scholarly journals The myth of standardized workflow in primary care

2015 ◽  
Vol 23 (1) ◽  
pp. 29-37 ◽  
Author(s):  
G Talley Holman ◽  
John W Beasley ◽  
Ben-Tzion Karsh ◽  
Jamie A Stone ◽  
Paul D Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Physical Work ◽  
Primary Care Visit ◽  
Patient Centered ◽  
Face To Face ◽  
Primary Care Clinics ◽  
Task List ◽  
Workflow Pattern ◽  
Electronic Health

Abstract Objective Primary care efficiency and quality are essential for the nation’s health. The demands on primary care physicians (PCPs) are increasing as healthcare becomes more complex. A more complete understanding of PCP workflow variation is needed to guide future healthcare redesigns. Methods This analysis evaluates workflow variation in terms of the sequence of tasks performed during patient visits. Two patient visits from 10 PCPs from 10 different United States Midwestern primary care clinics were analyzed to determine physician workflow. Tasks and the progressive sequence of those tasks were observed, documented, and coded by task category using a PCP task list. Variations in the sequence and prevalence of tasks at each stage of the primary care visit were assessed considering the physician, the patient, the visit’s progression, and the presence of an electronic health record (EHR) at the clinic. Results PCP workflow during patient visits varies significantly, even for an individual physician, with no single or even common workflow pattern being present. The prevalence of specific tasks shifts significantly as primary care visits progress to their conclusion but, notably, PCPs collect patient information throughout the visit. Discussion PCP workflows were unpredictable during face-to-face patient visits. Workflow emerges as the result of a “dance” between physician and patient as their separate agendas are addressed, a side effect of patient-centered practice. Conclusions Future healthcare redesigns should support a wide variety of task sequences to deliver high-quality primary care. The development of tools such as electronic health records must be based on the realities of primary care visits if they are to successfully support a PCP’s mental and physical work, resulting in effective, safe, and efficient primary care.

scholarly journals A Time-Motion Study of Primary Care Physicians’ Work in the Electronic Health Record Era

2018 ◽  
Vol 50 (2) ◽  
pp. 91-99 ◽  
Author(s):  
Richard A. Young ◽  
Sandra K. Burge ◽  
Kaparaboyna A. Kumar ◽  
Jocelyn M. Wilson ◽  
Daniela F. Ortiz
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Research Network ◽  
Visit Time ◽  
Work Time ◽  
Face To Face ◽  
The Mean ◽  
Electronic Health ◽  
Face Time ◽  
Total Visit

Background and Objectives: Electronic health records (EHRs) have had mixed effects on the workflow of ambulatory primary care. In this study, we update previous research on the time required to care for patients in primary care clinics with EHRs. Methods: We directly observed family physician (FP) attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas. The FPs were purposely chosen to reflect a diversity of patient care styles. We measured total visit time, previsit chart time, face-to-face time, non-face time, out-of-hours EHR work time, and total EHR work time. Results: The mean (SD) visit length was 35.8 (16.6) minutes, not counting resident precepting time. The mean time components included 2.9 (3.8) minutes working in the EHR prior to entering the room, 16.5 (9.2) minutes of face-to-face time not working in the EHR, 2.0 (2.1) minutes working in the EHR in the room (which occurred in 73.4% of the visits), 7.5 (7.5) minutes of non-face time (mostly EHR time), and 6.9 (7.6) minutes of EHR work outside of normal clinic operational hours (which occurred in 64.6% of the visits). The total time and total EHR time varied only slightly between faculty physicians, third-year and second-year residents. Multivariable linear regression analysis revealed many factors associated with total visit time including patient, physician, and clinic infrastructure factors. Conclusions: Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits.

The relationship between usage intention and adoption of electronic health records at primary care clinics

2013 ◽  
Vol 112 (3) ◽  
pp. 731-737 ◽  
Author(s):  
Usman Iqbal ◽  
Cheng-Hsun Ho ◽  
Yu-Chuan(Jack) Li ◽  
Phung-Anh Nguyen ◽  
Wen-Shan Jian ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Health Records ◽  
Primary Care Clinics ◽  
Electronic Health ◽  
The Relationship

scholarly journals Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews

SAGE Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 215824401989909
Author(s):  
Eric Apaydin
Keyword(s):  
Primary Care ◽  
Los Angeles ◽  
Primary Care Physicians ◽  
Theory Approach ◽  
Structured Interviews ◽  
Job Roles ◽  
Face To Face ◽  
Administrative Work ◽  
Job Role ◽  
The Relationship

Primary care physicians face increasing amounts of administrative work (e.g., entering notes into electronic health records, managing insurance issues, delivering test results, etc.) outside of face-to-face patient visits. The objective of this study is to qualitatively describe the experience that primary care physicians have with administrative work, with an emphasis on their beliefs about their job role. I conducted semi-structured interviews with 28 family physicians and internists in Chicago, Los Angeles, and Miami and qualitatively analyzed themes from interview transcripts using the grounded theory approach. Two major themes concerning the relationship between primary care physicians and administrative work were discovered: (a) Administrative work was not central to primary care physicians’ job role beliefs, and (b) “below license” work should be delegated to nonphysicians. Job roles should be considered in future efforts to reduce physician administrative work in primary care.

scholarly journals Factors affecting general practitioners’ choice of drug therapy: A study in primary healthcare in Iceland

2021 ◽  
Vol 107 (11) ◽  
pp. 522-527
Author(s):  
Yrsa Ívarsdóttir ◽  
◽  
Jón Steinar Jónsson ◽  
Kristján Linnet ◽  
Anna Bryndís Blöndal ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Drug Interaction ◽  
Drug Therapy ◽  
Primary Care Physicians ◽  
New Drugs ◽  
Factors Affecting ◽  
Face To Face ◽  
Software Information ◽  
Strongly Agree

Introduction: This study aimed to analyse several factors that influence the decision-making of primary care physicians in Iceland in their choice of drug therapy for their patients. Also, to find which factors can act as a hindrance in making the best choices. Finally, to analyse which elements could be most important in facilitating decisions. Material and methods: A questionnaire was sent by e-mail to physicians working in primary care in Iceland. The questionnaire comprised closed questions, open text boxes, and ranking questions. The data was processed and analysed using Microsoft Excel. Results: The total number of primary care physicians who responded to the questionnaire was 93, a response rate of 40.7% of all the primary care physicians. The results reveal that physicians working in primary care consider clinical guidelines, the Icelandic National Formulary, and personal experience to be the most important factors when choosing a medication. Primary care physicians strongly agree that the lack of drug interaction software connected to medical records is a shortcoming. The most important factors that need improvement to facilitate primary care physicians' decision-making are drug formularies and interaction software. Conclusion: The results suggest some factors that support physicians in primary care in making decisions when choosing drug therapy, such as a drug formulary, drug interaction software, information about patients’ drug therapy, variable length in face-to-face consultations, evidence based information on new drugs, and counselling provided by clinical pharmacists.

scholarly journals P.025 Is this headache normal?: Assessing electronic referrals for headache from primary care physicians

2018 ◽  
Vol 45 (s2) ◽  
pp. S22-S22
Author(s):  
L Panamsky ◽  
A Bradi ◽  
L Sitwell ◽  
C Liddy ◽  
A Afkham ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Unusual Presentation ◽  
Imaging Findings ◽  
Electronic Resources ◽  
Consultation Service ◽  
Face To Face ◽  
Electronic Consultation ◽  
Headache Type ◽  
Clinical Resource

Background: Headache is one of the most frequent complaints in primary care. We reviewed headache questions submitted to an electronic consultation service in Ontario to classify the types of headaches and describe the questions being asked. We also identified reasons why answers were not retrievable within UpToDate, an online clinical resource. Methods: 65 headache eConsults were further divided into 85 questions and categorized by headache type and question theme. Questions were manually searched within UpToDate to determine if they could be answered using this resource. The intent to refer the patient for a face-to-face referral after the eConsult was collected. Results: The top classifications were migraine, unclassified headache, and exertional and/or coital headache. The themes -identified were medication questions (41.7%), investigation questions (33.3%), clinical concerns despite normal neurologic exam and/or imaging (15.5%); and abnormal imaging findings (9.5%). Answers to 40.1% of the questions were not retrievable in UpToDate. The main reason for irretrievability was an unusual presentation. Only 33.8% of eConsults resulted in a face-to-face referral to a specialist. Conclusions: Although electronic resources may be useful in some cases, clinical nuances cannot be accounted for. By providing physicians with rapid access to specialists, eConsult services may obviate the need for formal, face-to-face referrals.

scholarly journals A Survey of Kansas Physicians' Perceptions of Physician Assistant Education and Qualifications

2015 ◽  
Vol 8 (1) ◽  
pp. 18-25
Author(s):  
Gina R Brown ◽  
LaDonna S Hale ◽  
Molly C Britz ◽  
Mindy J Schrader ◽  
Sedera L Sholtz ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Physician Assistant ◽  
Healthcare Team ◽  
Full Time ◽  
Patient Centered ◽  
Chi Square ◽  
Grade Point ◽  
Credit Hours ◽  
Regulatory Standards

BACKGROUND: Effective physician-physician assistant (PA) teams improve patient access and satisfaction, and increase productivity and revenue while reducing physician workload. This survey assessed perceptions of Kansas primary care physicians regarding educational requirements and qualifications of PAs, professional and legal regulations, and the most important skills and competencies for PAs to possess. Understanding these perceptions may lead to improved communication and refined expectations of physician-physician assistant teams, thereby increasing their utilization and effectiveness. METHODS: A 20-question survey was emailed to all 1,551 primary care physicians registered with the Kansas Board of Healing Arts in 2012. Descriptive data were reported as frequencies; comparisons between groups were analyzed using Chi-square. RESULTS: The response rate was 9.2% (n = 143). Physicians were highly accurate regarding the program’s generalist/primary care educational model and moderately accurate regarding the degree awarded, average pre-program grade point average, lock-step full-time curriculum, weeks of clinical rotations, recertification and continuing medical education hours, and Medicare PA fee schedule. Physicians had low accuracy regarding program and pharmacology credit hours, strict dismissal policy, pre-program healthcare experience, and co-signatory regulations. Physicians with PA supervisory experience had higher knowledge than those without (p = 0.001). Physicians most commonly selected history taking and performing physical exam as the most important skill (49%) and providing patient care that is patient-centered, efficient, and equitable as the most important competency (42%). CONCLUSIONS: Physicians often underestimated the average PA applicant qualifications, program rigor and intensity, professional regulatory standards, and co-signatory requirements. Correcting misperceptions and improving understanding of which PA skills and competencies are most valued by physicians may optimize PAs as part of the healthcare team.

scholarly journals General practitioner attitudes and confidence to deprescribing for elderly patients

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Pier Riccardo Rossi ◽  
Sarah E. Hegarty ◽  
Vittorio Maio ◽  
Marco Lombardi ◽  
Andrea Pizzini ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Real Life ◽  
Care Physician ◽  
Local Health Authority ◽  
Local Health ◽  
Cross Sectional Survey ◽  
Patient Centered ◽  
Cross Sectional ◽  
Factors Affecting

Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.

Management of Patients with Type 2 Diabetes by Pharmacists in Primary Care Clinics

1998 ◽  
Vol 32 (6) ◽  
pp. 636-641 ◽  
Author(s):  
Elizabeth A Coast-Senior ◽  
Beverly A Kroner ◽  
Catherine L Kelley ◽  
Lauren E Trilli
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Face To Face ◽  
Primary Care Clinics ◽  
Blood Glucose Concentrations

OBJECTIVE: To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus. DESIGN: Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose. The pharmacists provided diabetes education, medication counseling, monitoring, and insulin initiation and/or adjustments. All initial patient interactions with the pharmacists were face-to-face. Thereafter, patient–pharmacist interactions were either face-to-face or telephone contacts. SETTING: Two primary care clinics in a university-affiliated Veterans Affairs Medical Center. PARTICIPANTS: Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control. OUTCOME MEASURES: Primary outcome variables were changes from baseline in glycosylated hemoglobin, fasting blood glucose, and random blood glucose measurements. Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia, and the number of emergency room visits or hospitalizations related to diabetes. Twenty-three veterans aged 65 ± 9.4 years completed the study. Fifteen (65%) patients were initiated on insulin by the pharmacists; 8 (35%) were already using insulin. Patients were followed for a mean ± SD of 27 ± 10 weeks. Glycosylated hemoglobin, fasting blood glucose concentrations, and random blood glucose concentrations significantly decreased from baseline by 2.2% (p = 0.00004), 65 mg/dL (p < 0.01), and 82 mg/dL (p = 0.00001), respectively. Symptomatic hypoglycemic episodes occurred in 35% of patients. None of these episodes required physician intervention. CONCLUSIONS: This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin.

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