Childhood and adolescent depression: The role of primary care providers in diagnosis and treatment

2005 ◽  
Vol 35 (1) ◽  
pp. 6-24 ◽  
Author(s):  
Laura P. Richardson ◽  
Rachel Katzenellenbogen
Keyword(s):  
Primary Care ◽  
Adolescent Depression ◽  
Primary Care Providers ◽  
Diagnosis And Treatment ◽  
Care Providers

Improving diagnosis and treatment of benign paroxysmal positional vertigo

2021 ◽  
pp. 42-46
Author(s):  
Larry D. McIntire ◽  
Kindall Martin ◽  
Kunal Shah ◽  
Lauren Malinowski ◽  
John Paulson
Keyword(s):  
Primary Care ◽  
Population Health ◽  
Healthcare Costs ◽  
Benign Paroxysmal Positional Vertigo ◽  
Primary Care Providers ◽  
Diagnosis And Treatment ◽  
Care Providers ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care. Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated. Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.

The Implementation of a Clinical Toolkit and Adolescent Depression Screening Program in Primary Care

2014 ◽  
Vol 53 (14) ◽  
pp. 1336-1344
Author(s):  
Jonathan M. Libby ◽  
Eileen Stuart-Shor ◽  
Almas Patankar
Keyword(s):  
Primary Care ◽  
Adolescent Depression ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Program ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Care Providers ◽  
Comfort Levels ◽  
Survey Results

Problem/Background. Adolescent depression is a growing problem for today’s society with only 30% receiving services. Aim and Methods. The aim of this project was to increase identification and treatment of depressed adolescents, and comfort levels of primary care providers with the implementation of a depression-screening program and use of a clinical depression toolkit within a primary care setting. Setting. The setting was a private pediatric practice in central Maine. Results. Over an 8-week period, 266 adolescents were screened. Twelve adolescents (4.5%) received a diagnosis of depression and 11 received treatment within 8 days. Survey results showed a significant increase in providers’ feelings of comfort and accountability. Conclusion. This project demonstrates that it is feasible to implement a depression screening and treatment program in primary care. It demonstrates that primary care providers can increase their comfort and feelings accountability in treating depression in primary care, thus increasing access for this monumental and potential catastrophic problem.

scholarly journals Hemophagocytic Lymphohistiocytosis for the Internist and Other Primary Care Providers

2021 ◽  
Vol 12 ◽  
pp. 215013272110537
Author(s):  
Tanmayi Srinivas Pai ◽  
Fernando F. Stancampiano ◽  
Candido Rivera
Keyword(s):  
Primary Care ◽  
Immune System ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Immunosuppressive Treatment ◽  
Primary Care Providers ◽  
Outpatient Setting ◽  
Adult Patients ◽  
Diagnosis And Treatment ◽  
Care Providers ◽  
Life Threatening

Hemophagocytic lymphohistiocytosis (HLH) syndrome is a hyperinflammatory state that leads to life-threatening, disproportionate activation of the immune system and may be confused for and concomitantly exist with sepsis. However, its treatment differs from sepsis, requiring early initiation of immunosuppressive treatment. While HLH syndrome is more commonly diagnosed in children, internists and other primary care providers must be familiar with the diagnosis and treatment of adult patients with HLH in the hospital and outpatient setting. In this article, we review the essentials that an internist and other primary care providers managing adult HLH patients should know.

scholarly journals A Primary Care Perspective on Gout

2016 ◽  
Vol 9 (1) ◽  
pp. 27-34
Author(s):  
Eva Rimler ◽  
Jennifer Lom ◽  
Jason Higdon ◽  
Dominique Cosco ◽  
Danielle Jones
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Hospital Admissions ◽  
Primary Care Providers ◽  
Treat To Target ◽  
Care Providers ◽  
Work Related ◽  
Treat All ◽  
Care Costs

Gout causes patients’ significant morbidity, work-related disability, loss of productivity, increased health care costs, and even all-cause hospital admissions. As a result, primary care providers must be armed with the knowledge to properly diagnose and manage gout. While many aspects of care remain the same, some key updates that primary care providers must consider when treating their patients with gout will be discussed. In this perspective we will highlight and discuss acceptable circumstances for empiric treatment, renewed emphasis on treat to target, access to commonly used medications, recommended first line agents, and the role of primary care physicians in gout flare prevention among other topics. These strategies will aid primary care physicians treat all but the most complex cases of gout.

When should a PCP refer a patient with pustular psoriasis to a dermatologist?

2021 ◽  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Pustular Psoriasis ◽  
Care Providers

This video guide for primary care providers describes the reasons for referring patients with pustular psoriasis to the dermatologist and the role of the dermatologist in managing patients with pustular psoriasis.

Shaping the Next Generation of Providers

2019 ◽  
pp. 457-464
Author(s):  
Gerri Mattson ◽  
Karen Remley
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Clinical Medicine ◽  
Collaborative Work ◽  
Well Being ◽  
Primary Care Providers ◽  
Care Providers ◽  
Health Community ◽  
Changing Role

This chapter is about the changing role of the primary carer in the health setting with a particular focus on the training of primary carers. Primary care providers are already increasingly called on to expand their practice beyond their traditional knowledge and skills in clinical medicine. The chapter looks at the population health competency of primary health carers. Primary care providers, once trained, in the community can serve as mentors for trainees, which can provide additional perspective and experience outside of the academic setting. The chapter goes on to argue that the health and well-being of the entire community are dependent on the collaborative work of health care providers, public health, community organizations, faith-based organizations, and the community itself. Understanding the myriad connections, competencies, and impacts of these partnerships allows clinicians to engage with the community early in their careers; to deepen their engagement, understanding, and ability over time; and to be effective advocates with and on behalf of the communities they serve.

scholarly journals Matching Inhaler Devices with Patients: The Role of the Primary Care Physician

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Alan Kaplan ◽  
David Price
Keyword(s):  
Primary Care ◽  
Treatment Success ◽  
Primary Care Providers ◽  
Care Physician ◽  
Chronic Obstructive ◽  
Inhaler Technique ◽  
Care Providers ◽  
Obstructive Pulmonary Disease ◽  
Inhaler Devices

Poor inhaler technique and nonadherence impair the efficacy of medications for asthma and chronic obstructive pulmonary disease (COPD). A range of factors, including age, dexterity, inspiratory capacity, cognitive ability, health literacy, and ethnicity, can impact a patient’s ability and intention to use their device. Treatment success can also be influenced by patient preferences and perceptions. Therefore, it is important that healthcare professionals effectively match inhaler devices to individual patients’ needs and abilities and empower patients by including them in treatment decisions. Physicians must, therefore, fully understand the characteristics of each device, as well as their patients’ demographic characteristics and comorbidities. Following device selection, patient training and education, including a physical demonstration of the device, are key to eliminate any critical errors that may impact on health outcomes. Inhaler technique should be frequently rechecked. This review will examine the important role of primary care providers in the selection of appropriate inhaler devices and provision of training for patients with COPD and asthma to optimize correct inhaler use and adherence. An overview of the key features of available devices and of the factors to consider when selecting devices will be provided in the context of current asthma and COPD guidelines.

scholarly journals Primary Care Provider Involvement in Thyroid Cancer Survivorship Care

2020 ◽  
Vol 105 (9) ◽  
pp. e3300-e3306 ◽  
Author(s):  
Archana Radhakrishnan ◽  
David Reyes-Gastelum ◽  
Brittany Gay ◽  
Sarah T Hawley ◽  
Ann S Hamilton ◽  
...  
Keyword(s):  
Primary Care ◽  
Thyroid Cancer ◽  
Cancer Survivorship ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
High Confidence ◽  
Neck Ultrasound

Abstract Context While prior research has examined how primary care providers (PCPs) can care for breast and colon cancer survivors, little is known about their role in thyroid cancer survivorship. Objective To understand PCP involvement and confidence in thyroid cancer survivorship care. Design/Setting/Participants We surveyed PCPs identified by thyroid cancer patients from the Georgia and LA SEER registries (n = 162, response rate 56%). PCPs reported their involvement in long-term surveillance and confidence in handling survivorship care (role of random thyroglobulin levels and neck ultrasound, and when to end long-term surveillance and refer back to the specialist). We examined: 1) PCP-reported factors associated with involvement using multivariable analyses; and 2) bivariate associations between involvement and confidence in handling survivorship care. Main Outcome Measures PCP involvement (involved vs not involved) and confidence (high vs low). Results Many PCPs (76%) reported being involved in long-term surveillance. Involvement was greater among PCPs who noted clinical guidelines as the most influential source in guiding treatment (OR 4.29; 95% CI, 1.56-11.82). PCPs reporting high confidence in handling survivorship varied by aspects of care: refer patient to specialist (39%), role of neck ultrasound (36%) and random thyroglobulin levels (27%), and end long-term surveillance (14%). PCPs reporting involvement were more likely to report high confidence in discussing the role of random thyroglobulin levels (33.3% vs 7.9% not involved; P < 0.01). Conclusions While PCPs reported being involved in long-term surveillance, gaps remain in their confidence in handling survivorship care. Thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation.

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