Introduction and Approach to Headache

2021 ◽  
pp. 871-873
Author(s):  
Rashmi B. Halker Singh ◽  
Juliana H. VanderPluym
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
General Population ◽  
Primary Care Providers ◽  
Tension Type Headache ◽  
Care Providers ◽  
Red Flags ◽  
Common Complaint ◽  
Type Headache

Headache is experienced by 93% of men and 99% of women at some time in their lives. It is the most common complaint treated by neurologists and the seventh most common complaint treated by primary care providers. Although most headaches in the general population meet the criteria for tension-type headache, migraine is the most common headache treated in clinical practice and affects 18% of women and 6% of men, typically in their peak years of productivity. Evaluation of headache should include a thorough history and general, musculoskeletal, and neurologic examinations. Paramount in the headache evaluation is the proper identification of red flags that may indicate an underlying secondary cause of headache.

Comparison of Medical Students, Medical School Faculty, Primary Care Physicians, and the General Population on Attitudes toward Psychological Help-Seeking

2002 ◽  
Vol 91 (3_suppl) ◽  
pp. 1268-1272 ◽  
Author(s):  
Lisa D. Smith ◽  
Patrick L. Peck ◽  
Rene J. McGovern
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Medical Students ◽  
General Population ◽  
Help Seeking ◽  
Primary Care Providers ◽  
Psychological Help ◽  
Care Providers ◽  
Medical School Faculty ◽  
School Faculty

This study is a preliminary comparison of the attitudes of osteopathic medical students, medical school faculty, primary care providers, and the general population toward seeking professional psychological help. Attitudes were also studied in the former three groups for those who had and had not previously received mental health services. 103 medical students, 22 faculty, 31 primary care providers, and 395 people from the general population responded to the mail-out survey. Attitudes toward help-seeking were more negative among the general population group than among students and providers. For these students, faculty, and providers, attitudes toward seeking help were more positive if they reported having received mental health services in the past.

scholarly journals Dementia assessment and management in primary care settings: a survey of current provider practices in the United States

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Alissa Bernstein ◽  
Kirsten M. Rogers ◽  
Katherine L. Possin ◽  
Natasha Z.R. Steele ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Management Practices ◽  
Primary Care Providers ◽  
The United States ◽  
Cognitive Testing ◽  
Care Providers ◽  
High Confidence

Abstract Background Primary care providers (PCPs) are typically the first to screen and evaluate patients for neurocognitive disorders (NCDs), including mild cognitive impairment and dementia. However, data on PCP attitudes and evaluation and management practices are sparse. Our objective was to quantify perspectives and behaviors of PCPs and neurologists with respect to NCD evaluation and management. Methods A cross-sectional survey with 150 PCPs and 50 neurologists in the United States who evaluated more than 10 patients over age 55 per month. The 51-item survey assessed clinical practice characteristics, and confidence, perceived barriers, and typical practices when diagnosing and managing patients with NCDs. Results PCPs and neurologists reported similar confidence and approaches to general medical care and laboratory testing. Though over half of PCPs performed cognitive screening or referred patients for cognitive testing in over 50% of their patients, only 20% reported high confidence in interpreting results of cognitive tests. PCPs were more likely to order CT scans than MRIs, and only 14% of PCPs reported high confidence interpreting brain imaging findings, compared to 70% of specialists. Only 21% of PCPs were highly confident that they correctly recognized when a patient had an NCD, and only 13% were highly confident in making a specific NCD diagnosis (compared to 72 and 44% for neurologists, both p < 0.001). A quarter of all providers identified lack of familiarity with diagnostic criteria for NCD syndromes as a barrier to clinical practice. Conclusions This study demonstrates how PCPs approach diagnosis and management of patients with NCDs, and identified areas for improvement in regards to cognitive testing and neuroimaging. This study also identified all providers’ lack of familiarity with published diagnostic criteria for NCD syndromes. These findings may inform the development of new policies and interventions to help providers improve the efficacy of their decision processes and deliver better quality care to patients with NCDs.

scholarly journals When primary care providers and smokers meet: a systematic review and metasynthesis

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Emilie Manolios ◽  
Jordan Sibeoni ◽  
Maria Teixeira ◽  
Anne Révah-Levy ◽  
Laurence Verneuil ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Smoking Cessation ◽  
Clinical Practice ◽  
Smoking Status ◽  
Primary Care Providers ◽  
Care Providers ◽  
The Core ◽  
Primary Care Settings

AbstractPrimary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients’ motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.

HealthPathways: a detailed analysis of utilisation trends in the northern Sydney region

2020 ◽  
Vol 26 (4) ◽  
pp. 338
Author(s):  
Kimberly E. Lind ◽  
Mikaela Jorgensen ◽  
Chanelle Stowers ◽  
Martyn Brookes
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Clinical Practice ◽  
Detailed Analysis ◽  
Primary Care Providers ◽  
Interquartile Range ◽  
Descriptive Statistics ◽  
Care Providers ◽  
Search Terms ◽  
Mean Time

This study developed a model for using Google Analytics (GA) data to evaluate utilisation trends of the Sydney North HealthPathways portal. HealthPathways GA data merged with dates of page localisations and promotional events from March 2017 through June 2018 were analysed to evaluate engagement and use of HealthPathways, integration into clinical practice and how HealthPathways is used. Descriptive statistics and plots were generated for each clinical stream and page for the number of users per month (total, new and return users), mean time on page, navigation and search terms. The number of page views, new users and return users increased during the study period. Each clinical stream had between 26 and 2508 views, with a median of 199 views (interquartile range 84–461 views). Individual pages had 0–12388 total views. Return users visited seven times on average. Most usage occurred between mid-morning and mid-afternoon. Diabetes was the most frequently viewed and searched clinical stream, followed by palliative care. These streams had the greatest number of promotional events. Increasing use of and interaction with HealthPathways suggests that it is a useful tool to support clinical practice among northern Sydney primary care providers.

Wernicke–Korsakoff syndrome: Focus on low-threshold diagnosis and prompt treatment in the primary care setting

2019 ◽  
Vol 54 (3) ◽  
pp. 172-180 ◽  
Author(s):  
Christopher Yoon ◽  
Joanna Gedzior ◽  
Dwayne DePry
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
General Population ◽  
Alcohol Abuse ◽  
Primary Care Providers ◽  
Care Providers ◽  
Prompt Treatment ◽  
The Past ◽  
Korsakoff Syndrome ◽  
Low Threshold

The authors present the case of an inpatient hospitalized at the Veterans Affairs psychiatric unit diagnosed with Wernicke–Korsakoff syndrome to promote awareness of this prevalent yet often underdiagnosed and undertreated condition. Although Veterans present with a unique predisposition for alcohol abuse, it remains problematic in the general population as well. Analysis from 2000 to 2003 reveals alcohol use in the past month in Veterans at 56.6% and 50.8% in comparable non-Veterans. According to the National Survey on Drug Use and Health, it is estimated that of those who are 18 and older, 86.4% have used alcohol, 26.9% have engaged in binge drinking in the past month, 7% engaged in heavy alcohol use in the past month, and 6.2% (15.1 million) carried the diagnosis of alcohol use disorder., The lifetime prevalence of alcohol abuse in the general population is estimated to be between 4.5% and 13.2%. Primary care providers should maintain a high degree of vigilance in evaluating patients for timely diagnosis and prompt treatment of those suspected to have thiamine deficiency. Indeed, Wernicke’s encephalopathy carries a significant level of morbidity and mortality associated with the syndrome, even in cases when it does not present with all of the classic signs. This article aims to raise the primary and ambulatory care provider’s ability to recognize the condition, emphasize a low threshold to treat, and highlight current treatment recommendations.

Perceived Barriers and Facilitators to the use of Point-of-Care Ultrasound for Clinicians in Oregon

POCUS Journal ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 20-21
Author(s):  
Camellia Dalai, MD ◽  
Renee K. Dversdal, MD
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Point Of Care ◽  
Primary Care Providers ◽  
Perceived Barriers ◽  
Survey Study ◽  
Point Of Care Ultrasound ◽  
Care Providers ◽  
Qualitative Survey ◽  
Perceptions And Attitudes

The use of Point-of-Care Ultrasound (POCUS) to provide clinical data beyond the history and physical examination is a relatively new practice for primary care providers and hospitalists. It takes many hours of dedicated ultrasound (US) training and practice to achieve POCUS proficiency; further, perceptions and attitudes of clinicians play a major role in adopting POCUS into daily clinical repertoire [1, 2]. Thus there are many possible barriers that could impede a clinician’s ability to develop the skillset to use POCUS in clinical practice. The state of Oregon encompasses vast rural and underserved areas where POCUS could be a useful resource to improve local patient care [3,4]. For this reason, a qualitative survey study was conducted to assess the perceived barriers of clinicians to the clinical incorporation of POCUS.  

scholarly journals Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses

2018 ◽  
Vol 32 (8) ◽  
pp. 1730-1739 ◽  
Author(s):  
Scott P. Stumbo ◽  
Bobbi Jo H. Yarborough ◽  
Micah T. Yarborough ◽  
Carla A. Green
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Population ◽  
Behavioral Health ◽  
Preventive Care ◽  
Preventive Health Care ◽  
Primary Care Providers ◽  
Safety Net ◽  
Mental Illnesses ◽  
Care Providers

Purpose: Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Design: Cross-sectional; mixed methods. Setting: An integrated health system and a network of federally qualified health centers and safety net clinics. Participants: Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Measures: Semi-structured interviews and surveys. Analysis: Thematic analysis for qualitative data; frequencies for quantitative data. Results: More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients’ chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Conclusions: Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician–patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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