“I didn't feel like a number”: The impact of nurse care managers on the provision of buprenorphine treatment in primary care settings

2021 ◽  
pp. 108633
Author(s):  
Nisha Beharie ◽  
Marissa Kaplan-Dobbs ◽  
Adelya Urmanche ◽  
Denise Paone ◽  
Alex Harocopos
Keyword(s):  
Primary Care ◽  
Nurse Care ◽  
Primary Care Settings ◽  
Care Managers ◽  
The Impact ◽  
Buprenorphine Treatment

scholarly journals The Effects of Heatwaves on Human Morbidity in Primary Care Settings: A Case-Crossover Study

2022 ◽  
Vol 19 (2) ◽  
pp. 832
Author(s):  
Mahmoud Alsaiqali ◽  
Katrien De Troeyer ◽  
Lidia Casas ◽  
Rafiq Hamdi ◽  
Christel Faes ◽  
...  
Keyword(s):  
Primary Care ◽  
Crossover Study ◽  
Respiratory Infection ◽  
Respiratory Infections ◽  
Infection Risk ◽  
Incidence Density ◽  
Acute Effects ◽  
Primary Care Settings ◽  
Case Crossover ◽  
The Impact

Purpose: This study assesses the potential acute effects of heatwaves on human morbidities in primary care settings. Methods: We performed a time-stratified case-crossover study to assess the acute effects of heatwaves on selected morbidities in primary care settings in Flanders, Belgium, between 2000 and 2015. We used conditional logistic regression models. We assessed the effect of heatwaves on the day of the event (lag 0) and X days earlier (lags 1 to X). The associations are presented as Incidence Density Ratios (IDR). Results: We included 22,344 events. Heatwaves are associated with increased heat-related morbidities such as heat stroke IDR 3.93 [2.94–5.26] at lag 0, dehydration IDR 3.93 [2.94–5.26] at lag 1, and orthostatic hypotension IDR 2.06 [1.37–3.10] at lag 1. For cardiovascular morbidities studied, there was only an increased risk of stroke at lag 3 IDR 1.45 [1.04–2.03]. There is no significant association with myocardial ischemia/infarction or arrhythmia. Heatwaves are associated with decreased respiratory infection risk. The IDR for upper respiratory infections is 0.82 [0.78–0.87] lag 1 and lower respiratory infections (LRI) is 0.82 [0.74–0.91] at lag 1. There was no significant effect modification by age or premorbid chronic disease (diabetes, hypertesnsion). Conclusion: Heatwaves are associated with increased heat-related morbidities and decreased respiratory infection risk. The study of heatwaves’ effects in primary care settings helps evaluate the impact of heatwaves on the general population. Primary care settings might be not suitable to study acute life-threatening morbidities.

scholarly journals The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 113
Author(s):  
Mo Chen ◽  
Tejal Patel ◽  
Feng Chang
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Family Health ◽  
Primary Care Settings ◽  
Pain Intervention ◽  
Family Health Team ◽  
The Impact

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists’ extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.

scholarly journals Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

2010 ◽  
Vol 2 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Olawale O. Ogunsemi ◽  
Francis A. Oluwole ◽  
Festus Abasiubong ◽  
Adebayo R. Erinfolami ◽  
Olufemi E. Amoran ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Primary Health ◽  
Patient Health ◽  
The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

scholarly journals Antidepressant Medication Use Among Patients with Depression: Comparison between Usual Care and Collaborative Care Using Care Managers

2013 ◽  
Vol 9 (1) ◽  
pp. 84-87 ◽  
Author(s):  
Ramona S DeJesus ◽  
Kurt B Angstman ◽  
Stephen S Cha ◽  
Mark D Williams
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Antidepressant Medication ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Care Managers ◽  
Significant Difference ◽  
Depression Management ◽  
Treatment Improvement

Depression poses a significant economic and health burden, yet it remains underdiagnosed and inadequately treated. The STAR*D trial funded by the National Institute of Mental Health showed that more than one antidepressant medication is often necessary to achieve disease remission among patients seen in both psychiatric and primary care settings. The collaborative care model (CCM), using care managers, has been shown to be effective in numerous studies in achieving sustained outcomes in depression management compared to usual care. This model was adopted in a statewide depression treatment improvement initiative among primary care clinics in Minnesota, which was launched in March 2008. In this study, records of patients who were enrolled in CCM from March 2008 until March 2009 were reviewed and compared to those under usual care. Patients who were followed under the CCM had a significantly greater number of antidepressant medication utilizations when compared to those under usual care. After 6 months, mean PHQ-9 score of patients under CCM was statistically lower than those in usual care. There was no significant difference in both mean PHQ-9 scores at 6 months and antidepressant utilization between the 2 groups among patients aged 65 years and older.

scholarly journals The Impact of Pharmacist Care on Diabetes Outcomes in Primary Care Settings: An Umbrella Review of Systematic Reviews

2020 ◽  
Author(s):  
Sara Hamdi Abdulrhim ◽  
Sownd Sankaralingam ◽  
Mohamed Izham
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Systematic Reviews ◽  
Diabetes Care ◽  
Economic Outcomes ◽  
Diabetes Outcomes ◽  
Primary Care Settings ◽  
Pharmacist Interventions ◽  
The Impact ◽  
Pharmacist Care

Objective: To systematically review published systematic reviews (SRs) examining the impact of pharmacist interventions in multidisciplinary diabetes care teams on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Methods: PubMed, EMBASE, Scopus, Database of Abstracts of Reviews of Effects, Cochrane Library, Joanna Briggs Institute (JBI) Database, Google Scholar, and PROSPERO were searched from inception to 2018. Studies published in English evaluating the effect of pharmacist interventions on diabetes outcomes were included. Two independent reviewers were involved in the screening of titles and abstracts, selection of studies, and methodological quality assessment. Results: Seven SRs were included in the study. Three of them included only randomized controlled trials, while the rest involved other study designs. Educational interventions by clinical pharmacists within the healthcare team were the most common types of interventions reported across all SRs. Pharmacist’s interventions compared to usual care resulted in favorable significant improvements in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, body mass index, total cholesterol, lowdensity lipoprotein, high-density lipoprotein and triglycerides in more than 50% of the SRs. Improvement in HbA1c was the mostly reported clinical outcome of pharmacist intervention in the literature (reported in six SRs). Pharmacist’s interventions led to significant cost-saving ($8–$85,000 per person per year), cost-utility, and cost-benefit (benefit-to-cost ratio range from 1:1 to 8.5:1) versus usual care. Pharmacist’s interventions improved patients’ quality of life (QoL) in three SRs; however, no conclusion can be drawn due to the use of diverse QoL assessment tools. Conclusion: Most SRs support the benefit of pharmacist care on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Improvements in diabetes outcomes can significantly reduce the burden of diabetes on the healthcare system. Hence, the incorporation of pharmacists into multidisciplinary diabetes care teams is beneficial and should be strongly considered by clinicians and health policymakers.

scholarly journals Impact of Interprofessional Primary Care Practice on Patient Outcomes: A Scoping Review

SAGE Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 215824402093589
Author(s):  
Livia R. M. McCutcheon ◽  
Stuart T. Haines ◽  
Ruta Valaitis ◽  
Deborah A. Sturpe ◽  
Grant Russell ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Primary Care Practice ◽  
Collaborative Practice ◽  
Economic Outcomes ◽  
Future Research ◽  
Care Practice ◽  
Interprofessional Collaborative Practice ◽  
Primary Care Settings ◽  
The Impact

Systematic reviews have provided some insight into the impact of interprofessional collaborative practice on patient outcomes. Despite strong interest in interprofessional collaborative practice, relatively little is known about its impact in primary care settings. This scoping literature review describes the essential elements of an interprofessional primary care practice and explores what is known about its impact on patient care including clinical, humanistic, and economic outcomes. We completed a review of the literature examining the breadth of knowledge related to interprofessional collaborative practice in primary care settings. A search was conducted to identify studies based on predefined criteria. A total of 51 studies met the criteria. A total of 27 studies reported a significantly positive clinical outcome with the interprofessional collaborative practice model, 27 studies reported no difference, and one study reported negative outcome in mortality. A total of 15 studies reported a significantly positive humanistic outcome. There was little to no difference in economic outcomes. This study provides new insights for future research that examines the impact of interprofessional primary care practice.

scholarly journals Prevalence of depressive symptoms in urban primary care settings: Botswana

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Keneilwe Motlhatlhedi ◽  
Keneilwe Molebatsi ◽  
Grace N. Wambua
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Economic Status ◽  
Capital City ◽  
Chi Square ◽  
Missed Opportunities ◽  
Primary Care Settings ◽  
Care Facilities ◽  
Patient Health ◽  
The Impact

Background: The prevalence of depression is estimated to be high in primary care settings, especially amongst people with chronic diseases. Early identification and management of depression can improve chronic disease outcomes and quality of life, however, there are many missed opportunities in primary care.Aim: This study aimed to determine the prevalence and correlates of depression and depressive symptoms in two urban primary care settings.Setting: The study was conducted at two primary care facilities in the capital city of Botswana.Methods: We administered a demographic questionnaire and the Patient Health Questionnaire-9 (PHQ-9) to adults attending two primary care facilities. The association between depressive symptoms and demographic variables was determined using Chi-square; level of significance was set at 0.05. We carried out a multivariate analysis using Kruskal-Wallis test to determine the association between demographic characteristics and depression.Results: A sample of 259 participants were recruited (66.8% women, median age 32). The mean PHQ-9 score was 8.71. A total of 39.8% of participants screened positive for depression at a cut-off of 9.0% and 35.1% at a cut-off of 10. Depressive symptoms were significantly associated with employment status and income using the Kruskal-Wallis test, χ2 (1) = 5.649, p = 0.017.Conclusion: The high rates of depressive symptoms amongst the study population highlight the need for depression screening in primary care settings. The association between unemployment and income underscore the impact of socio-economic status on mental health in this setting.

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