1318. Are We PrEPared? Awareness and Prescribing Patterns of HIV Pre-Exposure Prophylaxis (PrEP) by Internal Medicine Resident Physicians at an Academic Medical Center

Abstract Background HIV PrEP uptake remains low by primary care physicians, amongst whom increased awareness has been positively associated with its adoption. Prior studies have also revealed deficits in knowledge and comfort providing PrEP amongst internal medicine (IM) trainees. This is among the first reports of assessing PrEP uptake by IM residents; this appears to be the first examining pre- and post-instruction assessment of prescribing attitudes following a single lecture on the topic. Methods An anonymous, online survey was distributed to all IM residents at our institution to measure baseline PrEP awareness and prescribing patterns. A comprehensive PrEP lecture was formulated with assistance from infectious diseases (ID) faculty; focus was paid to addressing concerns about cost, safety, risk behavior compensation, and drug resistance. The lecture was made available electronically to those unable to attend the live session. PrEP knowledge and prescribing attitudes were measured and compared pre- and post-lecture. Fisher’s exact test was used for descriptive statistics. Results Of 97 initial surveys distributed, 41 were completed. A majority of respondents were aware of PrEP (68%). A modest number had either prescribed PrEP or referred a prospective patient to an ID specialist in the prior year (15%). The majority preferred to learn about PrEP with a dedicated didactic session (76%). Compared with baseline data, following the lecture, residents were better able to identify both the number of daily pills required (100% vs. 49%, P = 0.007) and the proper medication regimen (100% vs. 49%, P = 0.007); there was no significant difference in self-reported comfort with providing PrEP (89 vs. 65%, P = 0.25). In the post-lecture survey, nearly half reported a preference to refer a PrEP candidate to an ID specialist or PrEP clinic (43%). Conclusion These findings suggest value in providing PrEP education to IM trainees, but indicate that a single lecture may not be effective for ultimately improving its adoption by this important group of physicians. Determining the optimal method for incorporating PrEP into residency curricula deserves further study. Despite efforts to expand PrEP into the realm of primary care, many of these physicians may continue to defer management of these patients to ID/HIV clinicians. Disclosures All authors: No reported disclosures.

Download Full-text

864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1059 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S523-S524

Author(s):

Genevieve Allen ◽

Jamie Riddell

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Family Medicine ◽

Hiv Testing ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Providers ◽

Care Providers ◽

Academic Medical ◽

Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

Download Full-text

Effect of Regional Medical Campus Education on Student Pursuit of Primary Care Specialties

Journal of Regional Medical Campuses ◽

10.24926/jrmc.v1i1.1002 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Casey P. Collins ◽

John F. McCarthy

Keyword(s):

Primary Care ◽

Residency Program ◽

Primary Care Physicians ◽

Medical Center ◽

Academic Medical Center ◽

Care Physician ◽

University Of Washington ◽

Primary Care Residency ◽

Regional Medical ◽

Primary Care Specialty

Purpose To investigate whether education at a regional medical campus (RMC) affects the likelihood of University of Washington School of Medicine (UWSOM) students choosing a primary care specialty. Method Two approaches were taken to answer the study question. First, the percentage of UWSOM students who matched to a primary care residency program between 1996-2016 was compared between two groups of students: those educated at an RMC and those educated at the academic medical center (a non-RMC). Second, physician specialty data was obtained from the AMA Physician Masterfile for UWSOM graduates from 1996-2011. Physicians were again split into RMC and non-RMC groups, and the percentage of primary care physicians was compared between the two groups. This study was completed in 2016. Results Among graduates from 1996-2016, 33% (564/1707) of those educated at an RMC were matched to a primary care residency program compared to 39% (787/2003) of students educated at the non-RMC (P < 0.001). Graduates from 1996-2011 had similar likelihoods of becoming a primary care physician regardless of first year education site (37% [395/1078] versus 39% [551/1403], P = 0.18, Figure 2). Conclusions The results of this study did not support the hypothesis that the WWAMI RMCs produce more primary care physicians than the non-RMC. A greater percentage of students who attended the non-RMC matched into a primary care residency program compared to the RMC group, while the percentage of students who ultimately chose a primary care specialty was quite similar. Financial support: Mr. Collins was supported in part for this study by the Smith Family Endowed Chair in Medicine. Ethical Approval: The University of Washington Institutional Review Board approved the acquisition and analysis of subject data. Application #52065. Approval date 5/24/2016.

Download Full-text

Practice, Preferences, and Practical Tips From Primary Care Physicians to Improve the Care of Cancer Survivors

Journal of Oncology Practice ◽

10.1200/jop.18.00740 ◽

2019 ◽

Vol 15 (7) ◽

pp. e600-e606 ◽

Cited By ~ 4

Author(s):

Allison L. McDonough ◽

Julia Rabin ◽

Nora Horick ◽

Yvonne Lei ◽

Garrett Chinn ◽

...

Keyword(s):

Primary Care ◽

Cancer Survivorship ◽

Primary Care Physicians ◽

Care Delivery ◽

Medical Center ◽

Academic Medical Center ◽

Late Complications ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans

PURPOSE: There is a need to improve the coordination of care and communication between primary care physicians (PCPs) and oncology after completion of initial cancer treatment. We sought to evaluate PCP experiences and perspectives in cancer survivorship and to identify practical opportunities to improve care within an integrated health care system with a shared electronic health record (EHR). METHODS: We conducted a self-administered, anonymous, electronic survey of PCPs in practices affiliated with an academic medical center to evaluate practices, the sense of preparedness, and preferences in the delivery of survivorship care and communication with oncology. RESULTS: One hundred seventeen of 225 PCPs responded (response rate, 52%). A majority were engaged in survivorship care, with 94% reporting managing psychological sequelae of cancer, 84% managing chronic physical complications, 71% screening for cancer recurrence, and 60% screening for late complications. However, few PCPs felt prepared to manage these issues: 65% felt unprepared to screen for late complications, and 36% felt unprepared to screen for recurrence. Common barriers to survivorship care were uncertainty about delegation of responsibility (73%) and a lack of training (72%). PCPs expressed strong interest in survivorship care plans, preferring active tracking of ongoing care needs and delegation of care responsibility in the EHR active problem list over traditional summary documents. CONCLUSION: Most PCPs are engaged in cancer survivorship care but report barriers to optimal care delivery. Opportunities to improve care could include targeted education to increase preparedness to deliver survivorship care, and optimization of communication among providers, including active survivorship care plans in the EHR.

Download Full-text

Pediatric primary care and subspecialist providers’ comfort, attitudes and practices screening and referring for social determinants of health

BMC Health Services Research ◽

10.1186/s12913-021-06975-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yonit Lax ◽

Eleanor Bathory ◽

Sandra Braganza

Keyword(s):

Primary Care ◽

Low Income ◽

Primary Care Physicians ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Providers ◽

Pediatric Primary Care ◽

Care Providers ◽

Low Income Children ◽

Academic Medical

Abstract Background Early detection and management of poverty-related disorders is a recommended pediatric practice; however, little is known about variations of practice between pediatric primary care physicians and subspecialists. The objectives of this study were to assess (1) provider perceptions and attitudes toward caring for low-income children in an urban academic medical center, and (2) variations between primary care physicians and subspecialists in social and financial needs screening and referral practices for low-income children. Design/Methods Primary care providers (pediatric and family medicine) and subspecialists providing direct patient care in an urban academic medical center (response rate = 24 %, n = 85/356) completed a 24-item survey (adapted with permission from the AAP Periodic Survey of Fellows No.90) assessing feasibility and comfort screening and addressing social and financial needs, rates of screening for financial hardship, and referrals to local resources. Chi-square tests were performed. Results Among respondents, 88 % (75/85) reported comfort caring for low-income children, while 28 % (24/85) reported comfort inquiring about social and financial needs and 34 % (29/85) referring to community resources. Primary care providers more commonly than subspecialists screened for childcare (80 % vs. 59 %, p = 0.04), parental: employment (84 % vs. 59 %, p = 0.01), education (40 % vs. 17 %, p = 0.02) and mental health (86 % vs. 46 %, p = 0.0001), and less commonly screened for transportation (47 % vs. 73 %, p = 0.01). Primary care providers more commonly referred for public health insurance (74 % vs. 39 %, p = 0.001), public food assistance (30 % vs. 12 %, p = 0.04), and adult mental health services (65 % vs. 44 %, p < 0.05). Conclusions In an urban academic institution serving a population with high poverty rates, pediatric providers feel comfortable providing medical care for low-income children but lack comfort screening and addressing SDH. Though most feel it is their job to refer to resources, less than half felt it was feasible to screen for or address financial needs. Pediatric primary care providers report higher rates of screening and referring than subspecialists. Understanding variations in practice and perceptions among primary care providers and subspecialists may aid in creating interventions to increase screening and referral rates.

Download Full-text

Reducing the Pain Behind Opioid Prescribing in Primary Care

Pain Medicine ◽

10.1093/pm/pnz365 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1377-1384

Author(s):

José Luis González ◽

Radhika Prabhakar ◽

Jennifer Marks ◽

Cheryl L P Vigen ◽

Jagruti Shukla ◽

...

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Medical Center ◽

Academic Medical Center ◽

Primary Care Clinic ◽

High Dose ◽

Care Clinic ◽

Opioid Prescribing ◽

Number Of Patients ◽

Primary Care Resident

Abstract Objective To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic. Design Retrospective observational study. Setting Internal medicine primary care resident clinic at a large urban academic medical center. Subjects All patients receiving opioid prescriptions from the primary care clinic. Methods We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed. Results We observed an average monthly reduction of 2.44% (P < 0.001) in the number of prescriptions dispensed and a 1.83% (P < 0.001) monthly reduction in the number of patients receiving prescriptions. Over the two-year period, there was a 74.3% reduction in total MMEs prescribed and a 66.5% reduction in the average MMEs prescribed per patient. Conclusions Our findings demonstrate a significant reduction in opioid prescribing after implementation of a comprehensive initiative. Although our study was observational in nature, we witnessed a nearly threefold decrease in opioid prescribing compared with national trends. Our results offer important insights for other primary care resident clinics hoping to engender safe prescribing practices and curb high-dose opioid prescribing.

Download Full-text

Primary care psychiatry eConsults: Descriptive Analysis of an electronic consultation program in a rural, academic medical center (Preprint)

10.2196/preprints.24650 ◽

2020 ◽

Author(s):

Jade Avery ◽

Dennis Dwan ◽

Gillian Sowden ◽

Matthew Duncan

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Medical Center ◽

Descriptive Analysis ◽

Academic Medical Center ◽

Primary Care Providers ◽

Question Type ◽

High Rate ◽

Care Providers ◽

Academic Medical

BACKGROUND While primary care providers serve a crucial role in addressing the mental health needs of patients, referrals to specialists may be necessary in the treatment of complex psychiatric conditions. Psychiatry electronic consultations (eConsults) can serve as a valuable tool in providing specialist advice for primary care physicians when specialty care is not readily available. OBJECTIVE The goal of this study was to evaluate the content and implementation rate of eConsults by primary care providers in a rural, academic medical center. METHODS This is retrospective review of 343 electronic consults placed between May 2016 and February 2019 by primary care providers at a single academic medical center. Response time and eConsult content, including patient demographics, distance of patient and PCP from consulting provider, consult question type, patient diagnosis, recommendations, and implementation of recommendation, were analyzed. RESULTS The most common diagnoses associated with our eConsults were depression (40.2%) and anxiety (32.3%). The most commonly asked consult question was regarding medication management, including medication choice, dosage, and side effects (83.5%). A majority of recommendations by the consulting psychiatrist were implemented by the PCP (94%). The average time to respond to an eConsult was 26 hours. CONCLUSIONS This study demonstrates that psychiatry eConsults can be conducted in a timely manner and that PCPs implement the recommendations at a high rate.

Download Full-text

Validity and reliability of an adapted questionnaire measuring knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01845-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmad Baihaqi Azraii ◽

Anis Safura Ramli ◽

Zaliha Ismail ◽

Suraya Abdul-Razak ◽

Siti Fatimah Badlishah-Sham ◽

...

Keyword(s):

Primary Care ◽

Work Experience ◽

Primary Care Physicians ◽

Online Survey ◽

Familial Hypercholesterolaemia ◽

Kappa Statistics ◽

Content Validation ◽

Validity And Reliability ◽

Postgraduate Qualification ◽

The Mean

Abstract Background Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP. Methods This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test–retest reliability was tested on 26 PCP using kappa statistics. Results During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p < 0.001. The median percentage awareness score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 15.38), p = 0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (69.2, SD ± 17.62 vs. 54.4, SD ± 19.28), t(128) = 3.79, p < 0.001. KR-20 value was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement). Conclusion This study has proven that the 25-item adapted FH KAP questionnaire is valid and reliable. It can be used to measure and establish FH KAP among PCP in Malaysia.

Download Full-text

Cooking Education Improves Cooking Confidence and Dietary Habits in Veterans

The Diabetes Educator ◽

10.1177/0145721719848429 ◽

2019 ◽

Vol 45 (4) ◽

pp. 442-449 ◽

Cited By ~ 1

Author(s):

Ashley S. Dexter ◽

Janet F. Pope ◽

Dawn Erickson ◽

Catherine Fontenot ◽

Elizabeth Ollendike ◽

...

Keyword(s):

Primary Care ◽

Nutrition Education ◽

Weight Status ◽

Dietary Habits ◽

Medical Center ◽

Laboratory Data ◽

Dietary Quality ◽

Group Setting ◽

Lipid Panel ◽

Significant Difference

Purpose The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes. Methods The sample for this study included 75 veterans within the Overton Brooks Veteran Affairs Medical Center who completed the 12-week class in an in-person group setting in Shreveport, Louisiana, or via Clinical Video Telehealth (CVT) in Longview, Texas. Veterans were referred to the Healthy Teaching Kitchen by their primary care provider or primary care dietitian. Enrollment in the class was on a volunteer basis. The cooking and nutrition education classes included topics such as carbohydrate counting, safety and sanitation, meal planning, and creating budget-friendly recipes. Participants completed 2 questionnaires for assessment of healthy dietary habits and confidence related to cooking. Changes in body weight, lipid panel, and hemoglobin A1C were assessed. Differences in class settings were tested via independent samples t tests. Paired samples t tests were completed to compare changes in mean laboratory results, weight, and questionnaire responses. Results Subjects lost a mean 2.91 ± 5.8 lbs ( P < .001). There was no significant difference in percent change in laboratory data and weight between subjects participating via CVT and subjects in the live class. Overall, there was significant improvement in the confidence questionnaire ratings and Healthy Habits Questionnaire responses. Conclusions Cooking and nutrition education can increase cooking confidence and dietary quality. These results provide support for the need for further research on the long-term effects of nutrition cooking education and for the benefits of using CVT software to provide education to remote facilities.

Download Full-text

1289. Knowledge, Attitudes and Barriers of Pre-exposure Prophylaxis for HIV Infection Among Resident Physicians in Rural, Eastern North Carolina

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1122 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S394-S394

Author(s):

Arianne Morrison ◽

Ciarra Dortche ◽

Nada Fadul

Keyword(s):

Primary Care ◽

North Carolina ◽

Hiv Infection ◽

Sexual Behaviors ◽

Residency Program ◽

Primary Care Physicians ◽

Online Survey ◽

Risky Sexual Behaviors ◽

Resident Physicians ◽

Exposure Prophylaxis

Abstract Background North Carolina bears a high burden of HIV and was ranked number 8 for the number of new infections in 2015. In 2014, the Centers for Disease Control and Prevention (CDC) published updated practice guidelines recommending the use of pre-exposure prophylaxis (PrEP) with daily oral dosing of tenofovir/emtricitabine to help prevent HIV infection in high-risk individuals. However, the use of PrEP in the primary care setting remains low and 1 in three primary care physicians is not aware of PrEP. The objective of our study was to evaluate PrEP knowledge among primary care resident physicians. Methods 149 resident physicians were surveyed at East Carolina University from the following specialties; Internal Medicine, Medicine-Pediatrics, Obstetrics Gynecology and Family Medicine. We collected participants’ age, biological sex, current residency program, and current year within the residency program. Results Sixty out 149 residents completed the online survey. 20% of residents had never heard of PrEP. 17% of residents did not feel comfortable discussing sexual preferences with their patients. 15% of residents thought prescribing would increase risky sexual behaviors and 12% would not prescribe PrEP to patients with multiple sexual partners. Only 3% of residents identified potential side effects of PrEP (e.g., an increase in creatinine levels or decrease in mineral bone density) as a reason to not prescribe PrEP. One resident had ever prescribed PrEP. 83% of residents wanted more information on PrEP and 95% of residents would be willing to prescribe PrEP if educational workshops were offered. Conclusion PrEP is an underutilized tool among resident physicians in Eastern, NC. We identified lack of knowledge of PrEP and concern for increased risky sexual behaviors as barriers to prescribing. Resident physicians require more education on PrEP in order to prescribe it to their patients. Disclosures All authors: No reported disclosures.

Download Full-text