PCV41 PATIENT EDUCATION AND ADHERENCE AND HYPERTENSION CONTROL IN TWO ACADEMIC MEDICAL CENTER PRIMARY CARE PRACTICES

Introduction: Hospitalists have been shown to have shorter lengths of stays than physicians with concurrent outpatient practices. However, hospitalists at academic medical centers may be less aware of local resources that can support the hospital to home transition for local primary care patients. We hypothesized that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical center. Methods: A retrospective cohort study was conducted at an academic medical center with a department of family medicine providing primary care to over 80 000 local patients. A total of 3100 consecutive family medicine patients admitted to either the family medicine inpatient service or a general medicine inpatient service over 3 years were studied. The primary outcome was length of stay, which was adjusted using multivariate linear regression for demographics, prior utilization, diagnosis, and disease severity. Results: Adjusted length of stay was 33% longer (95% CI 24%-44%) for local family medicine patients admitted to general medicine inpatient services as compared with the family medicine inpatient service. Readmission rates within 30 days were not different (19% vs 16%, P = .14). Conclusions: Local primary care patients were safely discharged from the hospital sooner on the family medicine inpatient service than on general medicine inpatient services. This is likely because the family physicians staffing their inpatient service are more familiar with outpatient resources that can be effectively marshaled to help local patients with the transition from hospital to home.

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Predictors of Primary Care Referral to Bariatric Surgery or Weight Loss Medicine at a Major Academic Medical Center

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.055 ◽

2020 ◽

Vol 231 (4) ◽

pp. S27-S28

Author(s):

Jacob Nudel ◽

Susanna W.L. de Geus ◽

Jayakanth Srinivasan ◽

Jonathan Woodson ◽

Donald Thomas Hess

Keyword(s):

Bariatric Surgery ◽

Primary Care ◽

Weight Loss ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical

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The Evolving Role of Medical Assistants in Primary Care Practice: Divergent and Concordant Perspectives from MAs and Family Physicians

Medical Care Research and Review ◽

10.1177/1077558720966148 ◽

2020 ◽

pp. 107755872096614

Author(s):

Erin P. Fraher ◽

Allison Cummings ◽

Dana Neutze

Keyword(s):

Primary Care ◽

Patient Education ◽

Population Health ◽

Low Cost ◽

Family Physicians ◽

Direct Patient Care ◽

Care Practice ◽

Medical Assistants ◽

Care Practices ◽

Primary Care Practices

Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their perspectives about MA roles, training, and confidence in performing activities related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. For most activities, we did not find evidence of role confusion between MAs and physicians, physician resistance to delegate tasks to properly trained MAs, or MA reluctance to pursue training to take on new roles. Three areas emerged where the gap between the potential and actual implementation of MA role transformation could be narrowed—population health and panel management; patient education, coaching, and counseling; and scribing. Closing these gaps will become increasingly important as our health care system moves toward value-based models of care.

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Starting a Clinic for Transgender Youth in an Academic Medical Center: Applications of the Primary Care Medical Home Model

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2013.10.124 ◽

2014 ◽

Vol 54 (2) ◽

pp. S55-S56

Author(s):

Katherine Blumoff Greenberg ◽

Richard Kreipe ◽

Cheryl Kodjo ◽

Mandy Coles

Keyword(s):

Primary Care ◽

Medical Home ◽

Medical Center ◽

Academic Medical Center ◽

Transgender Youth ◽

Academic Medical ◽

Medical Home Model ◽

Primary Care Medical Home

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864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1059 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S523-S524

Author(s):

Genevieve Allen ◽

Jamie Riddell

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Family Medicine ◽

Hiv Testing ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Providers ◽

Care Providers ◽

Academic Medical ◽

Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

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Approaches to shared decision-making for PSA screening in primary care practice.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.33 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 33-33

Author(s):

Cara B Litvin ◽

Steven M. Ornstein ◽

Lynne Nemeth

Keyword(s):

Prostate Cancer ◽

Primary Care ◽

Decision Making ◽

Patient Education ◽

Shared Decision Making ◽

Prostate Cancer Screening ◽

Shared Decision ◽

Psa Screening ◽

Care Practices ◽

Primary Care Practices

33 Background: In April 2017, the United States Preventive Services Task Force published a draft statement recommending that clinicians inform men ages 55 to 65 about the potential benefits and harms of prostate-specific antigen (PSA)-based screening for prostate cancer. The HIT-OVERUSE study is an ongoing 2 year group randomized study in 20 primary care practices to test a practice-based intervention to reduce overuse, including avoidance of routine PSA screening without shared decision making. The purpose of this report is to present qualitative findings about approaches participating practices have adopted to facilitate shared decision-making for PSA screening. Methods: Eleven practices in ten states randomized to the HIT-OVERUSE intervention group have hosted on-site visits for academic detailing and participatory planning and sent two practice representatives to a one day meeting to share ‘best practices.’ Detailed notes from site visits, follow-up emails, and the ‘best practice’ meeting were reviewed to identify strategies adopted by practices to facilitate shared decision-making for PSA screening for prostate cancer screening. Results: All practices adopted at least one strategy to promote shared-decision making for PSA screening. Four practices removed standing orders for routine PSA screening. Four practices educated their clinical staff about the test; three developed scripts for staff to use when asked by patients about the test. Six practices began using patient education handouts about PSA screening. One provider started showing a brief YouTube video with patients, while another practice developed a slide show to show in the waiting room. Most providers in nearly all practices reported modifying their conversation about PSA screening with patients to include some discussion about the benefits and the harms of screening. Conclusions: Primary care practices participating an intervention to reduce overuse have adopted varied approaches to facilitate shared-decision making for prostate cancer screening. While having face-to-face conversations is one approach, other strategies may employ staff or utilize patient education or videos to convey the benefits and harms of screening.

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Responding to SUPPORT: An Academic Medical Center Examines Its End-of-Life Care Practices

Journal of Pain and Symptom Management ◽

10.1016/s0885-3924(00)00257-8 ◽

2001 ◽

Vol 21 (2) ◽

pp. 121-128 ◽

Cited By ~ 2

Author(s):

Nancy Dendaas ◽

Teresa A Pellino ◽

Kate Ford Roberts ◽

James Cleary

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Medical Center ◽

Academic Medical Center ◽

Life Care ◽

Academic Medical ◽

Care Practices

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Integrating education into primary care quality and cost improvement at an academic medical center

Journal of Continuing Education in the Health Professions ◽

10.1002/chp.80 ◽

2006 ◽

Vol 26 (4) ◽

pp. 268-284 ◽

Cited By ~ 6

Author(s):

R. Van Harrison ◽

Connie J. Standiford ◽

Lee A. Green ◽

Steven J. Bernstein

Keyword(s):

Primary Care ◽

Medical Center ◽

Academic Medical Center ◽

Care Quality ◽

Academic Medical ◽

Primary Care Quality

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Enhancing Pediatricians’ Behavioral Health Competencies Through Child Psychiatry Consultation and Education

Clinical Pediatrics ◽

10.1177/0009922817738330 ◽

2017 ◽

Vol 57 (8) ◽

pp. 958-969 ◽

Cited By ~ 4

Author(s):

Heather J. Walter ◽

Gina Kackloudis ◽

Emily K. Trudell ◽

Louis Vernacchio ◽

Jonas Bromberg ◽

...

Keyword(s):

Primary Care ◽

Learning Community ◽

Behavioral Health ◽

Self Efficacy ◽

Large Scale ◽

Medical Center ◽

Academic Medical Center ◽

Child And Adolescent Psychiatry ◽

Academic Medical ◽

Primary Care Practitioners

The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care. After participation in the program, nearly all PCPs believed that mild to moderate presentations of common BH problems can be effectively managed in the primary care setting, and PCP consultation utilization was congruent with that belief.

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