What Motivates Adolescent Behavior Change: A Content Analysis of Patient-Reported Strategies Delivered by Primary Care Providers

2018 ◽  
Vol 62 (2) ◽  
pp. S89 ◽  
Author(s):  
Heather Spielvogle ◽  
Adriana Arghira ◽  
Elsie Rockers ◽  
Carolyn McCarty ◽  
Laura Richardson
Keyword(s):  
Primary Care ◽  
Content Analysis ◽  
Behavior Change ◽  
Primary Care Providers ◽  
Adolescent Behavior ◽  
Care Providers ◽  
Patient Reported

scholarly journals Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks

2020 ◽  
Vol 4 ◽  
pp. 239920262092250
Author(s):  
Natalie Kennie-Kaulbach ◽  
Rachel Cormier ◽  
Olga Kits ◽  
Emily Reeve ◽  
Anne Marie Whelan ◽  
...  
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Behavior Change ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
System Level ◽  
Care Providers ◽  
Behavior Change Wheel ◽  
Primary Healthcare Providers

Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.

scholarly journals Training Primary Care Providers in the Use of Motivational Interviewing for Youth Behavior Change

2017 ◽  
Vol 31 (3) ◽  
pp. 219-232 ◽  
Author(s):  
Monique K. Vallabhan ◽  
Alberta S. Kong ◽  
Elizabeth Yakes Jimenez ◽  
Linda C. Summers ◽  
Conni J. DeBlieck ◽  
...  
Keyword(s):  
Primary Care ◽  
Nursing Education ◽  
Behavior Change ◽  
Motivational Interviewing ◽  
Nurse Practitioners ◽  
Primary Care Providers ◽  
Adolescent Obesity ◽  
Care Providers ◽  
Youth Behavior ◽  
Over Time

Background and Purpose: Adolescent obesity is a global epidemic. Motivational interviewing (MI) is a promising strategy to address adolescent obesity risk behaviors. However, primary care providers (PCPs) tend to express discomfort with learning and adopting MI practices and with addressing patient weight issues. PCP proficiency in using MI to discuss body mass index, health screening results, and nutrition and physical activity behaviors after receiving training and coaching from an MI expert and practicing the technique was evaluated. We hypothesized that comfort with MI would increase consistently over time. Methods: Self-assessment surveys in MI proficiency were administered to PCPs after every youth participant MI session. MI comfort as determined by proficiency was categorized into low, medium, and high comfort according to survey Likert scale responses. Data were analyzed using analysis of variance (ANOVA) and Fisher’s exact tests. Results: Two hundred twenty-seven youth were seen for MI-based discussions by 4 PCPs. Two hundred twenty-six surveys had complete data for analysis. As anticipated, overall PCPs reported significantly more comfort with MI from the first to the final MI session over a 2- to 3-month period (p < .001). Comfort scores did not increase linearly over time for all PCPs. Despite standard training practices, overall MI proficiency as measured by comfort scores varied by PCP (p < .01). Implications for Practice: This type of MI training program should be considered for clinical nurses and nurse practitioners during their nursing education training to facilitate their ability to consistently and effectively support youth behavior change for conditions such as obesity (ClinicalTrials.gov Number NCT02502383).

“There Are so Many Nuances . . . ”: Health Care Providers’ Perspectives of Pain Communication With Hmong Patients in Primary Care Settings

2020 ◽  
pp. 104365962095943
Author(s):  
Maichou Lor ◽  
David Rabago ◽  
Miroslav Backonja
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Content Analysis ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Limited English Proficiency ◽  
Qualitative Content Analysis ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pain Communication

Introduction While researchers have studied Hmong patients with limited English proficiency in pain communication, no research has examined primary care providers’ (PCPs’) interpretation of Hmong pain communication. This study examines PCPs’ pain communication experience with Hmong patients. Method A qualitative content analysis was conducted with PCPs. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Results Fifteen PCPs—including seven physicians, one osteopathic physician, four nurse practitioners, and three physician assistants—participated. PCPs’ interpretations of pain communication with Hmong patients were characterized by three themes: (a) the providers experienced pain communication problems related to language, (b) the providers perceived the Hmong to have different beliefs about pain, and (c) the providers used different strategies to improve communication. Discussion The findings suggest that challenges are present in achieving effective pain communication between Hmong patients and their PCPs. Ineffective pain communication hinders the delivery of culturally congruent health care for Hmong patients.

scholarly journals Feasibility of an Electronic Health Tool to Promote Physical Activity in Primary Care: Pilot Cluster Randomized Controlled Trial

10.2196/15424 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e15424
Author(s):  
Payal Agarwal ◽  
Natasha Kithulegoda ◽  
Zachary Bouck ◽  
Beth Bosiak ◽  
Ilana Birnbaum ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Patient Reported ◽  
Secondary Outcomes ◽  
Electronic Health ◽  
Cluster Randomized ◽  
And Control

Background Physical inactivity is associated with increased health risks. Primary care providers (PCPs) are well positioned to support increased physical activity (PA) levels through screening and provision of PA prescriptions. However, PCP counseling on PA is not common. Objective This study aimed to assess the feasibility of implementing an electronic health (eHealth) tool to support PA counseling by PCPs and estimate intervention effectiveness on patients’ PA levels. Methods A pragmatic pilot study was conducted using a stepped wedge cluster randomized trial design. The study was conducted at a single primary care clinic, with 4 pre-existing PCP teams. Adult patients who had a periodic health review (PHR) scheduled during the study period were invited to participate. The eHealth tool involved an electronic survey sent to participants before their PHR via an email or a tablet; data were used to automatically produce tailored resources and a PA prescription in the electronic medical record of participants in the intervention arm. Participants assigned to the control arm received usual care from their PCP. Feasibility was assessed by the proportion of completed surveys and patient-reported acceptability and fidelity measures. The primary effectiveness outcome was patient-reported PA at 4 months post-PHR, measured as metabolic equivalent of task (MET) minutes per week. Secondary outcomes assessed determinants of PA, including self-efficacy and intention to change based on the Health Action Process Approach behavior change theory. Results A total of 1028 patients receiving care from 34 PCPs were invited to participate and 530 (51.55%) consented (intervention [n=296] and control [n=234]). Of the participants who completed a process evaluation, almost half (88/178, 49.4%) stated they received a PA prescription, with only 42 receiving the full intervention including tailored resources from their PCP. A cluster-level linear regression analysis yielded a non–statistically significant positive difference in MET-minutes reported per week at follow-up between intervention and control conditions (mean difference 1027; 95% CI −155 to 2209; P=.09). No statistically significant differences were observed for secondary outcomes. Conclusions Our results suggest that it is feasible to build an eHealth tool that screens and provides tailored resources for PA in a primary care setting but suboptimal intervention fidelity suggests greater work must be done to address PCP barriers to resource distribution. Participant responses to the primary effectiveness outcome (MET-minutes) were highly variable, reflecting a need for more robust measures of PA in future trials to address limitations in patient-reported data. Trial Registration ClinicalTrials.gov NCT03181295; https://clinicaltrials.gov/ct2/show/NCT03181295

scholarly journals Use and Reported Helpfulness of Cannabinoids Among Primary Care Patients in Vermont

2020 ◽  
Vol 11 ◽  
pp. 215013272094695
Author(s):  
Nicole Wershoven ◽  
Amanda G. Kennedy ◽  
Charles D. MacLean
Keyword(s):  
Primary Care ◽  
Adult Population ◽  
Primary Care Providers ◽  
Medical Conditions ◽  
Care Providers ◽  
The Past ◽  
Number Of Patients ◽  
Patient Reported ◽  
Potential Benefits ◽  
Primary Care Patients

Introduction: While cannabis has been medically legal in Vermont since 2004 and recreationally legal since 2018 there has been minimal published research regarding the use and practices in the adult population. This gap in understanding results in primary care providers having difficulty navigating conversations surrounding cannabinoid use. The purpose of this research was to identify current use and perceptions of cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in adult primary care patients in Vermont. Methods: An anonymous written survey was given to 1009 Vermont primary care patients aged 18 years and older. All measures were patient-reported and included use of CBD and THC products, perceived helpfulness for certain medical conditions, knowledge of CBD and THC, perceived knowledge of their provider, and concerns regarding cannabis legalization. Results: 45% of adult primary care patients reported using cannabinoids in the past year. Only 18% of patients reported their provider as being a good source of information regarding cannabis. Of the patients who used cannabis in the past year, a majority reported it helpful for conditions such as anxiety and depression, arthritis, pain, sleep, and nausea. Conclusions: Primary care providers need to be knowledgeable about cannabinoids to best support patient care. In addition, with a significant number of patients reporting cannabinoids helpful for medical conditions common in primary care, it is important that research continue to identify the potential benefits and harms of cannabis.

scholarly journals Involvement of Primary Care Physicians in the Decision Making and Care of Patients With Breast Cancer

2016 ◽  
Vol 34 (33) ◽  
pp. 3969-3975 ◽  
Author(s):  
Lauren P. Wallner ◽  
Paul Abrahamse ◽  
Jaspreet K. Uppal ◽  
Christopher R. Friese ◽  
Ann S. Hamilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Treatment Decisions ◽  
Care Providers ◽  
Breast Cancer Care ◽  
Patient Reported

Purpose Collaborative care between cancer specialists and primary care providers (PCPs) may improve the delivery of high-quality cancer care. Yet, patient perspectives about how involved the PCPs were in their breast cancer care and treatment decisions remain unknown. Patients and Methods A weighted random sample of women newly diagnosed with breast cancer in 2013 to 2014, as reported to the SEER registries in Los Angeles, California, and Georgia, were sent a survey approximately 6 months after diagnosis (N = 2,279, 71% response rate). The distributions of patient-perceived PCP quality (six questions about PCP access and awareness of values) and the following three measures of patient-reported PCP involvement were assessed: how informed the respondent felt her PCP was about her breast cancer (engagement); how often the respondent talked with her PCP (communication); and how often the respondent felt the PCP participated in treatment decisions (participation). Adjusted mean scores of patient-reported satisfaction with and deliberation about the surgical treatment decision were then compared across levels of PCP engagement, communication, and participation using multivariable linear regression. Results The majority of women in this sample perceived high PCP quality (63.6%), high PCP breast cancer engagement (66.2%), and high PCP communication (69.1%). More than a third of women (35.4%) reported that their PCP participated in their treatment decisions. Higher PCP engagement was associated with higher decision satisfaction when compared with low PCP engagement (adjusted P = .003). Conclusion Patient perceptions of PCP quality and PCP involvement in breast cancer care during treatment are high for most women, and PCPs often participate in breast cancer treatment decisions. However, PCP involvement did not lead to meaningful improvements in patients’ appraisals of their decision making.

scholarly journals Pain Management of Budd Chiari Syndrome in the Primary Care Setting: A Case Study

2021 ◽  
Vol 12 (2) ◽  
pp. 19
Author(s):  
Pilar Z. Murphy ◽  
Jimiece Thomas ◽  
Taylor P. McClelland
Keyword(s):  
Primary Care ◽  
Abdominal Pain ◽  
Pain Management ◽  
Liver Injury ◽  
Treatment Options ◽  
Primary Care Providers ◽  
Care Providers ◽  
Budd Chiari Syndrome ◽  
Patient Reported ◽  
Chiari Syndrome

Introduction: Budd Chiari Syndrome (BCS) is a very rare disease affecting approximately 1 in 100,000 people in the general population.  It is caused by an obstruction of the hepatic veins leading to blood backing up in the liver. Treatment options to improve hepatic blood flow and relieve ascites are well documented. However, there are no established guidelines or treatment preferences for pain associated with BCS while patients are awaiting other treatment options.  Case: A 22-year-old African American female was diagnosed with Budd Chiari Syndrome.  The initial attempt at a transjugular intrahepatic portosystemic shunt (TIPS) procedure failed.  While awaiting a second attempt at the procedure, the patient presented to her primary care provider complaining of abdominal and right upper quadrant pain.  Treatment guidelines were searched for acute pain management options; however, no BCS pain management guidelines exist. Discussion: Individuals with BCS often present with abdominal pain, however, no guidelines outlining analgesic options in BCS exists.  Acetaminophen, NSAIDs, and opioids are commonly used prescription medications for moderate to severe pain.  Acetaminophen use was not considered due to acute liver injury and portal venous thrombosis.  Anticoagulation with apixaban prevented concurrent use with NSAIDs.  Opioid medications combined with acetaminophen were excluded to minimize exacerbating the liver injury.  Tramadol 25 mg was chosen due to its lower abuse profile than other opioid analgesics, and was initiated for pain management. Conclusion: The patient reported adequate pain control with tramadol, tolerated the medication with no complications, and underwent a successful TIPS procedure one month later.  Abdominal pain is a common symptom of BCS and needs to be effectively managed.  Guidelines on treating pain associated with BCS in the outpatient setting would improve quality of life for patients and provide guidance to primary care providers requiring direction on how to address pain associated with Budd Chiari Syndrome safely and adequately.

scholarly journals Exploring the perspectives of primary care providers on use of the electronic Patient Reported Outcomes tool to support goal-oriented care: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hardeep Singh ◽  
Farah Tahsin ◽  
Jason Xin Nie ◽  
Brian McKinstry ◽  
Kednapa Thavorn ◽  
...  
Keyword(s):  
Primary Care ◽  
Technology Acceptance ◽  
Digital Health ◽  
Primary Care Providers ◽  
External Factors ◽  
Perceived Usefulness ◽  
Behavioural Intention ◽  
Care Providers ◽  
Health Technologies ◽  
Patient Reported

Abstract Background Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and web portal designed to support goal-oriented care. To better understand implementation drivers and barriers primary care providers’ usage behaviours are compared to their perspectives on ePRO utility and fit to support care for patients with complex care needs. Methods This qualitative sub-analysis was part of a larger trial evaluating the use of the ePRO tool in primary care. Qualitative interviews were conducted with providers at the midpoint (i.e. 4.5–6 months after ePRO implementation) and end-point (i.e. 9–12 months after ePRO implementation) of the trial. Interviews explored providers’ experiences and perceptions of integrating the tool within their clinical practice. Interview data were analyzed using a hybrid thematic analysis and guided by the Technology Acceptance Model. Data from thirteen providers from three distinct primary care sites were included in the presented study. Results Three core themes were identified: (1) Perceived usefulness: perceptions of the tool’s alignment with providers’ typical approach to care, impact and value and fit with existing workflows influenced providers’ intention to use the tool and usage behaviour; (2) Behavioural intention: providers had a high or low behavioural intention, and for some, it changed over time; and (3) Improving usage behaviour: enabling external factors and enhancing the tool’s perceived ease of use may improve usage behaviour. Conclusions Multiple refinements/iterations of the ePRO tool (e.g. enhancing the tool’s alignment with provider workflows and functions) may be needed to enhance providers’ usage behaviour, perceived usefulness and behavioural intention. Enabling external factors, such as organizational and IT support, are also necessary to increase providers’ usage behaviour. Lessons from this study advance knowledge of technology implementation in primary care. Trial registration Clinicaltrials.gov Identified NCT02917954. Registered September 2016, https://www.clinicaltrials.gov/ct2/show/study/NCT02917954

scholarly journals The provider perspective: investigating the effect of the Electronic Patient-Reported Outcome (ePRO) mobile application and portal on primary care provider workflow

2017 ◽  
Vol 19 (02) ◽  
pp. 151-164 ◽  
Author(s):  
Parminder K. Hans ◽  
Carolyn Steele Gray ◽  
Ashlinder Gill ◽  
James Tiessen
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Mobile Application ◽  
Primary Care Providers ◽  
Patient Reported Outcome ◽  
Care Providers ◽  
Care Plans ◽  
Patient Reported ◽  
Patient Reported Measures

AimThis qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows.BackgroundThe Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows.MethodsOver a six-week period interdisciplinary primary care providers (n=6) and their complex care patients (n=12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015.FindingsKey issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to be addressed. New models and technologies cannot be disruptive in an environment that is resisting change.

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