2.32 Moving Into a Higher Gear: The Most Recent Data on the CAP PC Program, a Multi-University Education and Collaborative Care Program for Primary Care Providers in New York State

2017 ◽  
Vol 56 (10) ◽  
pp. S188
Author(s):  
David L. Kaye ◽  
Victor Fornari ◽  
Michael A. Scharf ◽  
Wanda Fremont ◽  
Rachel Zuckerbrot ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Collaborative Care ◽  
New York State ◽  
Care Program ◽  
Primary Care Providers ◽  
University Education ◽  
Care Providers ◽  
York State

Estimating the Effect of the New York State Nurse Practitioners Modernization Act on Care Received by Medicaid Patients

2021 ◽  
pp. 152715442110181
Author(s):  
Edward Joseph Timmons ◽  
Conor Norris ◽  
Grant Martsolf ◽  
Lusine Poghosyan
Keyword(s):  
Primary Care ◽  
New York ◽  
Nurse Practitioners ◽  
New York State ◽  
Primary Care Providers ◽  
Care Providers ◽  
York State ◽  
More Care ◽  
Total Care ◽  
The Impact

The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. health care system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. New York State (NYS) changed its regulatory environment for NPs in 2015. We estimate the impact of expanded NP scope of practice (SOP) regulations in NYS on total care days received by Medicaid beneficiaries from 2015 to 2018 using a model derived from national historical data from 1999 to 2011. We used a longitudinal data policy analysis framework and a generalized difference-in-differences model to identify the effect of changes in NP SOP regulations on total care days. The model included controls for state income and unemployment rates. Our results suggest that the policy change increased total care days provided to patients, but that this difference was not statistically significant and became negligible after computing the number of days per beneficiary. In addition, our results suggest that had NYS moved to a full practice environment, more care days could have been provided to Medicaid patients, and this difference was found to be statistically significant. Our results suggest that states should adopt full NP SOP practice environments to realize measurable benefits of expanded NP SOP.

Lamotrigine and lithium in primary care psychiatric consultation: adoption and adverse effects

2020 ◽  
Author(s):  
James R Phelps ◽  
Olivia R Pipitone ◽  
Kenneth Squires ◽  
Jonathan D Bale
Keyword(s):  
Primary Care ◽  
Weight Gain ◽  
Adverse Effects ◽  
Collaborative Care ◽  
Bipolar Depression ◽  
Care Program ◽  
Primary Care Providers ◽  
Thyroid Stimulating Hormone ◽  
Care Providers ◽  
Psychiatric Consultation

Abstract Background The Collaborative Care Model of psychiatric consultation in primary care has improved outcomes for unipolar depression, but bipolar depressions are challenging for providers and consultants. Although lamotrigine and lithium are both first line medications for bipolar depression, their use in primary care has been declining over the last decade. Objective Our project aimed to quantify the frequency of and adoption of recommendations for lamotrigine and lithium, and their adverse effects, in a Collaborative Care program. Methods Chart review. Results For 620 depressed adult patients (Public Health Questionnaire, 9-item ≥10), lamotrigine and lithium were recommended by psychiatric consultant for 35% and 26% of patients, respectively; and when recommended, were prescribed by primary care providers 50% and 32% of the time, respectively. Eighty-four percent of lithium dosages were 600 mg or less; average serum level 0.32 mEq/l. In follow-up up to 6 months, lithium was associated with no more weight gain than lamotrigine; but 12% of patients receiving lithium had thyroid stimulating hormone increases exceeding the upper limit of normal, occurring in an average of 32 days after the initial prescription. Conclusions (i) In a Collaborative Care program of psychiatric consultation, recommendations for lamotrigine and lithium were very frequent. (ii) Adoption of these recommendations is variable, warranting further investigation. (iii) Like higher doses, low doses of lithium induced hypothyroidism (rapidly)—but not weight gain.

scholarly journals Relationship Between COVID-19 Cases and Vaccination Rates in New York State Counties

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Halle Cerio ◽  
Laura A. Schad ◽  
Telisa M. Stewart ◽  
Christopher P. Morley
Keyword(s):  
New York ◽  
Population Size ◽  
New York State ◽  
Primary Care Providers ◽  
Outcome Variable ◽  
Care Providers ◽  
York State ◽  
Vaccination Rates ◽  
County Population ◽  
The Impact

Introduction: Vaccines against SARS-CoV-2 have been developed with unprecedented speed. The phased introduction of vaccines may be serving to offset the impact of new viral variants and policy relaxation. In order to assess the impact of vaccination, we examined a snapshot of vaccination rates across counties in a single state, at a single time point, comparing them with population-adjusted case counts. Methods: We calculated descriptive statistics and bivariate correlations for vaccination rates and cases across counties in New York State (NYS). We conducted a linear regression using cases/100K population per NYS county, frozen at a single snapshot in time, as the outcome variable, predicted by percentage of each county’s population (completed series/two doses), controlling for county population. Results: Percentages with one dose and with two doses were highly correlated (r=.935, P<.001) with one another. Both the one dose and two dose z rates were negatively correlated with cases per 100K population (not significant). Population size was strongly correlated with cases per 100K (r=.715, P<.001). The two-dose vaccination rate was a significant negative predictor of cases per 100K population in NYS counties (β= -.866, P=.031), with each percentage point of completed vaccination nearly equating to one case less in the daily count when controlling for county population size (β =2.732, P<.001). Conclusion: While variants may impact vaccine effectiveness, current vaccination efforts are helping forestall some cases in NYS. Widespread vaccination is still an important goal. Primary care providers, public officials, and public health scientists should continue to urgently promote and support vaccination efforts.

Economic Grand Rounds: Incentives for Primary Care Providers to Participate in a Collaborative Care Program for Depression

2005 ◽  
Vol 56 (11) ◽  
pp. 1344-1346 ◽  
Author(s):  
Mitchell D. Feldman ◽  
Patricia A. Areán ◽  
Michael K. Ong ◽  
Deborah L. Lee ◽  
Saul Feldman
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Care Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Grand Rounds

scholarly journals Population-based implementation of behavioral health detection and treatment into primary care: Early data from New York State

2021 ◽  
Author(s):  
Deborah J. Bowen ◽  
Ashley Heald ◽  
Erin LePoire ◽  
Amy Jones ◽  
Danielle Gadbois ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
New York ◽  
Behavioral Health ◽  
Collaborative Care ◽  
Technical Assistance ◽  
New York State ◽  
Health Clinic ◽  
Initial Contact ◽  
York State

Abstract Background The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. Despite a robust evidence base, real world implementation of Collaborative Care has been limited and very slow. The goal of this analysis is to better understand the relationship between training, technical assistance, and implementation in the largest state-led Collaborative Care program in the nation—the New York State Collaborative Care Medicaid Program.Data are presented using the RE-AIM model, examining the proportion of clinics in each of the model’s five stages from 2014 to 2019.MethodsWe used the RE-AIM model to shape our data presentation, focusing on the proportion of clinics moving into each of the five stages of this model over the years of implementation. Data sources included: a New York State Office of Mental Health clinic tracking database, billing applications, quarterly reports, and Medicaid claims.ResultsA total lf 84% of clinics with which OMH had an initial contact [n = 611clinics (377 FQHCs and 234 non-FQHCs)] received some form of training and technical assistance. 51% went on to complete a billing application, 41% reported quarterly data at least once, and 20% were able to successfully bill Medicaid. 79% of clinics that reported data maintained Collaborative Care for one year or more. The receipt of any training and technical assistance was significantly associated with our implementation indices: (completed billing application, data reporting, billing Medicaid, and maintaining Collaborative Care). The average percent of patient improvement for depression and anxiety across 155 clinics that had at least one quarter of data was 44.81%. Training and technical assistance source (Office of Mental Health, another source, or both) and intensity (high/low) were significantly related to implementation indices and were observed in FQHC versus non-FQHC samples.ConclusionsOffering Collaborative Care training and technical assistance, particularly high intensity training and technical assistance, increases the likelihood of implementation. Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care.

scholarly journals Population-based implementation of behavioral health detection and treatment into primary care: early data from New York state

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Deborah J. Bowen ◽  
Ashley Heald ◽  
Erin LePoire ◽  
Amy Jones ◽  
Danielle Gadbois ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
New York ◽  
Behavioral Health ◽  
Collaborative Care ◽  
Technical Assistance ◽  
New York State ◽  
Health Clinic ◽  
Initial Contact ◽  
York State

Abstract Background The Collaborative Care Model is a well-established, evidence-based approach to treating depression and other common behavioral health conditions in primary care settings. Despite a robust evidence base, real world implementation of Collaborative Care has been limited and very slow. The goal of this analysis is to better describe and understand the progression of implementation in the largest state-led Collaborative Care program in the nation—the New York State Collaborative Care Medicaid Program. Data are presented using the RE-AIM model, examining the proportion of clinics in each of the model’s five steps from 2014 to 2019. Methods We used the RE-AIM model to shape our data presentation, focusing on the proportion of clinics moving into each of the five steps of this model over the years of implementation. Data sources included: a New York State Office of Mental Health clinic tracking database, billing applications, quarterly reports, and Medicaid claims. Results A total of 84% of clinics with which OMH had an initial contact [n = 611clinics (377 FQHCs and 234 non-FQHCs)] received some form of training and technical assistance. Of those, 51% went on to complete a billing application, 41% reported quarterly data at least once, and 20% were able to successfully bill Medicaid. Of clinics that reported data prior to the first quarter of 2019, 79% (n = 130) maintained Collaborative Care for 1 year or more. The receipt of any training and technical assistance was significantly associated with our implementation indices: (completed billing application, data reporting, billing Medicaid, and maintaining Collaborative Care). The average percent of patient improvement for depression and anxiety across 155 clinics that had at least one quarter of data was 44.81%. Training and technical assistance source (Office of Mental Health, another source, or both) and intensity (high/low) were significantly related to implementation indices and were observed in FQHC versus non-FQHC samples. Conclusions Offering Collaborative Care training and technical assistance, particularly high intensity training and technical assistance, increases the likelihood of implementation. Other state-wide organizations might consider the provision of training and technical assistance when assisting clinics to implement Collaborative Care.

“I felt useless”: a qualitative examination of COVID-19’s impact on home-based primary care providers in New York

2021 ◽  
pp. 1-15
Author(s):  
Ksenia Gorbenko ◽  
Emily Franzosa ◽  
Sybil Masse ◽  
Abraham A Brody ◽  
Orla Sheehan ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Primary Care Providers ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based

Impact of the New York State Prescription Drug Monitoring Program (IStop) on chronic pain management by primary care providers

2021 ◽  
Vol 17 (1) ◽  
pp. 39-54
Author(s):  
Josiah D. Strawser, MD ◽  
Lauren Block, MD, MPH
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Risk Reduction ◽  
New York State ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Objective: To explore the impact of the New York State Prescription Drug Monitoring Program (IStop) on the self-reported management of patients with chronic pain by primary care providers.Design: Mixed-methods study with survey collection and semistructured interviews.Setting: Multiple academic hospitals in New York.Participants: One hundred and thirty-six primary care providers (residents, fellows, attendings, and nurse practitioners) for survey collection, and eight primary care clinicians (residents, attending, and pharmacist) for interviews. Interventions: Introduction of IStop.Main outcome measure(s): Change in usage of four risk reduction strategies (pain contracts, urine tests, monthly visits, and co-management) as reported by primary care providers for patients with chronic pain.Results: After the introduction of IStop, 25 percent (32/128) of providers increased usage of monthly visits, 28 percent (36/128) of providers increased usage of pain management co-management with other healthcare providers, and 46 percent (60/129) of providers increased usage of at least one of four risk reduction strategies. Residents indicated much higher rates of change in risk reduction strategies due to IStop usage; increasing in the use of monthly visits (32 vs. 13 percent, p = 0.02) and co-management (36 vs. 13 percent, p = 0.01) occurred at a much higher rate in residents than attending physicians. Interview themes revealed an emphasis on finding opioid alternatives when possible, the need for frequent patient visits in effective pain management, and the importance of communication between the patient and provider to protect the relationship in chronic pain management.Conclusions: After the introduction of IStop, primary care providers have increased usage of risk reduction strategies in the care of chronic pain patients.

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