scholarly journals Clinical Recommendations for Reducing the Risk of Cognitive Decline

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 187-188
Author(s):  
G Adriana Perez ◽  
Kelly O'Brien ◽  
Marwan Sabbagh ◽  
Michelle Bruno
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Primary Prevention ◽  
Cognitive Decline ◽  
Risk Reduction ◽  
Routine Care ◽  
Leadership Group ◽  
Patients At Risk ◽  
Primary Care Clinicians ◽  
Improve Health

Abstract As much as 40% of dementia cases can be attributed to modifiable risk factors (Livingston et al., 2020). Much of that risk-reduction can be accomplished by changing behavior in midlife. In light of the emerging evidence that dementia may be preventable, UsAgainstAlzheimer’s convened a workgroup of national experts to develop new recommendations that primary care clinicians and general neurologists can use to initiate primary prevention conversations with their patients about cognitive decline. Few resources address steps that clinicians can take in their routine care to help patients reduce risk. Some relevant resources provide excellent guidance but tend to be more focused on early detection or slowing disease progression rather than primary prevention. The Risk Reduction Workgroup (RRWG) was convened to help address the need for clinicians to know how to discuss cognitive decline with their patients. The workgroup aligned on 11 recommendations for primary care clinicians and general neurologists. In addition the RRWG provide considerations for implementing the recommendations in clinical practice. The recommendations are mindful of social determinants of health, account for cultural differences, and are designed for general accessibility. This effort is part of a broader initiative by UsAgainstAlzheimer’s to address risk-reduction for cognitive decline and early interventions. Under the guidance of a multidisciplinary Provider Leadership Group consisting of representatives from some of the nation's largest health provider serving organizations, three independent workgroups are developing guidance and tools to assist providers in their clinical practice and improve health outcomes for patients at-risk for Alzheimer's and related dementias.

scholarly journals Managing Patients at Risk of Medication Related Complications Requiring Dental Extractions in Primary Care

2020 ◽  
Vol 9 (3) ◽  
pp. 54-58
Author(s):  
Jamie Toole ◽  
Gerry McKenna ◽  
Joanna Smyth
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Dual Antiplatelet Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Clinical Effectiveness ◽  
Bleeding Risk ◽  
Antiresorptive Drugs ◽  
Patients At Risk ◽  
Primary Care Clinicians

When undertaking dental extractions in modern dental practice, two of the complications that have the potential to cause most apprehension for clinicians are the risks of osteonecrosis of the jaws and uncontrollable haemorrhage. This is especially the case when treating older patients because of the increased likelihood of co-morbidities and accompanying polypharmacy which can predispose patients to these problems. Specific medications of concern to practitioners in relation to osteonecrosis risk are antiangiogenic and antiresorptive drugs. Patients taking dual antiplatelet therapy and direct oral anticoagulants require consideration in relation to bleeding risk. With these medications coming increasingly to the forefront over recent years, guidance has been developed by organisations such as the Scottish Dental Clinical Effectiveness Programme (SDCEP). Appropriate use of these guideline should ensure that patients felt to be at particular risk of these complications can frequently be safely managed in primary care. This article aims to provide advice on recognising patients at risk, and to discuss how to utilise key messages within published guidelines when making treatment decisions. The overall intent is to help primary care clinicians who are likely to encounter these patients more and more.

scholarly journals Are We Treating The Patient or the Disease?

2014 ◽  
Vol 5 (4) ◽  
Author(s):  
Eleanor Vogt ◽  
Patricia Shane ◽  
Henry Kahn
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Medication Management ◽  
Healthcare Delivery ◽  
Psychosocial Health ◽  
Routine Care ◽  
Care Patient ◽  
Psychosocial Stressors ◽  
Institute Of Medicine ◽  
Primary Care Clinicians

The evidence abounds. A compelling body of research estimates that psychosocial stressors play a role in a significant number of patient complaints seen in primary care. In addition to the challenges faced by primary care clinicians who must consider their patients' psychosocial stressors, these factors can also affect pharmacists' care. Patient stress, through a number of mechanisms, can limit the efficacy of medicine as well as our efforts to achieve optimal medication management, and adds a poorly examined complexity to patient care practices. A landmark Institute of Medicine report calls for "whole patient "care, addressing psychosocial health needs, not as an embellishment, but as part of routine care. Whole patient care requires a fundamental shift, with patient needs at the center of healthcare delivery, and psychosocial-linked distress considered as integral to that model. These considerations place this topic squarely within the pharmacists' scope of practice and urgently call for an expanded approach to patient care and an opportunity for pharmacists to address that need. To parallel this discussion, the contributing role of practitioner stress is briefly reviewed.   Type: Idea Paper

Implementing Serious Illness Communication Processes in Primary Care: A Qualitative Study

2020 ◽  
pp. 104990912095109
Author(s):  
Joanna Paladino ◽  
Elise Brannen ◽  
Emily Benotti ◽  
Natalie Henrich ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Program Implementation ◽  
Primary Care Physicians ◽  
Care Program ◽  
Routine Care ◽  
Structured Interviews ◽  
Patient Centered ◽  
Serious Illness ◽  
Primary Care Clinicians

Purpose: Primary care clinicians face barriers to engaging patients in conversations about prognosis, values, and goals (“serious illness conversations”). We introduced a structured, multi-component intervention, the Serious Illness Care Program (SICP), to facilitate conversations in the primary care setting. We present findings of a qualitative study to explore practical aspects of program implementation. Methods: We conducted semi-structured interviews of participating primary care physicians, nurse care coordinators, and social workers and coded transcripts to assess the activities used to integrate SICP into the workflow. Results: We conducted interviews with 14 of 46 clinicians from 6 primary care clinics, stopping with thematic saturation. Qualitative analysis revealed major themes around activities in the timing of the conversation (before, during, and after) and overarching insights about the program. Clinicians used a variety of strategies to adapt program components while preserving key program goals, including processes to generate accountability to ensure that conversations happen in busy clinical workflows. The interviews revealed changes to clinicians’ mindset and norms, such as the recognition of the need to start conversations earlier in the illness course and the use of more expansive models of prognostic communication that address function and quality of life. Data also revealed indicators of sustainable behavior change and the spread of communication practices to patients outside the intended program scope. Conclusion: SICP served as a framework for primary care clinicians to integrate serious illness communication into routine care. The shifts in processes employed by inter-professional clinicians revealed comprehensive models for prognostic communication and creative workflows to ensure that patients with complex illnesses had proactive, longitudinal, and patient-centered serious illness conversations and care planning.

scholarly journals Polygenic risk score and statin relative risk reduction for primary prevention in a real-world population

2021 ◽  
Author(s):  
Akinyemi Oni-Orisan ◽  
Tanushree Haldar ◽  
Mari Angelica Cayabyab ◽  
Dilrini K Ranatunga ◽  
Thomas J Hoffmann ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Relative Risk ◽  
Primary Prevention ◽  
Risk Reduction ◽  
Risk Score ◽  
Relative Risk Reduction ◽  
Routine Care ◽  
Polygenic Risk Score ◽  
Polygenic Risk ◽  
Ascvd Risk

Background Randomized-controlled trials demonstrate that high coronary heart disease (CHD) polygenic risk score modifies statin CHD relative risk reduction, but it is unknown if the association extends to statin users undergoing routine care. Objectives The primary objective was to determine how statin effectiveness is modified by CHD polygenic risk score in a real-world cohort of primary prevention participants. Methods We determined polygenic risk scores in participants of the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. Cox regression models were used to compare the risk of the cardiovascular outcomes between statin users and matched nonusers. Results The hazard ratio (HR) for statin effectiveness on incident myocardial infarction was similar within 10-year atherosclerotic cardiovascular disease (ASCVD) risk score groups at 0.65 (95% confidence interval [CI] 0.39-1.08; P=0.10), 0.65 (95% CI 0.56-0.77; P=2.1E-7), and 0.67 (95% CI 0.57-0.80; P=4.3E-6) for borderline, intermediate, and high ASCVD groups, respectively. In contrast, statin effectiveness by polygenic risk was largest in the high polygenic risk score group (HR 0.62, 95% CI 0.50-0.77; P=1.4E-5), intermediate in the intermediate polygenic risk score group (HR 0.70, 95% CI 0.61-0.80; P=5.7E-7), and smallest in the low polygenic risk score group (HR 0.86, 95% CI 0.65-1.16; P=0.33). ASCVD risk and statin LDL-C lowering did not differ across polygenic risk score groups. Conclusions In primary prevention patients undergoing routine care, CHD polygenic risk modified statin relative risk reduction of incident myocardial infarction independent of statin LDL-C lowering. Our findings extend prior work by identifying a subset of patients with attenuated clinical benefit from statins.

17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

2007 ◽  
Vol 30 (4) ◽  
pp. 36
Author(s):  
M. L. Russell ◽  
L. McIntyre
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Community Health ◽  
Royal College ◽  
Community Medicine ◽  
Work Setting ◽  
Public Health Medicine ◽  
Work Settings ◽  
Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

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