scholarly journals Huddle Up! A Comprehensive Approach to Improving Interdisciplinary Huddle in a VA Geriatric Primary Care Clinic

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 13-13
Author(s):  
Juliana Wilking-Johnson ◽  
Joleen Sussman
Keyword(s):  
Primary Care ◽  
Geriatric Medicine ◽  
Primary Care Clinic ◽  
Post Intervention ◽  
Allied Health Professionals ◽  
Care Clinic ◽  
Team Members ◽  
Needed Information ◽  
Initial Survey ◽  
The Impact

Abstract Spending time in brief meetings or “huddles” is associated with greater job satisfaction and less burnout, especially when team members have mutually agreed upon goals and can participate in decision-making. However, huddles are often unproductive and may have opposite the intended effect if not tailored to the specific team involved. We sent a survey to all members of our VA Geriatric primary care team (including geriatric medicine fellows, social work, psychology, audiology, pharmacy, faculty and support staff) asking them to rate our huddle’s impact on their stress level, efficiency, learning, preparedness and feeling supported at work. Responders indicated if they received needed information and if they understood what information was needed from them. We then held a team meeting to establish mutually agreed upon goals, expectations and organization of huddle, which were then reinforced with visual and timer reminders. After 6 weeks utilizing the new format, we administered a post intervention survey assessing the impact of the change. The initial survey revealed that the geriatric medicine fellows had worse ratings than other trainees, staff, and faculty. Fellows were more likely to say that they did not know what information was needed from them; and they did not receive information needed from others. The follow up survey showed improvement in all scores among geriatrics medicine fellows and allied health professionals, including 100% of respondents indicating they receive needed information. Overall, comments regarding the intervention were positive, demonstrating that a structured, organized huddle tailored to a specific team, can be beneficial.

Abstract 142: Increasing Appropriate Statin Use in the Primary Care Clinic

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Aditya K Khetan ◽  
Omer Khan ◽  
Umar Rashid ◽  
Christopher Pleyer ◽  
Mamta Singh
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Relative Increase ◽  
Atherosclerotic Cardiovascular Disease ◽  
Post Intervention ◽  
Care Clinic ◽  
Targeted Interventions ◽  
New Guidelines ◽  
Cholesterol Management ◽  
Statin Use

Background: In 2013, ACC/AHA released new guidelines for cholesterol management. Historically, new guidelines can take up to a decade to diffuse into clinical practice, leading to suboptimal patient management. We hypothesized that systematic identification of barriers, and targeted interventions can improve management of cholesterol. Objectives: To increase appropriate intensity statin prescription, as enumerated in the 2013 ACC/AHA guidelines, in all primary care clinic patients with atherosclerotic cardiovascular disease (ASCVD) or diabetes mellitus (DM), with an aim to make a 25% relative improvement from baseline (Dec’14) to Dec’ 15. Methods: Information regarding statin use was obtained from the primary care clinic database. MD, NP and PharmD providers in the clinic were surveyed with an aim to understand the barriers to prescribing statins. A series of tailored interventions was subsequently deployed through multiple PDSA cycles, including pocket cards on statin guidelines, education sessions and EMR generated lists of patients who were not on a statin as per guidelines. Result: Baseline data showed that 59.7% (238 of 398) patients with ASCVD were on an appropriate dose statin, while 70.7% (619 of 875) patients with DM were on an appropriate dose statin. Post intervention results after 12 months showed a 8.4% relative increase (258 of 398) in appropriate dose statin use amongst patients with ASCVD and a 2.1% relative increase (632 of 875) in patients with DM. Conclusions and implication: A targeted strategy of PDSA cycles can increase the rates of statin usage, and lead to quicker uptake of ACC/AHA guidelines on cholesterol management.

The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization

2016 ◽  
Vol 73 (6) ◽  
pp. 681-692 ◽  
Author(s):  
Autumn Lanoye ◽  
Karen E. Stewart ◽  
Bruce D. Rybarczyk ◽  
Stephen M. Auerbach ◽  
Elizabeth Sadock ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Safety Net ◽  
Psychological Services ◽  
Medical Utilization ◽  
Care Clinic ◽  
The Impact

scholarly journals Utilization of an Integrated Medicare Advantage Model Is Positively Associated With Medication Adherence

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 479-479
Author(s):  
Renae Smith-Ray ◽  
Tanya Singh ◽  
Chester Robson
Keyword(s):  
Primary Care ◽  
Medication Adherence ◽  
Health Outcomes ◽  
Kansas City ◽  
Primary Care Clinic ◽  
Future Research ◽  
Medicare Advantage ◽  
Care Clinic ◽  
The Impact ◽  
Optimal Adherence

Abstract An estimated 30% of U.S. healthcare costs are due to waste, inefficiencies, and excessive pricing. Research shows that integrated primary care models (IPC) improve health outcomes and reduce costs. Nearly all IPCs embed ancillary clinicians, including pharmacists, within the clinic. IPCs that embed a primary care clinic within a pharmacy are novel. This study describes the first known IPC for older adults that is based in a pharmacy and examines its impact on medication adherence. In January 2018, Walgreens launched an IPC focused on Medicare Advantage patients at select Kansas City Walgreens locations. Each morning the entire IPC team meets to review needs of patients who will be seen that day. Upon arrival, the patient is first seen by a pharmacist who completes medication and immunization reviews and fall risk screening. If a new medication is prescribed during the physician visit, the pharmacist returns to consult the patient. The IPC team works together to ensure that the Medicare Annual Wellness Exam is completed in entirety. We examined the impact of IPC utilization on adherence to the top seven chronic condition drug groups. IPC patients age 50+ with sub-optimal adherence (<80% proportion of days covered) during the year prior to the clinic opening were included (n=64). A Student’s t-test revealed an 11% improvement in optimal adherence year-over-year between the pre- and post- periods (p<0.001). The pharmacy-based IPC is associated with improved medication adherence. Future research should examine the impact of this model on patient satisfaction and additional health outcomes.

scholarly journals HPV vaccination uptake among Somali American patients at an urban primary care clinic in Minnesota, USA: identifying and testing interventions to improve uptake using video reflexive ethnography

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055637
Author(s):  
Rebekah Pratt ◽  
Channelle Ndagire ◽  
Abayomi Oyenuga ◽  
Serena Xiong ◽  
Katherine Carroll ◽  
...  
Keyword(s):  
Primary Care ◽  
Hpv Vaccination ◽  
Primary Care Clinic ◽  
Health Inequities ◽  
Primary Outcome Measure ◽  
Vaccine Hesitancy ◽  
Care Clinic ◽  
Vaccination Rates ◽  
Vaccination Uptake ◽  
The Impact

ObjectivesWhile there have been efforts to address common and culturally informed barriers to healthcare, Somali Americans have low rates of human papillomavirus (HPV) vaccination. This study aimed to use video reflexive ethnography (VRE) to identify primary care health inequities, derive interventions aimed at improving HPV vaccination rates in Somali Americans, and then test their impact on vaccination rates.DesignThe VRE methodology involves three sequential steps: data collection, reflexive discussion and identifying intervention in practice. Preintervention and postintervention vaccination uptake data were collected for Somali patients.SettingVRE was conducted with medical assistants (MAs) and Somali patients for 3 months (June–August 2018) in an urban primary care clinic in Minnesota, USA. HPV vaccination rates were collected and analysed pre-VRE and for a period of 6 months post the implementation of the interventions identified by VRE.Participants14 MAs participated in the VRE which designed the study intervention, which was tested on 324 Somali patients eligible for HPV vaccination.Primary outcome measureHPV vaccination uptake among Somali patients.ResultsMAs identified three practice challenges related to HPV vaccination: provider fatigue related to ongoing patient vaccine hesitancy or refusal, MAs misinterpretation of patient’s vaccination dissent language, and missed opportunities to respond to unique patient concerns as a result of following standard work procedures. Using VRE, MAs identified and developed several interventions to address these practice challenges. Adjusted for age at clinic visit (years), the difference in preintervention and postintervention HPV immunisation rates was 10.1 per 100 patient-visits (95% CI 2.97 17.3; p=0.0057).ConclusionVRE can engage MAs in an innovative, participatory process to identify and address concerns about health inequities. In this study, MAs designed and implemented interventions that improved HPV vaccination rates in Somali Americans. Further research is needed to more fully assess the impact of such interventions.

scholarly journals A clinical audit of the diagnosis and management of chronic kidney disease in a primary care clinic

2021 ◽  
Vol 16 (3) ◽  
pp. 68-76
Author(s):  
Jazlan Jamaluddin ◽  
Mohamed Syarif Mohamed Yassin ◽  
Siti Nuradliah Jamil ◽  
Mohd Azzahi Mohamed Kamel ◽  
Mohamad Ya’akob Yusof
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Primary Care Clinic ◽  
Care Clinic ◽  
Team Members ◽  
Diagnosis And Management ◽  
Dedicated Team ◽  
Level Monitoring

Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

Vision Screening Among Primary Care Clinic Patients

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 93A-93A
Author(s):  
Lwbba Chait ◽  
Angeliki Makri ◽  
Rawan Nahas ◽  
Gwen Raphan
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Vision Screening ◽  
Care Clinic
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