Identifying Dementia in the Primary Care Practice

2000 ◽  
Vol 12 (4) ◽  
pp. 483-493 ◽  
Author(s):  
Paul R. Solomon ◽  
Michael Brush ◽  
Vivian Calvo ◽  
Felicity Adams ◽  
Richard D. DeVeaux ◽  
...  
Keyword(s):  
Primary Care ◽  
Negative Predictive Value ◽  
Random Sample ◽  
Predictive Value ◽  
Primary Care Practice ◽  
Diagnostic Evaluation ◽  
Care Practice ◽  
Test Retest Reliability ◽  
Cognitive Problems

Background: The purpose of this study was to evaluate the utility (i.e., positive and negative predictive value) of the 7 Minute Screen in identifying patients with probable Alzheimer's disease (AD) in a primary care practice. A second objective was to estimate the number of undiagnosed AD patients in a typical primary care practice. Methods: One hundred thirty-seven successive admissions (96%) of patients over the age of 60 to a primary care practice over a 53-day period who completed informed consent documents were administered the 7 Minute Screen. All patients who screened positive (n = 13) and a random sample of those who screened negative (n = 26) returned for full diagnostic evaluation. Positive predictive value (PPV) and negative predictive value (NPV) of the 7 Minute Screen were determined using the criterion standard of clinical diagnosis established by examination, history, and laboratory studies. Test-retest reliability and time for administration were also determined. Results: Of the 137 patients evaluated, 13 screened positive and 124 screened negative. Eleven of the 13 patients who screened positive were willing to return to the primary care practice for follow-up evaluation. A random sample of 26 patients who screened negative all agreed to return for follow-up evaluation. Of the 11 patients who screened positive who returned for evaluation, 10 were subsequently diagnosed with probable AD. The remaining patient was diagnosed with mixed dementia. The caregivers of the two patients who refused to return were contacted and both indicated that the patients were having significant cognitive problems as verified by an activities of daily living scale. Of the 26 patients who screened negative, 25 were judged to be cognitively normal and the 26th was judged to have mild cognitive impairment. Discussion: In successive admissions of patients over the age of 60 in a primary care practice, the 7 Minute Screen showed a PPV of 91% and an NPV of 96% in identifying patients who were subsequently identified with AD or other dementing disorder. These data suggest that this may be a useful instrument in identifying patients who should undergo diagnostic evaluation for AD and other dementing disorders. Additionally, extrapolation from the data in this practice suggests that there may be between 75 and 100 AD patients in the typical primary care practice, many of whom may not be diagnosed.

Follow-up of 100 dogs with acute diarrhoea in a primary care practice

2014 ◽  
Vol 199 (1) ◽  
pp. 188-190 ◽  
Author(s):  
C.M. Berset-Istratescu ◽  
O.J. Glardon ◽  
I. Magouras ◽  
C.F. Frey ◽  
S. Gobeli ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Acute Diarrhoea ◽  
Care Practice

scholarly journals Call your doctor: prospective description study of telemedicine during the first COVID-19 outbreak in a Swiss primary care practice

2020 ◽  
Author(s):  
Joëlle Suillot ◽  
Sophie Zuercher ◽  
Lydie Zufferey ◽  
Julien Sagez
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Care Practice ◽  
Emergency Services ◽  
Phone Call ◽  
Categorical Variables ◽  
Care Practice ◽  
Or Groups ◽  
Swiss Primary Care

Abstract Background: Telemedicine is a healthcare assistance method which has been promoted during the COVID-19 pandemic for the management of patients. The aim of this study is to quantify the type of request that primary care physicians are experiencing, as well as the healthcare assistance modalities and ultimately, how many physical consultations are necessary.Methods: We conducted a prospective, descriptive study in a primary care practice in Switzerland on telephone consultations related to COVID-19. The data collected included the reasons for the call, symptoms, healthcare assistance modalities and follow-up. The categorical variables are expressed as percentages of the total cases or groups.Results: We included 200 calls corresponding to 113 patients. The majority of patients (76.1%) were taken care of solely through telemedicine. The physical consultations were due to the need: for a swab test (12.4%), for a somatic assessment at the practice (9.7%) and for an emergency services consultation (1.8%). In 64.6% of cases, patient assistance required only one phone call. Calls lasted 7.85 minutes on average and were more frequent on Mondays (24%) and Fridays (18.5%). Calls led to the prescription of medication in 12.5% of cases, of a bronchodilator in 3% of cases and of an antibiotic in 0.5% of cases.Conclusion: A rigorous telephone follow-up strategy carried out by primary care physicians requires few physical consultations in patients showing symptoms of COVID-19.

Improving quality in general practice using the Primary Care Practice Improvement Tool (PC-PIT) with Primary Health Network support

2020 ◽  
Vol 26 (6) ◽  
pp. 484
Author(s):  
Samantha J. Borg ◽  
Maria Donald ◽  
Koula Totsidis ◽  
Narelle Quinn ◽  
Claire L. Jackson
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Care Home ◽  
Care Practice ◽  
Organisational Performance ◽  
Health Network ◽  
Practice Improvement ◽  
Primary Health ◽  
Primary Care Sector

Optimal primary care sector performance is vital for ensuring the delivery of quality health services and effective clinical management of populations. The Primary Care Practice Improvement Tool (PC-PIT) incorporates subjective staff input and objective indicators to measure 13 elements of organisational performance. This study aimed to measure change in organisational performance for general practices using the PC-PIT with Primary Health Network (PHN) support. A pre-post design was used for changes in PC-PIT subjective and objective scores. Practices used results with PHN support to complete two Plan Do Study Act initiatives and were reassessed 9-months later. PC-PIT scales were dichotomised into lower and higher scores, with odds ratios used to determine effect size. Staff survey response rates were 55.4% at baseline and 50.1% at follow up. There were modest increases in the likelihood of staff rating several elements higher at follow up. When implemented with PHN support staff, the PC-PIT has the potential for effective, focussed and sustained quality improvement, with capacity to support Health Care Home model transition and implementation.

Whose role is it? Primary care and the provision of emotional support for women experiencing miscarriage: a pilot qualitative Australian study

2020 ◽  
Vol 26 (5) ◽  
pp. 388
Author(s):  
Vellyna Sumarno ◽  
Meredith J. Temple-Smith ◽  
Jade E. Bilardi
Keyword(s):  
Primary Care ◽  
Emotional Support ◽  
Primary Care Practice ◽  
Care Practice ◽  
Health Issues ◽  
Structured Interviews ◽  
Self Blame ◽  
Physical Care

Miscarriage can cause significant psychological morbidity. Women frequently report dissatisfaction with healthcare professionals’ support following miscarriage. This pilot study aimed to explore the views and practices of GPs in providing emotional support to women experiencing miscarriage. Eight GPs participated in semi-structured interviews. GPs considered women’s physical care their top priority at the time of miscarriage; however, acknowledged miscarriage could result in significant emotional sequelae. Most GPs felt it was their role to provide emotional support, including expressing empathy, listening and normalising miscarriage to mitigate guilt and self-blame. GPs preferred an individualised approach to emotional support and mostly offered follow-up appointments if a patient requested it or was considered ‘high risk’ for mental health issues. Some GPs believed miscarriage support was within the scope of primary care practice; however, others felt it was the role of social networks and pregnancy loss support organisations. GPs identified several structural and external barriers that precluded enhanced emotional support. Further tools and resources to enhance support care may be of benefit to some GPs. The feasibility of GPs providing follow-up support remains uncertain. Further research is required to determine whether support is best placed within primary care or better served through external organisations.

scholarly journals eHealth-supported case management for patients with panic disorder or depression in primary care: Study protocol for a cRCT (PREMA)

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Karoline Lukaschek ◽  
◽  
Karola Mergenthal ◽  
Dirk Heider ◽  
Alexander Hanke ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Case Management ◽  
Cognitive Behaviour Therapy ◽  
Primary Care Practice ◽  
Care Practice ◽  
Behaviour Therapy ◽  
Treatment As Usual ◽  
Cognitive Behaviour

Abstract Background Panic disorder (PD), frequently occurring with agoraphobia (AG), and depression are common mental disorders in primary care and associated with considerable individual and societal costs. Early detection and effective treatment of depression and PD/AG are of major importance. Cognitive behavioural exposure exercises have been shown to be effective in reducing anxiety and depressive symptoms. Practice team-based case management can improve clinical outcomes for patients with chronic diseases in primary care. The present study aims at evaluating the effects and cost-effectiveness of a primary care team-based intervention using behavioural therapy elements and case management supported by eHealth components in patients with PD/AG or depression compared to treatment as usual. Methods/design This is a two-arm cluster-randomized, controlled trial (cRCT). General practices represent the units of randomisation. General practitioners recruit adult patients with depression and PD ± AG according to the International Classification of Diseases, version 10 (ICD-10). In the intervention group, patients receive cognitive behaviour therapy-oriented psychoeducation and instructions to self-managed exposure exercises in four manual-based appointments with the general practitioner. A trained health care assistant from the practice team delivers case management and is continuously monitoring symptoms and treatment progress in ten protocol-based telephone contacts with patients. Practice teams and patients are supported by eHealth components. In the control group, patients receive usual care from general practitioners. Outcomes are measured at baseline (T0), at follow-up after 6 months (T1), and at follow-up after 12 months (T2). The primary outcome is the mental health status of patients as measured by the Mental Health Index (MHI-5). Effect sizes of 0.2 standard deviation (SD) are regarded as relevant. Assuming a drop-out rate of 20% of practices and patients each, we aim at recruiting 1844 patients in 148 primary care practices. This corresponds to 12.5 patients on average per primary care practice. Secondary outcomes include depression and anxiety-related clinical parameters and health-economic costs. Discussion If the intervention is more effective than treatment as usual, the three-component (cognitive behaviour therapy, case-management, eHealth) primary care-based intervention for patients suffering from PD/AG or depression could be a valuable low-threshold option that benefits patients and primary care practice teams. Trial registration German clinical trials register, DRKS00016622. Registered on February 22nd, 2019.

scholarly journals FAMILY CAREGIVER SCREENING IN PRIMARY CARE: CLINICIAN AND CAREGIVER PERSPECTIVES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S207-S207
Author(s):  
Catherine Riffin
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Qualitative Content Analysis ◽  
Care Plan ◽  
Care Practice ◽  
Community Based ◽  
Multidisciplinary Practice ◽  
Depth Interviews ◽  
Community Based Services

Abstract Despite broad appreciation of family caregivers’ relevance to older adults’ health care, few primary care-based interventions have incorporated mechanisms to facilitate systematic caregiver identification, screening, and support. Actionable knowledge regarding how such interventions may be incorporated into clinical practice is remarkably limited. This study used in-depth interviews to elucidate clinicians’ (N=25) and caregivers’ (N=20) perspectives on and suggestions for integrating caregiver screening into primary care practice. Transcripts were analyzed using qualitative content analysis. Participants emphasized the importance of tailoring the caregiver screening intervention to local circumstances and to patient and caregiver preferences. They advocated for an action-oriented approach that would link identified risks with a concrete plan for follow-up (e.g., referral to training) and outcomes relevant to the patient’s care plan. Overall, participants advised that integrating the intervention into practice would require the support of multidisciplinary practice staff, stronger connections between medical and community-based services, and appropriate reimbursement for clinicians.

scholarly journals Incidence of Obesity at 1 and 3 Years Among Community Dwelling Adults: A Population-Based Study

2022 ◽  
Vol 13 ◽  
pp. 215013192110686
Author(s):  
Ramona S. DeJesus ◽  
Ivana T. Croghan ◽  
Debra J. Jacobson ◽  
Chun Fan ◽  
Jennifer St. Sauver
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Population Based ◽  
Incidence Rates ◽  
Overweight And Obesity ◽  
Community Dwelling ◽  
Care Practice ◽  
Weight Category ◽  
Study Results

Objective: This study determined the incidence rates for obesity among adult patients ages 20 and older empaneled in primary care practice in Midwest United States to potentially identify an optimum timeframe for initiating intervention. Background: Primary care practice patients are likely to reflect underlying community trends in overweight and obesity; however, data on overweight and obesity in primary care patients is limited. While childhood incidence rates of obesity have been well reported, there is still a paucity of data on the incidence of obesity among adult population; literature has mainly focused on its prevalence. Methods: Medical record review of identified cohort with BMI data was conducted. Population was stratified by age and sex and overweight category was subdivided into tertiles. Results: Majority of 40 390 individuals who comprised the final population and had follow-up data, consisted of adults ages 40 to 69 years (47.5%), female (59.8%) of non-Hispanic ethnicity (95.9%) with 21 379 (52.8%) falling in weight category of overweight. Incidence of obesity was 7% at 1 year and 16% at 3 years follow-up. Highest percentages of individuals who became obese at 1 and 3 years were in age category of 40 to 69 years among men and 20 to 39 years among women. In Cox regression analysis, there was statistically significant association to developing obesity among all tertile groups in the overweight category. Age and particularly gender appeared to be modifying factors to likelihood of developing obesity. Conclusion: Study results suggest that while obesity incidence is higher among certain age groups in both genders, middle-aged women, and men in all tertiles of overweight category are at highest risk and may be the optimum population to target for weight loss interventions. Findings support the initiation of population-based interventions before onset of obesity.

scholarly journals Topical Silver Diamine Fluoride for Dental Caries Arrest in Preschool Children: A Randomized Controlled Trial

2017 ◽  
Author(s):  
Peter Milgrom ◽  
Jeremy A. Horst ◽  
Sharity Ludwig ◽  
Marilynn Rothen ◽  
Benjamin W. Chaffee ◽  
...  
Keyword(s):  
Primary Care ◽  
Preschool Children ◽  
Primary Care Practice ◽  
Care Practice ◽  
Tooth Decay ◽  
Sequencing Analysis ◽  
Microbial Composition ◽  
Silver Diamine Fluoride ◽  
Caries Lesions

AbstractObjectives:The Stopping Cavities Trial investigated effectiveness and safety of 38% silver diamine fluoride in arresting caries lesions.Materials and Methods:Double-blind randomized placebo-controlled superiority trial with 2 parallel groups. Oregon preschools. 66 preschool children with ≥1 lesion. 38% silver diamine fluoride or placebo (blue-tinted water), applied topically to the lesion. The primary endpoint was caries arrest (lesion inactivity, Nyvad criteria) 14-21 days post intervention. Dental plaque was collected from all children, and microbial composition was assessed by RNA sequencing from 2 lesions and 1 unaffected surface before treatment and at follow-up for 3 children from each group.Results and Conclusion:Mean fraction of arrested caries lesions in the silver diamine fluoride group was higher (0.72; 95% CI; 0.55, 0.84) than in the placebo group (0.05; 95% CI; 0.00, 0.16). Confirmatory analysis using generalized estimating equation log-linear regression, accounting for the number of treated surfaces and length of follow-up, indicated the fraction of arrested caries was significantly higher in the treatment group (relative risk, 17.3; 95% CI: 4.3 to 69.4). No harms were observed. RNA sequencing analysis identified no consistent changes in relative abundance of caries-associated microbes, nor emergence of antibiotic or metal resistance gene expression. Topical 38% silver diamine fluoride was effective and safe in arresting cavities in preschool children. The treatment is applicable to primary care practice and may reduce the burden of untreated tooth decay in the population.Trial Registration:ClinicalTrials.gov NCT02536040.Clinical SignificanceIn this clinical trial, 72% of caries lesions were arrested by silver diamine fluoride, with no harms. Contrary to the presumed antibacterial mechanism, lesion bacterial composition changed negligibly. This simple topical treatment is applicable to primary care practice and may reduce the burden of untreated tooth decay in the population.

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