scholarly journals 849. Impact of a Combined Education and Data Driven Intervention on PrEP Uptake at the Veterans Health Administration

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S514-S515
Author(s):  
Lewis Musoke ◽  
Kristen A Allen ◽  
Kaylee Bray ◽  
Erin J Lea ◽  
Janet Briggs ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Intervention Period ◽  
Post Intervention ◽  
Chi Square ◽  
Pertinent Data ◽  
The Impact

Abstract Background Despite proven efficacy, uptake of pre-exposure prophylaxis (PrEP) for HIV prevention in the US remains suboptimal. Whether electronic medical record (EMR) driven data tools increase PrEP uptake is unknown. Our study sought to understand the impact of education and an EMR data tool to increase PrEP uptake at the Veterans Northeast Ohio Healthcare System (VANEOHS). Methods Using EMR data we identified persons at the VANEOHS with a diagnosis of bacterial Sexually Transmitted Illness (STI) as defined by a positive syphilis, gonorrhea or chlamydia test in the past 6 months. Beginning October 2020 Infectious Diseases (ID) staff launched an intensive PrEP education campaign for Primary care providers (PCP) and the emergency room (ER). During a 6-week intervention period, a ‘PrEP candidacy’ note was placed for the PCP in selected patients’ charts with recommendations for PrEP initiation and STI co-testing if appropriate. We measured the impact of the intervention on PrEP initiations from 3/1/21-5/31/21 and compared it to a pre-intervention period of 7/1/20-9/30/20 when candidates were identified in primary care only. We extracted pertinent data through the EMR and presented descriptive statistics as means and percentages. We compared outcomes using Chi-square test with simulated p-values due to small expected values. Results Forty-two potential PrEP candidates were identified during post-intervention period compared to 6 in the pre-intervention period. The post-intervention candidates included cis-gender women (5/42, 12%) and ER referrals (6/42, 14%), both absent from the pre-intervention cohort. Compared to the pre-intervention period there was an increase in PrEP consults to ID (6 vs. 16; p=0.003) and PrEP starts (4 vs. 9; p=0.04). We observed increased rates of STI (69% vs. 50%) and HIV co-testing (79% vs. 67%) from pre to post intervention but these were not statistically different. Of the 42 candidates, 24 had been identified using the STI data tool. Of these, only 4 were referred for PrEP and none were initiated on PrEP by the end of our observation period. Conclusion The use of the data tool had no direct impact on PrEP uptake. Instead, the doubling of PrEP starts was attributable to education. Further studies are needed to maximize the utility of data tools to increase PrEP uptake. Disclosures All Authors: No reported disclosures

Design Concepts to Support Management of Outpatient Consultations in the Veterans Health Administration

2016 ◽  
Vol 60 (1) ◽  
pp. 1475-1476 ◽  
Author(s):  
Laura Militello ◽  
Julie Diiulio ◽  
Alissa Russ ◽  
April Savoy ◽  
Mindy Flanagan ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Analysis ◽  
Poster Session ◽  
Primary Care Providers ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Design Concepts ◽  
Present Design

This poster describes a project to improve understanding of the challenges associated with managing consultations in the Veterans Health Administration (VHA). We conducted interviews and observations with primary care providers and specialists at two VHA facilities. Using qualitative analysis, we identified cognitive requirements, challenges associated with each, and design seeds. During the poster session, we will present design concepts exploring interventions to support management of consultations.

scholarly journals Addressing Patients’ Veteran Status: Primary Care Providers’ Knowledge, Comfort, and Educational Needs

2018 ◽  
Vol 50 (6) ◽  
pp. 455-459 ◽  
Author(s):  
Bonnie M. Vest ◽  
Jessica Kulak ◽  
Victoria M. Hall ◽  
Gregory G. Homish
Keyword(s):  
Primary Care ◽  
New York ◽  
Military Service ◽  
Primary Care Providers ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Military Population ◽  
Veteran Status ◽  
Health Related

Background and Objectives: The military population is frequently overlooked in civilian primary care due to an assumption that they are treated at the Veterans Health Administration (VA). However, less than 50% of eligible veterans receive VA treatment. Primary care providers (PCPs) may need support in addressing veterans’ needs. This regional pilot study explored the current state of practice among primary care providers as it pertains to assessing patients’ veteran status and their knowledge of and comfort with treating common conditions in this population. Methods: An electronic survey was administered to PCPs (N=102) in Western New York. Survey questions asked about assessing military status, understanding of military-related health problems, and thoughts on the priority of addressing these issues in practice. Data were analyzed using descriptive summary statistics. Results: The majority (56%; n=54) of respondents indicated they never or rarely ask their patients about military service, and only 19% (n=18) said they often or always ask. Seventy-one percent (n=68) of providers agreed or strongly agreed it was important to know if their patient was a veteran. Participants indicated limited knowledge about military stressors, resources available for military populations, and common medical conditions impacting veterans. Conclusions: Our pilot results demonstrate that in a regional sample of primary care providers, providers rarely ask patients about their military history; however, they feel it is important information for patient care. While further study is needed, it may be necessary to provide education, specifically pertaining to military culture and health-related sequelae, to address barriers that may be limiting PCPs’ provision of care for this population.

Evaluating a Pharmacist-Led Intervention on Cardiovascular- and Diabetes-Related Quality Measures in a Primary Care-Based Accountable Care Organization

2020 ◽  
pp. 089719002097774
Author(s):  
Tina Joseph ◽  
Genevieve Hale ◽  
Cynthia Moreau ◽  
Elaina D. Rosario ◽  
Nichelle Logan ◽  
...  
Keyword(s):  
Primary Care ◽  
Statin Therapy ◽  
Diabetes Management ◽  
Quality Measures ◽  
Primary Care Providers ◽  
Care Organization ◽  
Accountable Care ◽  
Care Providers ◽  
Post Intervention ◽  
The Impact

Background: The Centers for Medicare and Medicaid Services (CMS) publishes quality measures to gauge performance in Accountable Care Organizations (ACOs). ACO-27 (Diabetes Mellitus: Hemoglobin A1c Poor Control) and ACO-41 (Diabetes: Eye Exam), are 2 components for the Diabetes Composite measure. ACO-42 focuses on Statin Therapy for the Prevention and Treatment of Cardiovascular (CV) Disease. There are limited studies regarding the pharmacist role in CV and Diabetes Management in the ACO primary care setting. Objective: To evaluate the impact of pharmacist-led interventions on CV- and diabetes-related CMS quality measures within a primary care-based ACO. Methods: This retrospective pre-post intervention study included 3 primary care-based ACO offices. Patients who met eligibility criteria for CMS quality measures ACO-27, -41 and -42 were included. Pharmacist interventions occurred in December 2018. The study co-primary outcomes were the percentage of patient meeting ACO-27/-41 (composite diabetes-related) and -42 (statin-related) CMS quality measures in the pre-intervention compared to the post-intervention phases. Results: Of 105 patients meeting study inclusion criteria, 77.1% were on statin therapy prior to intervention. After pharmacist intervention, the prevalence of patients on statin therapy increased to 80.0% (p = 0.083). All patients had a HbA1c less than 9% pre-intervention. Sixty-one (58.1%) patients had a documented dilated eye exam prior to intervention. Post-intervention, the prevalence of exams increased to 73.3% (p < 0.0005). Conclusions: Pharmacists can assist primary care providers in the ACO setting meet CV- and diabetes-related CMS quality measures, demonstrating the value of the pharmacist in value-based health care settings.

Perceived Effectiveness of Home-Based Primary Care Teams in Veterans Health Administration

2019 ◽  
Vol 60 (3) ◽  
pp. 494-502 ◽  
Author(s):  
Helena Temkin-Greener ◽  
Jill Szydlowski ◽  
Orna Intrator ◽  
Tobie Olsan ◽  
Jurgis Karuza ◽  
...  
Keyword(s):  
Primary Care ◽  
Team Effectiveness ◽  
Primary Care Providers ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Data Set ◽  
Indirect Measure ◽  
Home Based Primary Care ◽  
Home Based

Abstract Background and Objectives Previous studies have shown that staff perception of team effectiveness is related to better health outcomes in various care settings. This study focused on the Veterans Health Administration’s Home-Based Primary Care (HBPC) program. We examined variations in HBPC interdisciplinary teamwork (IDT) and identified modifiable team and program characteristics that may influence staff perceptions of team effectiveness. Research Design We used a broadly validated survey instrument to measure perceived team effectiveness, workplace conditions/resources, group culture, and respondents’ characteristics. Surveys were initiated in January and completed in July, 2016. Methods Team membership rosters (n = 249) included 2,852 IDT members. The final analytical data set included 1,403 surveys (49%) from 221 (89%) teams. A generalized estimating equation model with logit link function, weighted by survey response rates, was used to examine factors associated with perceived team effectiveness. Results Respondents who served as primary care providers (PCPs) were 8% more likely (p = .0044) to view team’s performance as highly effective compared to other team members. Teams with nurse practitioners serving as team leader reported 6% higher likelihood of high-perceived team effectiveness (p = .0234). High team effectiveness was 13% more likely in sites where the predominant culture was characterized as group/developmental, and 7%–8% more likely in sites with lower environmental stress and better resources and staffing, respectively. Conclusions and Implications Team effectiveness is an important indirect measure of HBPC teams’ function. HBPC teams should examine their predominant culture, workplace stress, resources and staffing, and PCP leadership model as part of their quality improvement efforts.

Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: A Qualitative Formative Evaluation of a Web-Based Tool (Preprint)

2021 ◽  
Author(s):  
Sarah Javier ◽  
Justina Wu ◽  
Donna L. Smith ◽  
Fahisa Kanwal ◽  
Lindsey A. Martin ◽  
...  
Keyword(s):  
Primary Care ◽  
Management System ◽  
Formative Evaluation ◽  
Primary Care Providers ◽  
Population Based ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Clinical Workflow ◽  
Web Based

BACKGROUND Cirrhosis, or scarring of the liver, is a debilitating condition affecting millions of U.S. adults. Early identification, linkage to care, and retention in care are critical to preventing severe complications from cirrhosis and death. OBJECTIVE The purpose of this study was to conduct a pre-implementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management. METHODS Semi-structured interviews were conducted with frontline providers in liver disease and primary care clinics at three Veterans Health Administration medical centers. The Consolidated Framework for Implementation Research guided the development of interview guides. Inductive consensus coding was used to analyze transcribed interviews and abstracted coded passages elucidated themes and insights. RESULTS Ten providers were interviewed, including eight physicians and mid-level providers from liver-related specialty clinics and two primary care providers who managed patients with cirrhosis. Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability. CONCLUSIONS P-CIMS shows promise as a powerful tool for identifying, linking, and retaining in care patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in chronic disease populations.

Evaluation of a national telemedicine initiative in the Veterans Health Administration: Factors associated with successful implementation

2016 ◽  
Vol 24 (3) ◽  
pp. 168-178 ◽  
Author(s):  
Lauren Stevenson ◽  
Sherry Ball ◽  
Leah M Haverhals ◽  
David C Aron ◽  
Julie Lowery
Keyword(s):  
Primary Care ◽  
Implementation Research ◽  
Primary Care Providers ◽  
Veterans Health Administration ◽  
Audit And Feedback ◽  
Successful Implementation ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Design Quality

Background The Consolidated Framework for Implementation Research was used to evaluate implementation facilitators and barriers of Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) within the Veterans Health Administration. SCAN-ECHO is a video teleconferencing-based programme where specialist teams train and mentor remotely-located primary care providers in providing routine speciality care for common chronic illnesses. The goal of SCAN-ECHO was to improve access to speciality care for Veterans. The aim of this study was to provide guidance and support for the implementation and spread of SCAN-ECHO. Methods Semi-structured telephone interviews with 55 key informants (primary care providers, specialists and support staff) were conducted post-implementation with nine sites and analysed using Consolidated Framework for Implementation Research constructs. Data were analysed to distinguish sites based on level of implementation measured by the numbers of SCAN-ECHO sessions. Surveys with all SCAN-ECHO sites further explored implementation information. Results Analysis of the interviews revealed three of 14 Consolidated Framework for Implementation Research constructs that distinguished between low and high implementation sites: design quality and packaging; compatibility; and reflecting and evaluating. The survey data generally supported these findings, while also revealing a fourth distinguishing construct – leadership engagement. All sites expressed positive attitudes toward SCAN-ECHO, despite struggling with the complexity of programme implementation. Conclusions Recommendations based on the findings include: (a) expend more effort in developing and distributing educational materials; (b) restructure the delivery process to improve programme compatibility; (c) establish an audit and feedback mechanism for monitoring and improving the programme; (d) engage in more upfront planning to reduce complexity; and (e) obtain local leadership support for providing primary care providers with dedicated time for participation.

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