scholarly journals DETECTING PRE-FRAILTY STATUS: COMPARISON OF CLINICAL JUDGMENTS AND THE PAULSON LICHTENBERG FRAILTY INDEX.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S897-S898
Author(s):  
Yi-Ling Hu ◽  
Heather A Fritz
Keyword(s):  
Clinical Judgment ◽  
Medical Records ◽  
Frailty Index ◽  
Primary Care Clinic ◽  
Descriptive Statistics ◽  
Screening Tools ◽  
Clinical Judgments ◽  
Care Clinic ◽  
Frailty Status ◽  
Level Of Agreement

Abstract Nearly 50% of U.S. elders are prefrail and at risk for frailty. Identifying prefrail elders and escalating care could attenuate frailty progression. Screening tools are seldom used in practice. Thus, clinical judgment may be a realistic way to ensure widespread frailty screening. No studies, however, have assessed the validity of clinicians’ judgment in identifying prefrail elders. This study explored the level of agreement between clinical judgments of frailty status and status categorizations made using the validated Paulson Lichtenberg Frailty Index (PLFI). Older Blacks (n = 202) recruited from a primary care clinic were first categorized as healthy, pre-frail, or frail using the PLFI. Next, geriatric physicians and nurses categorized participants into one of the same categories based on clinical judgment. Clinicians could use medical records to make determinations. We used Cohen’s Kappa to determine the level of agreement of both approaches. We used descriptive statistics to explore if any of the 5 PLFI indicators explained discordant categorizations. Of the 202 participants (mean age: 76.7 8.6), 52 (26%) were prefrail and 57 (28%) were frail based on the PLFI. Physicians’ judgments aligned with the PLFI in 43% of prefrail and 65.7% of frail cases. Nurse judgments aligned with the PLFI in 43.9% of prefrail and 17% of frail cases. There was slight to fair agreement between clinical judgments and PLFI (physicians Cohen’s κ = .23; Nurses Cohen’s κ = .59). No specific PLFI indicators independently explained discordant categorizations. Findings suggest that clinical judgments did not align well with PLFI categorizations.

scholarly journals Pharmacotherapy assessment in chronic kidney disease: validation of the pair instrument for use in Brazil

2020 ◽  
Author(s):  
Alessandra Batista Marquito ◽  
Hélady Sanders Pinheiro ◽  
Natália Maria da Silva Fernandes ◽  
Rogério Baumgratz de Paula
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Judgment ◽  
Medical Records ◽  
Chronic Renal Disease ◽  
Drug Related Problems ◽  
Longitudinal Observational Study ◽  
Clinically Significant ◽  
Validated Instrument ◽  
Level Of Agreement

Abstract Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.

scholarly journals Precision of Medication Therapy Problem Identification and Classification amongst Primary Care Clinic Pharmacists

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 179
Author(s):  
Nicholas Cox ◽  
Bryce Ashby ◽  
Bradly Winter ◽  
Gregory Stoddard ◽  
Joanne LaFleur ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Management ◽  
Intraclass Correlation ◽  
Primary Care Clinic ◽  
Care Clinic ◽  
Medication Therapy ◽  
Disease States ◽  
Case Vignettes ◽  
Pharmacy Quality ◽  
Level Of Agreement

This study assesses the level of agreement on medication therapy problem (MTP) identification and classification between primary care, ambulatory care pharmacists within a health-system that recently implemented system-wide pharmacist provision of comprehensive medication management (CMM) services. Twenty standardized case vignettes were created and distributed to pharmacists who reviewed each case and identified and categorized MTPs. Outcomes include the number of MTPs identified, identification (yes/no) of specific MTPs within each case (e.g., need for a statin), and Pharmacy Quality Alliance (PQA) category used when classifying MTPs. The level of agreement on MTP identification/categorization was measured using intraclass correlation coefficient (ICC) and interpreted using the Landis and Koch interpretation scale. “Moderate agreement” was observed for the number of MTPs identified by pharmacists (ICC equal to 0.45; 95% confidence interval [CI]: 0.31 to 0.65). In approximately one-half of opportunities, the pharmacists agreed perfectly on the number of MTPs; in approximately one-third of opportunities, the number of MTPs identified varied by 1; and approximately one-tenth of the time, the number of MTPs varied by 2. In regard to the MTP identification (yes/no) and categorization, percent agreement was ≥73% across all MTPs. The results support the need for further training and education and provide the information necessary to target specific disease states.

scholarly journals Potential Drug-Drug Interactions among Medications Prescribed to Adult Filipinos at a Primary Care Clinic in a Government Teaching Hospital

2020 ◽  
Vol 54 (3) ◽  
Author(s):  
Shiela Marie S. Laviña ◽  
Regie A. Layug
Keyword(s):  
Primary Care ◽  
Drug Interactions ◽  
Teaching Hospital ◽  
Medical Records ◽  
Primary Care Clinic ◽  
Adverse Outcomes ◽  
Drug Prescriptions ◽  
Potential Drug ◽  
Care Clinic ◽  
Pharmacokinetic Interactions

Background. A drug-drug interaction (DDI) is a pharmacologic or clinical response to the administration of a drug that can result in adverse outcomes. DDIs are considered preventable adverse drug reactions because these interactions can be learned, predicted and recognized. Objective. To determine potential drug-drug interactions (pDDI) among medications prescribed to adult patients consulting at a primary care clinic in a government teaching hospital. Methods. This was a 6-month retrospective cross-sectional study of drug prescriptions based on medical records of adult Filipinos who were seen and managed at a primary care clinic in a government teaching hospital. Medical charts were systematically selected based on a sampling frame with inclusion and exclusion criteria. Results. A total of 1,490 medical records of adult Filipino patients were included in the study. There were a total of 261 unique prescriptions based on generic formulations and an overall total of 5,978 drugs for a 6-month period of clinic consultations. An average of 4 medications (SD±1.63) were prescribed for every consultation recorded in the medical chart. From the charts that were reviewed, 23% of all adults were given a prescription of 4 drugs (N=348/1490), 26% had 3 drug prescriptions (N=386/1490) and 18% had two drugs, respectively, per clinic visit. Overall, 714/9054 (7.88%) medication pairs were seen to have potential drug interactions. The top three most common drug pairs with pDDI were amlodipine-simvastatin, losartan/hydrochlorothiazide-metformin and aspirin-furosemide. Five hundred twenty-five drug pairs had pharmacodynamic interactions (525/714) while 94 drug pairs (15%) had pharmacokinetic interactions. Conclusion. Potential drug-drug interactions were observed in 8% of medications prescribed to adult Filipinos seen at Family Medicine Clinic in a government hospital. Seventy-four percent (74%) of the drug pairs with pDDIs were pharmacodynamic and 15% were pharmacokinetic interactions.

scholarly journals Toward Using a Smartwatch to Monitor Frailty in a Hospital Setting: Using a Single Wrist-Wearable Sensor to Assess Frailty in Bedbound Inpatients

Gerontology ◽  
2017 ◽  
Vol 64 (4) ◽  
pp. 389-400 ◽  
Author(s):  
Hyoki Lee ◽  
Bellal Joseph ◽  
Ana Enriquez ◽  
Bijan Najafi
Keyword(s):  
Frailty Index ◽  
Hospital Setting ◽  
Area Under The Curve ◽  
Screening Tools ◽  
Recursive Feature Elimination ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Flexion Extension ◽  
Sensor Configuration

Background: While various objective tools have been validated for assessing physical frailty in the geriatric population, these are often unsuitable for busy clinics and mobility-impaired patients. Recently, we have developed a frailty meter (FM) using two wearable sensors, which allows capturing key frailty phenotypes (weakness, slowness, and exhaustion), by testing 20-s rapid elbow flexion-extension test. Objective: In this study, we proposed an enhanced automated algorithm to identify frailty using a single wrist-worn sensor. Methods: The data collected from 100 geriatric inpatients (age: 78.9 ± 9.1 years, 49% frail) were reanalyzed to validate the new algorithm. The frailty status of the participants was determined using a validated modified frailty index. Different FM phenotypes (31 features) including velocity of elbow rotation, decline in velocity of elbow rotation over 20 s, range of motion, etc. were extracted. A regression model, bootstrap with 2,000 iterations, and recursive feature elimination technique were used for optimizing the FM parameters and identifying frailty using a single wrist-worn sensor. Results: A strong agreement was observed between two-sensor and wrist-worn sensor configuration (r = 0.87, p < 0.001). Results suggest that the wrist-worn FM with no demographic information still yields a high accuracy of 80.0% (95% CI: 79.7-80.3%) and an area under the curve of 87.7% (95% CI: 87.4-87.9%) to identify frailty status. Results are comparable with two-sensor configuration, where the observed accuracy and area under the curve were 80.6% (95% CI: 80.4-80.9%) and 87.4% (95% CI: 87.1-87.6%), respectively. Conclusion: The simplicity of FM may open new avenues to integrate wearable technology and mobile health to capture frailty status in a busy hospital setting. Furthermore, the reduction of needed sensors to a single wrist-worn sensor allows deployment of the proposed algorithm in the form of a smartwatch application. From the application standpoint, the proposed FM is superior to traditional physical frailty-screening tools in which the walking test is a key frailty phenotype, and thus they cannot be used for bedbound patients or in busy clinics where administration of gait test as a part of routine assessment is impractical.

scholarly journals Effectiveness of EHR-Depression Screening Among Adult Diabetics in an Urban Primary Care Clinic

2021 ◽  
Author(s):  
Filipina Schnabel ◽  
◽  
Danielle Aldridge
Keyword(s):  
Diabetes Mellitus ◽  
Quality Improvement ◽  
Depressive Disorders ◽  
Diabetes Management ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Mental Illnesses ◽  
Screening Tools ◽  
Depression Screening ◽  
Care Clinic

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR). Methods We conducted a retrospective chart review on patients aged 18 years and above with a diagnosis of DM2 and no initial diagnosis of depression or other mental illnesses. Chart reviews included those from 2018 or prior for before integration data and 2020 to present for after integration. Sixty subjects were randomly selected from a pool of 33,695 patients in the clinic with DM2 from the year 2013-2021. Thirty of the patients were prior to the integration of depression screening tools PHQ2 and PHQ9 into the EHR, while the other half were post-integration. The study population ranged from 18-83 years old. Results All subjects (100%) were screened using PHQ2 before integration and after integration. Twenty percent of patients screened had a positive PHQ2 among subjects before integration, while 10% had a positive PHQ2 after integration. Twenty percent of patients were screened with a PHQ9 pre-integration which accounted for 100% of those subjects with a positive PHQ2. However, of the 10% of patients with a positive PHQ2 post-integration, only 6.7 % of subjects were screened, which means not all patients with a positive PHQ2 were adequately screened post-integration. Interestingly, 10% of patients were treated with antidepressants before integration, while none were treated with medications in the post-integration group. There were no referrals made to the behavior team in either group. Conclusion There is no difference between the prevalence of depression screening before or after integration of depression screening tools in the EHR. The study noted that there is a decrease in the treatment using antidepressants after integration. However, other undetermined conditions could have influenced this. Furthermore, not all patients with positive PHQ2 in the after-integration group were screened with PHQ9. The authors are unsure if the integration of the depression screens influenced this change. In both groups, there is no difference between referrals to the behavior team. Implications to Nursing Practice This quality improvement study shows that providers are good at screening their DM2 patients for depression whether the screening tools were incorporated in the EHR or not. However, future studies regarding providers, support staff, and patient convenience relating to accessibility and availability of the tool should be made. Additional issues to consider are documentation reliability, hours of work to scan documents in the chart, risk of documentation getting lost, and the use of paper that requires shredding to comply with privacy.

scholarly journals Quality of asthma care at a university-based primary care clinic in Malaysia

2019 ◽  
Vol 33 (5) ◽  
pp. 425-434 ◽  
Author(s):  
Hizlinda Tohid ◽  
Sheen Dee Ng ◽  
Anis Azmi ◽  
Nur Farah Adrina Nur Hamidi ◽  
Syahirah Samsuri ◽  
...  
Keyword(s):  
Asthma Control ◽  
Medical Records ◽  
Primary Care Clinic ◽  
Asthma Management ◽  
Specific Information ◽  
Asthma Care ◽  
Care Clinic ◽  
Content Type ◽  
Asthma Patients

Purpose The quality of asthma care may be affected if asthma management is overlooked, thus needing frequent clinical audits to identify areas for improvement. The purpose of this paper is to evaluate the quality of the process (e.g. documentation of asthma-specific information), the structure (e.g. availability of resources) and the outcome (e.g. proportion of patients prescribed with asthma medications) at a university-based primary care clinic. The associated clinical factors for non-documentation of asthma control at the last visit were also examined. Design/methodology/approach This retrospective study involved auditing medical records and the pharmacy data system of 433 adult patients with asthma to evaluate 18 quality indicators. The standard target for the indicators of process and structure was 80 percent and the standard target for the indicators of outcome was 100 percent. Findings All the indicators failed to reach the standard targets. Documentation of asthma-specific information and availability of resources were deficient. The non-documentation of asthma control was significantly associated with presence of acute complaint(s) unrelated to asthma, presence of other issues and number of the documented parameters for asthma control. Although the prescription rates of inhaled reliever and preventer were substandard, they were reasonably high compared to the targets. Research limitations/implications In this study, evaluation of the quality of care was limited by absence of asthma register, use of paper-based medical records and restricted practice capacity. Besides, the asthma-specific assessments and management were only audited at one particular time. Furthermore, the findings of this study could not be generalised to other settings that used other methods of record keeping such as patient-held cards and electronic medical records. Future studies should sample asthma patients from a register, evaluate more reliable quality indicators (e.g. over-prescription of short-acting β-2 agonist and underuse of inhaled corticosteroid) and assess asthma management over a duration of time. Practical implications This study provides quality information on all aspects of asthma care (process, structure and outcome) which can be a basis for clinical improvement. It is hoped that the study could assist the stakeholders to plan strategies for improvement of the asthma care. A more strategic and reliable system of documentation is needed, such as the use of a simple template or structured form, which should not jeopardise the provision of personalised and comprehensive care. With complete documentation, thorough investigational audits can be continuously performed to determine the quality of asthma care. Social implications This study could provide useful findings to guide healthcare providers in developing a more strategic model of asthma care that can ensure asthma patients to receive a personalised, comprehensive, holistic and continuous care. Through this approach, their physical and psychosocial well-being can be optimised. Originality/value Even though our healthcare has advanced, the quality of asthma care is still suboptimal which requires further improvement. However, it could be considered assuring due to high outcome levels of asthma care despite having limited resources and practice capacity.

scholarly journals Puericulture consultation: problems found in those under 2 years old

2019 ◽  
Vol 13 ◽  
Author(s):  
Fabiana Angelo Ferreira ◽  
Rosideyse De Souza Cabral Freitas ◽  
Maria Carolina Salustino dos Santos ◽  
Suélida Rafaela De Melo Silva ◽  
Amanda Marinho da Silva ◽  
...  
Keyword(s):  
Child Care ◽  
Retrospective Study ◽  
Medical Records ◽  
Descriptive Statistics ◽  
Male Child ◽  
Care Clinic ◽  
Respiratory Problems ◽  
Care Consultation ◽  
Quantitative Descriptive ◽  
The Universe

Objective: to identify the main problems presented in children under 2 years of age during the nursing consultation in childcare. Method: this is a quantitative, descriptive, retrospective study. The universe of the survey was composed of 166 medical records of children attended at the child care clinic. It was identified, of these, 84 charts of children attended from 2012 to 2016. The results were presented in figures form. Results: data were analyzed by descriptive statistics and of the 84 children studied, a total of 139 complaints registered by the nurse during the child care consultation. Conclusion: respiratory problems (40%) followed by dermatological (33%) and gastrointestinal (23%) were highlighted. It is pointed out, by the study, the need to create a protocol of consultation of childcare for nurses, strengthening the prevention and promotion to the health of the child accompanied. Descritores: Child; Nurses, Male; Child Care; Pediatrics; Inquiry; Monitoring.  ResumoObjetivo: identificar os principais problemas apresentados nas crianças menores de 2 anos durante a consulta de enfermagem em puericultura. Método: trata-se de estudo quantitativo, descritivo, retrospectivo. Compôs-se o universo da pesquisa por 166 prontuários de crianças atendidas na consulta de puericultura. Identificou-se, desses, 84 prontuários de crianças atendidas de 2012 a 2016. Apresentaram-se os resultados em forma de figuras. Resultados: analisaram-se os dados por estatística descritiva e, das 84 crianças estudadas, houve um total de 139 queixas registradas pelo enfermeiro durante a consulta de puericultura. Conclusão: destacaram-se os problemas respiratórios (40%) seguidos de dermatológicos (33%) e gastrointestinais (23%). Aponta-se, pelo estudo, para a necessidade de criar um protocolo de consulta de puericultura para os enfermeiros, fortalecendo a prevenção e promoção à saúde da criança acompanhada. Descritores: Criança; Enfermeiro; Puericultura; Pediatria; Intervenção; Cuidado. Consulta. Acompanhamento. Resumen Objetivo: identificar los principales problemas presentados en niños menores de 2 años durante la consulta de enfermería en puericultura. Método: se trata de un estudio cuantitativo, descriptivo, retrospectivo. El universo de la investigación estaba compuesto por 166 registros médicos de niños atendidos en la clínica de cuidado infantil. Se identificó, de estos, 84 cuadros de niños atendidos entre 2012 y 2016. Los resultados se presentaron en forma de figuras. Resultados: se analizaron los datos mediante estadísticas descriptivas y de los 84 niños estudiados, hubo un total de 139 quejas registradas por el enfermero durante la consulta de puericultura. Conclusión: se resaltaron los problemas respiratorios (40%) seguidos de dermatológicos (33%) y gastrointestinales (23%). Se señala, según el estudio, la necesidad de crear un protocolo de consulta de puericultura para enfermeros, fortaleciendo la prevención y promoción a la salud del niño acompañado. Descritores: Niño; Enfermeros Hombres; Cuidado del Niño; Pediatría; Consulta; Monitoreo.

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
Sign in / Sign up

Export Citation Format

Share Document