Technology and Primary Care in the United States: A Challenge for Technology Assessment

1989 ◽  
Vol 5 (1) ◽  
pp. 9-19
Author(s):  
Donald A. Young ◽  
Wayne I. Roe ◽  
Michael J. Strauss
Keyword(s):  
United States ◽  
Primary Care ◽  
Technological Change ◽  
Technology Assessment ◽  
Medical Technology ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers

This article examines technology in primary care and its implications for technology assessment. Following an overview of the primary care setting and the importance of medical technology to primary care providers, the article identifies the new decisionmakers in medicine who both direct and respond to technological change in primary care, focusing, in particular, on their needs for information on primary care technologies. Furthermore, new methodologic issues for technology assessors are posed and examined. Finally, the authors offer conclusions about the need for changes in technology assessment and speculate about its future in primary care.

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

scholarly journals Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

2021 ◽  
Vol 10 ◽  
pp. 216495612110233
Author(s):  
Malaika R Schwartz ◽  
Allison M Cole ◽  
Gina A Keppel ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Knowledge ◽  
Care Delivery ◽  
Primary Care Providers ◽  
The United States ◽  
Research Network ◽  
Care Providers ◽  
Integrative Health ◽  
And Training

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

Abstract P720: Primary Stroke Prevention by Primary Care Providers: An Unmet Need

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raymond Reichwein ◽  
Alicia Richardson ◽  
Cesar Velasco
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Primary Prevention ◽  
Care Setting ◽  
Stroke Risk ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Large Vessel ◽  
Care Providers ◽  
Stroke Risk Factors

Introduction: The majority of patients who present with acute ischemic stroke (AIS) have known stroke risk factors which are not optimally managed. It has been suggested that a CHADS-VASC score can assist with primary prevention by calculating future stroke risk. This however, has not been widely adapted in the primary care setting. Methods: From 2018-2019, 686 AIS patients were included in retrospective analysis. Data elements included: historical stroke risk factors, historical CHADS-VASC score, antiplatelet/anticoagulant use at time of presentation, discharge location, and mRS. Results: Of the 686 AIS patients, 77% were age > 60, and 52% were male. Etiology subtypes were small vessel/lacunar 20%, large vessel 22%, cardioembolic 20%, undetermined 31% (cryptogenic 15%), and other determined 5%. On presentation, the majority of patients had 2 or more stroke risk factors and a calculated historical CHADS-VASC score > 2 (Table 1). Over half of the patients with large vessel or small vessel/lacunar etiology were not on any antiplatelets and 53% of patients with known history of atrial fibrillation weren’t on anticoagulants. Forty-nine percent of patients had a mRS > 3 at discharge. Conclusion: Patients with several stroke risk factors are sub optimally managed by primary care providers. Primary prevention education for PCPs in management of higher stroke risk individuals and additional analysis of the CHADS-VASC tool for this setting is needed. If widely adapted, this tool may prevent strokes by providing adequate risk reduction in the primary care setting.

Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review

2019 ◽  
Vol 77 (5) ◽  
pp. 387-401 ◽  
Author(s):  
Cilgy M. Abraham ◽  
Katherine Zheng ◽  
Lusine Poghosyan
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Organizational Level ◽  
Care Practice ◽  
Practice Environment ◽  
Care Providers ◽  
Cross Sectional ◽  
Study Designs

Primary care providers (PCPs) in the United States work in challenging environments and may be at risk for burnout. This article identifies the predictors and outcomes of burnout among PCPs in the United States. A comprehensive literature search of eight databases was conducted to identify studies investigating predictors or outcomes of PCP burnout. The Joanna Briggs Institute’s critical appraisal checklists for cross-sectional and cohort studies were used for quality appraisal. Overall, 21 studies met inclusion criteria, had sufficient quality, reported personal and/or organizational predictors of burnout, and described burnout outcomes at the patient, provider, or organizational level. Prevalence of PCP burnout ranged from 13.5% to 60%. The primary care practice environment was the most common predictor of PCP burnout. In conclusion, developing interventions to improve the practice environment may help reduce PCP burnout. Future studies using robust study designs and standardized instruments to consistently measure burnout are needed.

scholarly journals Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting

2020 ◽  
Vol 38 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Rebecca M. Crimmins ◽  
Lydia Elliott ◽  
Darren T. Absher
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Palliative Care ◽  
Patient Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Cochrane Library ◽  
Care Providers ◽  
Communication Time

Context: Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. Objectives: The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. Methods: An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. Results: Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. Conclusion: The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.

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