scholarly journals Physician-Nurse Practitioner Teamwork in Primary Care Practices in New York: A Cross-Sectional Survey

2020 ◽  
Vol 35 (4) ◽  
pp. 1021-1028
Author(s):  
Lusine Poghosyan ◽  
Affan Ghaffari ◽  
Jianfang Liu ◽  
Mark W. Friedberg
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioner ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e053633
Author(s):  
Kevin P Fiori ◽  
Caroline G Heller ◽  
Anna Flattau ◽  
Nicole R Harris-Hollingsworth ◽  
Amanda Parsons ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Electronic Health Records ◽  
Social Care ◽  
Social Needs ◽  
Cross Sectional ◽  
Health Records ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices

ObjectivesThere has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on ‘real-world’ practice. This study describes a health system’s experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network.SettingAcademic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA).ParticipantsThis retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices.MethodsWe organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices.ResultsBetween April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%–81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient.ConclusionsThese findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.

scholarly journals What You Don’t Know Might Hurt You: Cost Variations for Fecal Immunochemical Tests in Primary Care Practices

2021 ◽  
Author(s):  
Jennifer Coury ◽  
Katrina Ramsey ◽  
Rose Gunn ◽  
Jon Judkins ◽  
Melinda Davis
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
P Value ◽  
Fecal Occult Blood ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Effective Manner ◽  
Care Practices ◽  
Primary Care Practices ◽  
The Cost

Abstract Background Colorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Fecal immunochemical testing (FIT) is an effective way to screen more people for colorectal cancer, but barriers exist to implementation in clinical practice. Little research examines the impacts of cost on FIT selection and implemention. Methods We administered a multi-modal, cross-sectional survey to 252 primary care practices to assess readiness and implementation of direct mail fecal testing programs, including the cost and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson's chi-squared test of association and interpreted a low p-value (e.g. <0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT). Results Among the 84 practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on the cost of their FIT/FOBTs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significant different by FIT type. However, practices who received FITs from vendors were more likely to know the cost (p = 0.0002) and, if known, report a higher cost (p = 0.0002). Conclusions Our findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs in clinic-based encounters as well as through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have far reaching consequences for addressing colorectal cancer screening disparities in primary care practices.

scholarly journals What You Don’t Know Might Hurt You: Cost Variations for Fecal Immunochemical Tests in Primary Care Practices

2021 ◽  
Author(s):  
Jennifer Coury ◽  
Katrina Ramsey ◽  
Rose Gunn ◽  
Jon Judkins ◽  
Melinda Davis
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
P Value ◽  
Fecal Occult Blood ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Effective Manner ◽  
Care Practices ◽  
Primary Care Practices ◽  
The Cost

Abstract BackgroundColorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Fecal immunochemical testing (FIT) is an effective way to screen more people for colorectal cancer, but barriers exist to implementation in clinical practice. Little research examines the impacts of cost on FIT selection and implementation. MethodsWe administered a multi-modal, cross-sectional survey to 252 primary care practices to assess readiness and implementation of direct mail fecal testing programs, including the cost and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson's chi-squared test of association and interpreted a low p-value (e.g. <0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT). ResultsAmong the 84 practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on the cost of their FIT/FOBTs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significant different by FIT type. However, practices who received FITs from vendors were more likely to know the cost (p=0.0002) and, if known, report a higher cost (p=0.0002).ConclusionsOur findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs in clinic-based encounters as well as through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have far reaching consequences for addressing colorectal cancer screening disparities in primary care practices.

scholarly journals Variations in Nurse Practitioner Use in Veterans Affairs Primary Care Practices

2004 ◽  
Vol 39 (4p1) ◽  
pp. 887-904 ◽  
Author(s):  
Patty Y. Huang ◽  
Elizabeth M. Yano ◽  
Martin L. Lee ◽  
Betty L. Chang ◽  
Lisa V. Rubenstein
Keyword(s):  
Primary Care ◽  
Nurse Practitioner ◽  
Veterans Affairs ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals “At Home, with Care”: Lessons from New York City Home‐based Primary Care Practices Managing COVID ‐19

2020 ◽  
Author(s):  
Emily Franzosa ◽  
Ksenia Gorbenko ◽  
Abraham A. Brody ◽  
Bruce Leff ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
New York City ◽  
York City ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care Practices ◽  
Primary Care Practices ◽  
At Home

scholarly journals Modern work patterns of “classic” versus millennial family doctors and their effect on workforce planning for community-based primary care: a cross-sectional survey

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Lindsay Hedden ◽  
Setareh Banihosseini ◽  
Nardia Strydom ◽  
Rita McCracken
Keyword(s):  
Primary Care ◽  
British Columbia ◽  
Workforce Planning ◽  
Cross Sectional Study ◽  
Full Time ◽  
Cross Sectional Survey ◽  
Community Based ◽  
Cross Sectional ◽  
Family Doctors ◽  
Primary Care Practices

Abstract Background There are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care. Anecdotal evidence suggests that physicians are moving away from a community-based comprehensive practice model, which could contribute to shortages. Thus, we aimed to identify and describe how family physicians are currently organizing their primary care practices in a large health region in British Columbia and to examine differences between newer graduates and more established physicians. Methods Data for this cross-sectional study were drawn from an annual physician privileging survey. N = 1017 physicians were invited to participate. We categorized practice style into five distinct groupings and compared features across respondent groups, including personal and practice location characteristics, hospital and teaching work, payment and appointment characteristics, and scope of practice. We discuss the implications of styles of practice and associated characteristics on health workforce policy and planning. Results We received responses from 525 (51.6%) physicians. Of these, 355 (67.6%) reported doing at least some community-based primary care. However, only 112 (21.3%) provided this care full time. Most respondents supplemented community-based work with part-time hours in focused practice, hospitals, or inpatient facilities. We found diversity in the scope and style of practice across practice models. Compared to established physicians, new graduates (in practice less than 10 years) work more weekly hours (more patient care, and paperwork in particular). However, we found no difference between new and established physicians in the odds of providing any or full-time community-based primary care. Conclusions Despite a lack of formalized structural reform in British Columbia’s primary care system, most physicians are finding alternative ways to model their practice and shifting away from work at single-location, community-based clinics. This shift challenges assumptions that are relied on for workplace planning that is intended to ensure adequate access to longitudinal, community-based family medicine.

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