Postpartum Depression

Depression ◽  
2019 ◽  
pp. 435-445
Author(s):  
Nikita Patel ◽  
Emily B. Kroska ◽  
Zachary N. Stowe
Keyword(s):  
Primary Care ◽  
Postpartum Depression ◽  
Perinatal Care ◽  
Treatment Options ◽  
Primary Care Clinic ◽  
Depression Scale ◽  
Risk Groups ◽  
Primary Care Providers ◽  
Her Family ◽  
Effective Interventions

Perinatal care, including the management of mental health issues, is often under the auspices of primary care providers. This chapter provides an overview of identification, diagnosis, and treatment of postpartum depression (PPD). It reviews the prevalence of PPD in the general and minority populations, related disorders, common symptoms, and genetic and psychosocial risk factors to facilitate PPD management in the primary care clinic. The most commonly employed screening scale, the Edinburgh Postnatal Depression Scale, has several advantages in the primary care setting. The potential adverse consequences of untreated PPD on the mother and her family underscore the importance of identifying and providing effective interventions, including preventive strategies, in high-risk groups. As a class, antidepressant medications have amassed a large reproductive safety literature, including considerable data in breastfeeding and women with PPD. Notably, psychosocial therapies have demonstrated equal efficacy in women with PPD and are viable treatment options.

scholarly journals Cross-Cultural Comparisons of Subjective Cognitive Complaints in a Diverse Primary Care Population

2021 ◽  
pp. 1-11
Author(s):  
Danelly Rodríguez ◽  
Emmeline Ayers ◽  
Erica F. Weiss ◽  
Joe Verghese
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
African Americans ◽  
Primary Care Clinic ◽  
Depression Scale ◽  
Cognitive Complaints ◽  
Care Clinic ◽  
Primary Care Population ◽  
Subjective Cognitive Complaints

Background: Very few studies have explored the utility of subjective cognitive complaints (SCCs) in primary care settings. Objective: We aim to investigate associations between SCCs (item-level), objective cognitive function (across domains and global), and mood in a diverse primary care population, including subjects with mild cognitive impairment. Methods: We studied 199 (75.9%females; 57.8%Hispanics; 42.2%African Americans) older adults (mean age 72.5 years) with memory concerns at a primary care clinic. A five-item SCC questionnaire, and objective cognitive assessments, including the Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale, were administered. Results: Logistic regression analyses showed associations between SCC score and depressive symptoms. A memory-specific (“memory worsening”) SCC predicted scores on the MoCA (p = 0.005) in Hispanics. Conclusion: SCCs are strongly linked to depressive symptoms in African Americans and Hispanics in a primary care setting; a specific type of SCC is related to global cognitive function in Hispanics.

Abstract P119: Assessment of Cardiovascular Health among Older Women in Primary Care

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Randi E Foraker ◽  
Abigail B Shoben ◽  
Marcelo A Lopetegui ◽  
Albert M Lai ◽  
Philip R Payne ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Health ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Continuous Variables ◽  
Care Providers ◽  
Care Clinic ◽  
Female Patients ◽  
Life’S Simple 7 ◽  
Life's Simple 7

In 2010, the American Heart Association (AHA) launched the groundbreaking Life’s Simple 7™ campaign to improve the cardiovascular health (CVH) of Americans. Five of the 7 [smoking, body mass index (BMI), blood pressure, cholesterol, and glucose] are commonly recorded in electronic medical records (EMRs). Although CVH components are often included in patient-provider discussions, to date there has been no formal attempt to characterize CVH from EMR data. We characterized the CVH of 160 female patients ages 65 and older seen in an Ohio State University primary care clinic from May 1 through July 31, 2013. We defined CVH according to AHA criteria, and assigned each behavior and factor to either an “ideal”, “intermediate”, or “poor” category. We calculated an overall CVH score ranging from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. We calculated means and standard deviations (sd) of continuous variables and report frequencies within CVH categories. Patients were an average of 74.2 (sd=6.7) years old, and 35% were black. Among the 126 (79%) women who had data available on all 5 factors, mean CVH score was 6.0 (sd=1.3). Among all women, the mean fractional score (actual score/maximum possible) was 0.63 (sd=0.14), and it did not differ significantly by race. Greater than 10% of data were missing for BMI (13%) and cholesterol (11%). Figure 1 shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor. We have demonstrated that a majority of Life’s Simple 7™ components are easily queried from EMRs. These data indicate that older female patients seen in the primary care setting have less-than-ideal CVH. There exists great potential to leverage the EMR for patient-provider communication and engagement around CVH. As such, we are implementing an automated assessment of CVH targeted to primary care providers and their older female patients. Following the intervention, CVH values will be compared to these baseline data. Figure 1. Percent of older female patients (n=160) who were seen in a primary care clinic by category of CVH: behaviors and factors*. *Diabetes was defined as either treated by a glucose-lowering medication (intermediate) or not (ideal), since over 90% of data were missing for fasting glucose or hemoglobin A1c.

scholarly journals Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

2020 ◽  
Vol 11 ◽  
pp. 215013272090837
Author(s):  
Elizabeth Gregg ◽  
Carrie Linn ◽  
Emma Nace ◽  
Lillian Gelberg ◽  
Brianna Cowan ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Root Cause ◽  
Preexposure Prophylaxis ◽  
Provider Knowledge ◽  
Improve Access

Objective: Oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV-1 acquisition, yet it is underutilized among at-risk populations. In this pilot quality improvement (QI) initiative, we sought to identify barriers to PrEP implementation and create interventions to improve access to PrEP in a primary care clinic for homeless veterans. Methods: The setting was a large homeless primary care clinic at the Veterans Affairs in an urban area with high HIV prevalence. A root cause analysis was performed to identify barriers to PrEP expansion in the primary care clinic. Targeted interventions to improve provider knowledge and patient access to PrEP were implemented by the QI team. Results: Root cause analysis revealed 3 primary barriers to PrEP expansion in the primary care clinic: institutional limitations for prescribing PrEP, inconsistent screening and recognition of eligible patients by clinic staff, and lack of clinic workflow processes to support PrEP prescription. A multidisciplinary focus group found low levels of PrEP awareness and knowledge, with only 22% of providers reporting comfort discussing PrEP with patients. This improved to 40% of providers following targeted clinic educational interventions. The QI team also developed a pathway for primary care providers to obtain institutional PrEP prescribing privileges and used work groups to develop clinic workflows and protocols for PrEP. At the end of the intervention, at least 50% of primary care providers in the clinic had initiated PrEP in a new patient. Conclusions: We describe a multidisciplinary QI model to implement PrEP within a primary care setting serving Veterans and persons experiencing homelessness. Our program successfully addressed provider knowledge deficits and improved primary care capacity to prescribe PrEP. The primary care clinic can be a viable and important clinical setting to improve access to PrEP for HIV prevention, especially for vulnerable populations.

The relationship between older cancer survivors’ reports of depression, anxiety and pain to health providers’ findings and mortality

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8597-8597
Author(s):  
P. H. Seo ◽  
R. Sloane ◽  
S. S. Ingram ◽  
D. Misra ◽  
E. C. Clipp ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Karnofsky Performance Status ◽  
Depression Scale ◽  
Primary Care Providers ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Health Providers ◽  
Care Providers ◽  
Pain Anxiety

8597 Background: Older cancer survivors may experience psychological distress due to their cancer experience and aging health. This study aimed to compare primary care and specialty providers’ inquiries of pain, depression and anxiety to older cancer survivors’ questionnaire responses. Methods: 153 patients seen in oncology clinics at the Veterans Affairs Medical Center (Durham, NC) from November 1999 until April 2000 completed the Hospital Anxiety and Depression Scale and a pain thermometer questionnaire. Blinded chart review examined health provider inquiries of pain, anxiety and depression. Cox proportional hazards survival analyses were performed on subjective pain, anxiety and depression with comorbidities and Karnofsky performance status (KPS) added in controlled models. Results: Patients were on average aged 68, had 5.4 comorbidities, 87.4% KPS, and were 3.1 years from a cancer diagnosis. Health providers missed 17 of 94 patients with significant levels of self-reported pain (sensitivity 0.82). Although 28 (20.6%) and 33 (25.8%) patients screened positively for depression and anxiety respectively, providers asked 7 patients about anxiety (sensitivity 0.15) and 16 patients about depression (sensitivity 0.25). The overall three year mortality was 37.9%. Pain was not associated with mortality. Patients screening for depression [HR 2.03 (95% CI: 1.03, 4.01)] and anxiety [HR 2.02 (95% CI: 1.01, 4.04)] had lower 3 year survival. KPS and comorbidities diminished these effects. Conclusions: In older cancer survivors, anxiety and depression may have an association with mortality. To improve detection, oncology and primary care providers should routinely inquire about mood and aim to intervene with pharmacologic or supportive treatments. No significant financial relationships to disclose.

scholarly journals Reaching Out to Rural Caregivers and Veterans with Dementia Utilizing Clinical Video-Telehealth

2018 ◽  
Author(s):  
James S. Powers ◽  
Jennifer Buckner
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Mental Health Provider ◽  
Care Providers ◽  
Community Based ◽  
Term Care ◽  
Care Clinic

Context: A clinical video telehealth (CVT) program was implemented improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC’s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician – social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of 1 to 2 CVT encounters originating at their local CBOC lasting 20 to 30 minutes. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient-caregiver pairs, followed for a mean of 15 (1-36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of 8 medications, and resided at a distance of 103 (76-148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusion: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas.

377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A150-A150
Author(s):  
Cassandra Godzik ◽  
Adam Sorscher
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Sleep Medicine ◽  
Quality Metrics ◽  
Care Providers ◽  
National Guidelines ◽  
Daytime Functioning ◽  
Care Clinic

Abstract Introduction Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia. Methods We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months. Results Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%). Conclusion Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting. Support (if any) Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553

How to Diagnose and Manage “Difficult” Patients - Development of a Workshop for Interprofessional Audience

2011 ◽  
Vol 26 (S2) ◽  
pp. 1031-1031
Author(s):  
D. Kljenak
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Community Health Centers ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Pilot Program ◽  
Health Providers ◽  
Care Providers ◽  
Difficult Patients ◽  
Care Clinic

IntroductionMore than 15% of patients who present to a primary care clinic are considered “difficult” yet interprofessional members of primary care clinics receive little training on how to diagnose and manage these patients.ObjectivesBecome familiar with successful method of workshop development on how to diagnose and manage “difficult” patients to interprofessional audience of six community health centers.AimsThe aim of the workshop was to enhance primary care providers’ capacity to diagnose and manage “difficult” patients as well as serve as a pilot program for a larger conference on managing “difficult” patients.MethodsA half-day workshop was designed to fill this perceived need of community health providers to learn how to diagnose and manage “difficult” patients. The workshop consisted of didactic presentation and case based small group learning.This workshop served as a pilot program for the development of larger conference for community providers on managing “difficult” patients.ResultsThe workshop was evaluated by participants. 100% of respondents agreed that the workshop was relevant to their work and 87.5% of respondents reported that the workshop will alter their clinical practice.ConclusionThe workshop has met participants’ perceived learning needs as well as served as a pilot program for a larger conference on managing difficult patients.

Preventing Postpartum Depression in a Pediatric Primary Care Clinic

2014 ◽  
Vol 54 (5) ◽  
pp. 487-490 ◽  
Author(s):  
Julie A. Leis ◽  
Barry S. Solomon ◽  
Kate E. Wasserman ◽  
Tracy N. Carter ◽  
Tamar Mendelson ◽  
...  
Keyword(s):  
Primary Care ◽  
Postpartum Depression ◽  
Primary Care Clinic ◽  
Pediatric Primary Care ◽  
Care Clinic

Physicians' Attitudes toward Disclosure of Genetic Information to Third Parties

1993 ◽  
Vol 21 (2) ◽  
pp. 238-240 ◽  
Author(s):  
Gail Geller ◽  
Ellen S. Tambor ◽  
Barbara A. Bernhardt ◽  
Gary A. Chase ◽  
Karen J. Hofman ◽  
...  
Keyword(s):  
Primary Care ◽  
Genetic Testing ◽  
Genetic Information ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Third Parties ◽  
Care Providers ◽  
Physician Patient Relationship ◽  
Her Family ◽  
Physician Patient

Confidentiality is a cornerstone of the physician-patient relationship. Breaches of confidentiality in the context of genetic testing are of particular concern for a number of reasons. First, genetic testing reveals information not only about a particular patient, but also about his or her family members. Second,genetic testing can label healthy people as “at risk,” subjecting them to possible stigmatization or discrimination by third parties. Third, as genetic testing becomes more widespread and is incorporated into primary care, breaches of confidentiality might inadvertently occur more frequently because primary care providers may not be trained to understand the uniqueness of genetic information. Until now, genetic services have been provided primarily by medical geneticists and genetic counselors. However, with the proliferation of new genetic presymptomatic and carrier tests, primary care physicians are going to become increasingly involved in genetic testing. Currently, little is known about physicians’ attitudes (other than those of medical geneticists) toward disclosure of confidential genetic information to third parties.

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