Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health Care Utilization

2021 ◽  
pp. 102551
Author(s):  
Marianne Simonsen ◽  
Lars Skipper ◽  
Niels Skipper ◽  
Peter Rønø Thingholm
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Primary Care Providers ◽  
Care Utilization ◽  
Care Practice ◽  
Care Providers ◽  
Patient Health

scholarly journals Association between Electronic Health Records and Health Care Utilization

2015 ◽  
Vol 06 (01) ◽  
pp. 42-55 ◽  
Author(s):  
A. Edwards ◽  
L.M. Kern ◽  
R. Kaushal ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Health Records ◽  
Health Care Utilization ◽  
Primary Care Providers ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

SummaryBackground: The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited.Objective: To determine any association between EHRs and health care utilization.Methods: We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multi-provider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics.Results: Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions.Conclusions: Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.Citation: Kaushal R, Edwards A, Kern LM, with the HITEC Investigators. Association between electronic health records and health care utilization. Appl Clin Inf 2015; 6: 42–55http://dx.doi.org/10.4338/ACI-2014-10-RA-0089

scholarly journals Primary health care policy and vision for community pharmacy and pharmacists in Indonesia

2020 ◽  
Vol 18 (3) ◽  
pp. 2085
Author(s):  
Andi Hermansyah ◽  
Luh Wulandari ◽  
Susi A. Kristina ◽  
Sherly Meilianti
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Community Pharmacy ◽  
Health Care Policy ◽  
Primary Care Providers ◽  
Good Evidence ◽  
Care Practice ◽  
Health Coverage ◽  
Care Providers ◽  
Care System

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.

scholarly journals A Systems-Wide Approach for Early Detection and Management of Dementia in Primary Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 346-346
Author(s):  
Annette Fitzpatrick ◽  
Basia Belza
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Signs And Symptoms ◽  
Primary Care Providers ◽  
Population Increase ◽  
Community Advisory Board ◽  
Care Practice ◽  
Care Providers ◽  
Cognitive Changes

Abstract Dementia is frequently unrecognized and under-reported by health care providers. The needs of an aging population increase the burden on an already over-worked primary care system that is often without the appropriate training, resources, and reimbursement to address the growing number of people with cognitive decline in the US. In this symposium we present a systems-wide approach within University of Washington (UW) Primary Care to increase awareness of early signs and symptoms, detection of cognitive impairment, and support of providers, patients and caregivers that will ultimately improve outcomes of care. This quality improvement (QI) program integrates stakeholder-selected components of the GSA KAER (Kickstart-Assess-Evaluate and Refer) Model and Toolkit (2020 Edition), developed by the Gerontological Society of America (GSA), into primary care practice. We describe content and logistics of a continuing education intervention for primary care providers and clinical staff to increase skills for evaluation and management of dementia. Working with UW clinic managers and information technology (IT), we have developed a pragmatic system for streamlining operations and documenting care utilizing newly developed interdisciplinary workflows and electronic health record order sets. Using input from our Community Advisory Board, we explain development of a web-based resource directory to be used in-clinic and at home to support providers, staff, patients, families, and caregivers across cognitive changes. Strategies presented here are aimed to help other health care systems initiate steps to integrate KAER and other tools into a practical QI program for improving detection and management of dementia through support of primary care.

scholarly journals Adolescents’ Views on Barriers to Health Care

2011 ◽  
Vol 3 (2) ◽  
pp. 99-103 ◽  
Author(s):  
Sylvia W. Lim ◽  
Rosy Chhabra ◽  
Ayelet Rosen ◽  
Andrew D. Racine ◽  
Elizabeth M. Alderman
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Health Services ◽  
Waiting Times ◽  
Primary Care Providers ◽  
Care Practice ◽  
Care Providers ◽  
Group Interviews ◽  
Key Barrier

Objectives: To determine from adolescents using health care their: 1) perceptions of barriers to obtaining health services, 2) views on how to overcome the barriers and 3) views on how to create an adolescent-friendly primary care practice. Design: Six focus group interviews. Methods: Adolescents 11-21 years old from three health centers in the Bronx were recruited. Main Outcome Measures: 1) barriers to accessing health care such as insurance, language barriers, transportation, making an appointment; 2) identifying barriers related to issues of consent and confidentiality; 3) exploring barriers to accessing mental health and related issues; and 4) their visions of an adolescent-friendly office. Results: Thirty-one adolescents, aged 11-21 years old, participated. The majority were Hispanic and 52% were female. Fifty percent of adolescents had a routine visit within the past month. Most adolescents reported experiencing barriers to making an appointment. Additionally, they complained about long waiting times to be seen by providers on the day of their scheduled appointment. Another key barrier was related to knowledge and perceptions about consent and confidentiality. Further, in regard to mental health, many adolescents from focus groups reported that they felt that their primary providers had little interest in this topic and limited knowledge about it. Most of the adolescents reported no barriers with insurance, language or transportation. Their visions of an adolescent-friendly office would include a separate adolescent waiting area equipped with entertainment units. Conclusion: In this study of adolescents who already have primary care providers and are seemingly well-connected to the health care system, there remained significant reported barriers to accessing necessary health services.

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A294
Author(s):  
Ivan Vargas ◽  
Alexandria Muench ◽  
Mark Seewald ◽  
Cecilia Livesey ◽  
Matthew Press ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Depression Symptoms ◽  
Care Providers ◽  
Mild Depression ◽  
Significant Depression ◽  
Clinically Significant

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI &lt; 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI&gt;14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

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