS inhibitors has been categorically demonstrated only in patients with macro-albuminuria included in the IDNT and RENAAL trials - not in other individuals [4]. The lack of new therapies to treat DKD over the past two decades has therefore represented a tremendous challenge for patients and health care providers alike. In recent years, a number of powerful new therapies have emerged that promise to transform care of patients with diabetes and kidney disease. The challenge to the community is to ensure rapid implementation of these treatments. This white paper highlights advances in treatment, opportunities for patients, challenges and possible solutions to advance kidney health and introduces the launch of the Diabetic Kidney Disease Collaborative at the American Society of Nephrology, to aid in accomplishing these goals.

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