Effect of Educating the Primary Care Physician About Headache to Help Reduce “Trivial” Referrals and Improve the Number and Quality of “Substantial” Referrals that Truly Need Subspecialty Headache Medicine Care

2017 ◽  
Vol 19 (7) ◽  
Author(s):  
Robert Cowan ◽  
Meredith Barad
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

2020 ◽  
pp. 009121742097799
Author(s):  
Krista Schultz ◽  
Sharan Sandhu ◽  
David Kealy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Primary Care Physician ◽  
Population Based ◽  
Borderline Personality ◽  
Care Physician ◽  
Cross Sectional

Objective The purpose of the current study is to examine the relationship between the quality of the Patient-Doctor Relationship and suicidality among patients seeking mental health care; specifically, whether patients who perceive having a more positive relationship with primary care physician will have lower levels of suicidality. Method Cross-sectional population-based study in Greater Vancouver, Canada. One-hundred ninety-seven participants were recruited from three Mental Health Clinics who reported having a primary care physician. Participants completed a survey containing questions regarding items assessing quality of Patient-Doctor Relationship, general psychiatric distress (K10), borderline personality disorder, and suicidality (Suicidal Behaviours Questionnaire-Revised-SBQ-R). Zero-order correlations were computed to evaluate relationships between study variables. Hierarchical regression analysis was used to control for confounding variables. Results The quality of the patient doctor relationship was significantly negatively associated with suicidality. The association between the quality of the patient-doctor relationship and suicidality remained significant even after controlling for the effects of psychiatric symptom distress and borderline personality disorder features. Conclusions The degree to which patients’ perceive their primary care physician as understanding, reliable, and dedicated, is associated with a reduction in suicidal behaviors. Further research is needed to better explicate the mechanisms of this relationship over time.

scholarly journals Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

2016 ◽  
Vol 14 (1) ◽  
pp. 26-33 ◽  
Author(s):  
S. Dahrouge ◽  
W. Hogg ◽  
J. Younger ◽  
E. Muggah ◽  
G. Russell ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Primary Care Physician ◽  
Population Based ◽  
Care Physician ◽  
Population Based Study ◽  
Panel Size

scholarly journals Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Natasha E. Lane ◽  
Vicki Ling ◽  
Richard H. Glazier ◽  
Thérèse A. Stukel
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Retrospective Cohort ◽  
Cholinesterase Inhibitors ◽  
Care Physician ◽  
Patient Volume ◽  
People With Dementia ◽  
To Receive

Abstract Background Some jurisdictions restrict primary care physicians’ daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. Methods Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians’ daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. Results People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. Conclusions People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.

Primary Care Physician Volume and Quality of Diabetes Care

2016 ◽  
Vol 166 (4) ◽  
pp. 240 ◽  
Author(s):  
Andrew Cheung ◽  
Thérèse A. Stukel ◽  
David A. Alter ◽  
Richard H. Glazier ◽  
Vicki Ling ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Diabetes Care ◽  
Care Physician ◽  
Quality Of Diabetes Care

The aging methadone maintenance patient: Treatment adjustment, long-term success, and quality of life

2018 ◽  
Vol 5 (1) ◽  
pp. 27 ◽  
Author(s):  
Ranjit Rajaratnam, MD ◽  
David Sivesind, PhD ◽  
McWelling Todman, PhD ◽  
David Roane, MD ◽  
Randy Seewald, MD
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Primary Care Physician ◽  
Methadone Maintenance ◽  
Well Being ◽  
Care Physician ◽  
Satisfaction With Life Scale ◽  
Medical Problems ◽  
Regular Contact

Objective: To evaluate the features and modes of adaptation to aging among Methadone Maintenance Treatment (MMT) enrollees.Setting: Beth Israel Medical Center in New York City.Participants: A sample of 156 MMT enrollees (103/66 percent males and 53/34 percent females) age 24-68 years. Twenty-nine percent of participants were aged 55 or older.Design: A cross-sectional, multivariate, correlational design.Outcome Measures: Participants were administered the MMSE, ASI, BSI, as well as measures of impulsiveness and quality of life (QOL).Results: Older adults were more likely to have had longer periods of treatment (p < 0.01), less likely to report current heroin use (p < 0.05) and overall drug use (p < 0.05), but were more likely to have a history of comorbid alcohol misuse (p < 0.01). Advanced age was also associated with less impulsiveness, hostility, paranoia, and interpersonal sensitivity (p < 0.01), more chronic medical problems (p < 0.05), greater use of medication for medical problems (p < 0.05), and more liberal take home medicine schedules (p < 0.01). However, no differences were found between older and younger participants with respect to their scores on the Overall Social Support scale (p > 0.05), the Personal Well-Being Index (p > 0.05) and the Satisfaction with Life Scale (p > 0.05), suggesting comparable levels of QOL. Furthermore, the rate of contact for older participants with medical professionals did not differ significantly from that of younger participants (p > 0.05). Only 7.1 percent of older participants reported regular contact with a primary care physician; a rate that is slightly lower than the rate in the overall population.Conclusions: The findings from the present study highlight at least two underappreciated challenges that clinicians are increasingly likely encounter in their work with the aging MMT population. These challenges are: (1) that despite numerous medical and psychiatric complaints, only a small proportion of MMT patients have regular contact with a primary care physician and the rate of contact does not appear to increase with age and (2) even with age-related declines in psychiatric comorbidity and illicit substance use, the suboptimal level of QOL that is characteristic of the MMT population as a whole does not improve with aging and length of tenure in MMT.

scholarly journals Patient Experience with Primary Care Physician and Risk for Hospitalization in Hispanics with CKD

2018 ◽  
Vol 13 (11) ◽  
pp. 1659-1667 ◽  
Author(s):  
Esteban A. Cedillo-Couvert ◽  
Jesse Y. Hsu ◽  
Ana C. Ricardo ◽  
Michael J. Fischer ◽  
Ben S. Gerber ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Promotion ◽  
Primary Care Physician ◽  
Patient Experience ◽  
Proportional Hazards ◽  
Care Physician ◽  
Spanish Speakers ◽  
Communication Quality ◽  
Adjusted Rate

Background and objectivesIn the general population, the quality of the patient experience with their primary care physician may influence health outcomes but this has not been evaluated in CKD. This is relevant for the growing Hispanic CKD population, which potentially faces challenges to the quality of the patient experience related to language or cultural factors. We evaluated the association between the patient experience with their primary care physician and outcomes in Hispanics with CKD.Design, setting, participants, & measurementsThis prospective observational study included 252 English- and Spanish-speaking Hispanics with entry eGFR of 20–70 ml/min per 1.73 m2, enrolled in the Hispanic Chronic Renal Insufficiency Cohort study between 2005 and 2008. Patient experience with their primary care physician was assessed by the Ambulatory Care Experiences Survey subscales: communication quality, whole-person orientation, health promotion, interpersonal treatment, and trust. Poisson and proportional hazards models were used to assess the association between the patient experience and outcomes, which included hospitalization, ESKD, and all-cause death.ResultsParticipants had a mean age of 56 years, 38% were women, 80% were primary Spanish speakers, and had a mean eGFR of 38 ml/min per 1.73 m2. Over 4.8 years (median) follow-up, there were 619 hospitalizations, 103 ESKD events, and 56 deaths. As compared with higher subscale scores, lower scores on four of the five subscales were associated with a higher adjusted rate ratio (RR) for all-cause hospitalization (communication quality: RR, 1.54; 95% confidence interval [95% CI], 1.25 to 1.90; health promotion: RR, 1.31; 95% CI, 1.05 to 1.62; interpersonal treatment: RR, 1.50; 95% CI, 1.22 to 1.85; and trust: RR, 1.57; 95% CI, 1.27 to 1.93). There was no significant association of subscales with incident ESKD or all-cause death.ConclusionsLower perceived quality of the patient experience with their primary care physician was associated with a higher risk of hospitalization.

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