scholarly journals 1317. Online Simulation-Based Education to Improve Primary Care Providers’ Knowledge About Best Practices in HIV Preexposure Prophylaxis Care

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S402-S403
Author(s):  
Allison Gardner ◽  
David Evans ◽  
Alan McCord ◽  
Douglas Krakower
Keyword(s):  
Primary Care ◽  
Best Practices ◽  
Real Time ◽  
Educational Intervention ◽  
Primary Care Providers ◽  
Clinical Decisions ◽  
Care Providers ◽  
Online Simulation ◽  
Educational Grant ◽  
The Impact

Abstract Background Primary care providers’ (PCPs’) lack of knowledge about and use of pre-exposure prophylaxis (PrEP) represent important barriers to its effective implementation on a national scale. To address these barriers, a collaboration of infectious diseases clinicians, patient advocates, and continuing medical education (CME) specialists developed and tested an educational intervention for PCPs to increase their knowledge about best practices for providing PrEP-related care. Methods An interactive, online CME-accredited simulation prompted PCPs to make clinical decisions about a hypothetical case of a 44-year-old African-American man seeking treatment for rectal gonorrhea who thus had indications for PrEP. The intervention included real-time educational feedback on clinical decisions and an opportunity to revisit suboptimal care decisions after feedback. PCPs were recruited via email and links on CME/patient advocacy websites and public health listservs. Outcomes included proportions of learners selecting correct answers prior to and after receiving feedback on their decisions. Results During October 2017–April 2018, 234 PCPs (88% physicians, 7% NP, 5% PA) completed the simulation for a total of 4,701 unique clinical decisions. Less than half (45%) of PCPs elicited a comprehensive sexual health history to begin the visit, which improved to 83% after feedback. Two-thirds (67%) of PCPs sought permission before asking about sexual behaviors, which increased to 82% after feedback. Nearly one-quarter of PCPs (24%) needed corrective action to nonjudgmentally ask about condom use. Almost all PCPs (91%) identified that PrEP was appropriate for the case patient on their first attempt. However, only 54% of PCPs initially selected all recommended baseline laboratory tests for PrEP; 75% did so after feedback. Of providers recommending PrEP, 29% selected regimens not FDA approved for this indication. Conclusion Many PCPs participating in an online simulation enacted clinical decisions that were inconsistent with best practices for providing PrEP-related care, but hypothetical care decisions improved after real-time educational feedback. Future studies to test the impact of this educational intervention on clinical practices are warranted. Disclosures D. Evans, Project Inform: Employee, Educational grant. A. McCord, Project Inform: Employee, Educational grant. D. Krakower, Gilead Sciences: Grant Investigator, Research grant.

scholarly journals Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
Trever Burgon ◽  
Linda Casebeer ◽  
Holly Aasen ◽  
Czarlota Valdenor ◽  
Diana Tamondong-Lachica ◽  
...  
Keyword(s):  
Primary Care ◽  
Real Time ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
The United States ◽  
Physician Satisfaction ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Care Providers ◽  
Evidence Based Care

BACKGROUND Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. OBJECTIVE In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). METHODS We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians “cared” for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. RESULTS We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, <i>P</i>&lt;.001) and osteoarthritis (+7.6%, <i>P</i>=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, <i>P</i>&lt;.001), depression screening (+11%, <i>P</i>&lt;.001), and asthma medications (+33%, <i>P</i>&lt;.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. CONCLUSIONS Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. CLINICALTRIAL ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901

scholarly journals Measuring and Improving Evidence-Based Patient Care Using a Web-Based Gamified Approach in Primary Care (QualityIQ): Randomized Controlled Trial

10.2196/31042 ◽  
2021 ◽  
Vol 23 (12) ◽  
pp. e31042
Author(s):  
Trever Burgon ◽  
Linda Casebeer ◽  
Holly Aasen ◽  
Czarlota Valdenor ◽  
Diana Tamondong-Lachica ◽  
...  
Keyword(s):  
Primary Care ◽  
Real Time ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
The United States ◽  
Physician Satisfaction ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Care Providers ◽  
Evidence Based Care

Background Unwarranted variability in clinical practice is a challenging problem in practice today, leading to poor outcomes for patients and low-value care for providers, payers, and patients. Objective In this study, we introduced a novel tool, QualityIQ, and determined the extent to which it helps primary care physicians to align care decisions with the latest best practices included in the Merit-Based Incentive Payment System (MIPS). Methods We developed the fully automated QualityIQ patient simulation platform with real-time evidence-based feedback and gamified peer benchmarking. Each case included workup, diagnosis, and management questions with explicit evidence-based scoring criteria. We recruited practicing primary care physicians across the United States into the study via the web and conducted a cross-sectional study of clinical decisions among a national sample of primary care physicians, randomized to continuing medical education (CME) and non-CME study arms. Physicians “cared” for 8 weekly cases that covered typical primary care scenarios. We measured participation rates, changes in quality scores (including MIPS scores), self-reported practice change, and physician satisfaction with the tool. The primary outcomes for this study were evidence-based care scores within each case, adherence to MIPS measures, and variation in clinical decision-making among the primary care providers caring for the same patient. Results We found strong, scalable engagement with the tool, with 75% of participants (61 non-CME and 59 CME) completing at least 6 of 8 total cases. We saw significant improvement in evidence-based clinical decisions across multiple conditions, such as diabetes (+8.3%, P<.001) and osteoarthritis (+7.6%, P=.003) and with MIPS-related quality measures, such as diabetes eye examinations (+22%, P<.001), depression screening (+11%, P<.001), and asthma medications (+33%, P<.001). Although the CME availability did not increase enrollment in the study, participants who were offered CME credits were more likely to complete at least 6 of the 8 cases. Conclusions Although CME availability did not prove to be important, the short, clinically detailed case simulations with real-time feedback and gamified peer benchmarking did lead to significant improvements in evidence-based care decisions among all practicing physicians. Trial Registration ClinicalTrials.gov NCT03800901; https://clinicaltrials.gov/ct2/show/NCT03800901

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.

The Impact of Primary Care Providers’ Bias on Depression Screening for Lesbian Women

2021 ◽  
pp. 152483992110660
Author(s):  
Shuying Sha ◽  
Mollie Aleshire
Keyword(s):  
Primary Care ◽  
Statistical Tests ◽  
Secondary Analysis ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Lesbian Women ◽  
Care Providers ◽  
Explicit Bias ◽  
Implicit And Explicit ◽  
The Impact

Primary care providers’ (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs’ implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs’ implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs ( n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women ( p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers’ awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

scholarly journals A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

2021 ◽  
Vol 53 (10) ◽  
pp. 843-856
Author(s):  
Constance Gundacker ◽  
Tyler W. Barreto ◽  
Julie P. Phillips
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Health Outcomes ◽  
Primary Care Providers ◽  
The United States ◽  
Traumatic Experiences ◽  
Search Term ◽  
Care Providers ◽  
Trauma Informed ◽  
The Impact

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

Improving Primary Care Access to Respirologists Using eConsult

2021 ◽  
Author(s):  
Jean-Grégoire Leduc ◽  
Erin Keely ◽  
Clare Liddy ◽  
Amir Afkham ◽  
Misha Marovac ◽  
...  
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Nurse Practitioners ◽  
Clinical Course ◽  
Primary Care Providers ◽  
Clinical Question ◽  
Care Providers ◽  
Provider Perspectives ◽  
Course Of Action ◽  
The Impact

Abstract Background: Patients and primary care providers (PCP) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7 days. Methods: This is a retrospective review of the Champlain BASETM respirology eConsults from January 2017 to December 2018. The eConsults were categorized by types of question asked by the referring provider, and by the clinical content of the referral. Specialists’ response time and time spent answering the clinical question was analyzed. Referring providers close out surveys were reviewed to assess the impact of the respirology eConsult service on traditional referral rates and clinical course of action. Results: Of the 26,679 cases submitted to the Champlain BASE TM eConsult service 268 were respirology cases (1%). 91% were sent by family physicians, 9% by nurse practitioners. The median time to respond by specialists was 0.8 days, and the median time billed by specialists was 20 minutes. The most common topics were pulmonary nodules and masses (16.4%), cough (10.4%), infective problems (8.6%), COPD (8.6%) and dyspnea NYD (7.8%). The most common types of question asked by PCP were related to investigations warranted (43.1% of cases), general management (17.5%), monitoring (12.6%), need for a respirology referral (12.3%), and drug of choice (6.3%). In 23% of cases the PCP indicated they were planning to refer the patient and no longer need to (avoided referrals) and in 13% of cases the PCP was not going to refer but did after receiving the eConsult advice (prompted referrals). The eConsult led to a new or additional clinical course of action by the PCP in 49% of cases. In 51% of cases the PCP suggested the clinical topic would be well suited to a CME event. Conclusions: Participation in eConsult services can improve timely access to respirologists while potentially avoiding clinic visit and significantly impacting referring PCPs clinical course of action. Using the most common clinical topics and types of question for CME planning should be considered. Future research may include a cost analysis, and provider perspectives on the role of eConsult in respirology care.

scholarly journals Mobile Self-Monitoring ECG Devices to Diagnose Arrhythmia that Coincide with Palpitations: A Scoping Review

Healthcare ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 96 ◽  
Author(s):  
Hannah Ramsden Marston ◽  
Robin Hadley ◽  
Duncan Banks ◽  
María Del Carmen Miranda Duro
Keyword(s):  
Primary Care ◽  
Mobile Devices ◽  
Scoping Review ◽  
Care Pathway ◽  
Primary Care Providers ◽  
Positive Trend ◽  
Care Providers ◽  
Heart Monitoring ◽  
The Impact ◽  
Monitoring Devices

The use and deployment of mobile devices across society is phenomenal with an increasing number of individuals using mobile devices to track their everyday health. However, there is a paucity of academic material examining this recent trend. Specifically, little is known about the use and deployment of mobile heart monitoring devices for measuring palpitations and arrhythmia. In this scoping literature review, we identify the contemporary evidence that reports the use of mobile heart monitoring to assess palpitations and arrhythmia across populations. The review was conducted between February and March 2018. Five electronic databases were searched: Association for Computing Machinery (ACM), CINHAL, Google Scholar, PubMed, and Scopus. A total of 981 records were identified and, following the inclusion and exclusion criteria, nine papers formed the final stage of the review. The results identified a total of six primary themes: purpose, environment, population, wearable devices, assessment, and study design. A further 24 secondary themes were identified across the primary themes. These included detection, cost effectiveness, recruitment, type of setting, type of assessment, and commercial or purpose-built mobile device. This scoping review highlights that further work is required to understand the impact of mobile heart monitoring devices on how arrhythmias and palpitations are assessed and measured across all populations and ages of society. A positive trend revealed by this review demonstrates how mobile heart monitoring devices can support primary care providers to deliver high levels of care at a low cost to the service provider. This has several benefits: alleviation of patient anxiety, lowering the risk of morbidity and mortality, while progressively influencing national and international care pathway guidelines. Limitations of this work include the paucity of knowledge and insight from primary care providers and lack of qualitative material. We argue that future studies consider qualitative and mixed methods approaches to complement quantitative methodologies and to ensure all actors’ experiences are recorded.

Is the Far West Mental Health Integration Project Making a Difference? The General Practitioner Perspective

2005 ◽  
Vol 11 (3) ◽  
pp. 32 ◽  
Author(s):  
David Perkins ◽  
David Lyle
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Care Providers ◽  
Care Staff ◽  
Care Providers ◽  
Community Based ◽  
Mental Health Integration ◽  
Integration Project ◽  
The Impact

This paper reports on the evaluation of an Australian Government and NSW State funded Mental Health Integration Project in remote far western NSW. The project was part of the Mental Health Integration Program, developed from the Second National Mental Health Plan. The project implemented a model of community-based mental health services and used innovative financing arrangements to allow the provision of community-based specialist mental health teams to remote communities and to recruit visiting psychiatrists to support the local primary care providers. The evaluation strategy included a survey of general practitioners (GPs) in the Upper Western Sector and Broken Hill, designed to investigate their level and type of contact with psychiatrists and community-based specialist mental health care teams, their perceptions about the impact of the new services, and their interest in further professional development in mental health care.The project has shown that visiting specialists can be deployed in a primary care setting with a focus on meeting the needs of local GPs, primary health care staff and their patients.

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