scholarly journals 1109. Factors Impacting the Decision to Order Stool Diagnostic Testing in Patients With Acute Gastroenteritis Among Primary Care Providers

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S332-S333
Author(s):  
Sean O’Leary ◽  
Mandy Allison ◽  
Cristina V Cardemil ◽  
Laura Hurley ◽  
Lori Crane ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Gastroenteritis ◽  
Pathogen Detection ◽  
Immunocompromised Patient ◽  
Diagnostic Testing ◽  
Primary Care Providers ◽  
Care Providers ◽  
Risk Area ◽  
High Risk Area ◽  
History Of

Abstract Background Diagnostic options for stool pathogens are evolving and expanding rapidly. The majority of acute gastroenteritis (AGE) patients seeking medical care are seen by primary care providers (PCPs), and stool testing may not be performed as AGE is generally self-limited. Little is known about how PCPs decide for which patients to order testing. Our objective was to describe among PCPs factors affecting the decision of whether to order stool diagnostic testing for pathogen detection in patients with AGE symptoms in the outpatient setting. Methods A national survey was conducted from January to March 2018 among primary care pediatricians (Peds), family physicians (FP), and internists (GIM). Results The response rate was 50% (689/1,383; Peds 59% [275/466], FP 49% [226/461], GIM 41% [188/456]). Factors most often reported as greatly increasing the likelihood of testing that did not differ significantly between specialties included patient history of travel to a high-risk area (75% Peds, 71% FP, 72% GIM), immunocompromised patient (Peds 67%, FP 60%, GIM 69%), and clinical suspicion of a pathogen that can be treated with antibiotics or antiparasitics (Peds 63%, FP 56%, GIM 65%). Factors with significant differences between specialties that were most often reported as greatly increasing likelihood of testing included presence of blood in stool (Peds 76%, FP 58%, GIM 48%, P < 0.0001), history of recent antibiotic use (Peds 31%, FP 66%, GIM 72%, P < 0.0001), history of recent hospitalization (Peds 29%, FP 61%, GIM 64%, P < 0.0001), consideration of inpatient admission (Peds 36%, FP 57%, GIM 56%, P < 0.0001), and fever ≥38.5 C (Peds 13%, FP 27%, GIM 40%, P < 0.0001). Factors most often reported as greatly decreasing the likelihood of testing included presence of vomiting without diarrhea (Peds 49%, FP 43%, GIM 50%) and presence of vomiting and diarrhea together (Peds 12%, FP 7%, GIM 9%). Conclusion Physicians rely on a variety of factors when considering diagnostic testing for stool pathogens in AGE, with recent travel, caring for an immunocompromised patient, and antibiotic/antiparasitic treatment decisions often reported as increasing the likelihood of testing. Consideration of the clinical presentation and most common AGE pathogens by age group may be driving some of the differences between specialties. Disclosures All authors: No reported disclosures.

Barriers To Diagnosis In Myeloproliferative Neoplasms

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5248-5248
Author(s):  
Raymond H L Yip ◽  
Lynda M Foltz
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Primary Care Physicians ◽  
Myeloproliferative Neoplasms ◽  
Diagnostic Testing ◽  
Primary Care Providers ◽  
Care Providers ◽  
Average Delay ◽  
Delay In Diagnosis ◽  
Hemorrhagic Complications

Abstract Background Timely diagnosis of patients (pts) with polycythemia vera (PV) and essential thrombocythemia (ET) is important given the risks of thrombotic and hemorrhagic complications, disease progression and associated symptoms.  Pts often present initially to primary care physicians, who may have limited previous experience with PV/ET given the low prevalence.  Little is known about the timeliness of referral or diagnostic testing after identification of abnormal blood test results or if delays in diagnosis affect patient outcomes. Objectives To determine the time from initial lab abnormality to referral, diagnosis and treatment of pts with PV and ET. Methods Pts at a single Canadian academic institution newly diagnosed with PV or ET from Jan 2010 to May 2013 were identified.  Retrospective data was collected including demographics, lab values, diagnostic testing and treatments. Results Demographics: 26 pts with PV and 34 with ET were identified.  Median age was 67.5 (44-89) y for PV and 66.5 (34-92) y for ET. Delay in Referral and Diagnosis: 98% of pts were referred directly to a hematologist by their primary care physician.  69% of PV pts were referred within 30 days and 92% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 98 (0-221) days.  41% of ET pts were referred within 30 days and 56% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 121 (8-638) days.  PV pts were referred sooner, median 20 (0-187) days, than ET pts, median 67 (0-3743) days (p=0.01).  The median delay from referral until hematology assessment was 51 days for PV compared to 78 days for ET (p=0.08).  After assessment by the hematologist, it required a median of 35 days to make a diagnosis of PV and 25 days for a diagnosis of ET (p=0.31). Referrals by platelet (plt) count: There was a trend to earlier referral of ET pts with higher platelet (plt) counts.  15/20 (75%) ET pts with plt count >600 were referred within 90 days of initial lab abnormality whereas only 4/14 (29%) of pts with plt count 450-600 were referred within 90 days (p=0.056). Treatment of PV pts: 22/26 (85%) pts received phlebotomy at or after referral at the direction of a hematologist.  Average delay in referral (and phlebotomy initiation) for patients treated with phlebotomy was 32 days.  13/26 (50%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 142 days.   11/26 (42%) pts were receiving ASA prior to the initial hematological consultation.  12/26 (46%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 90 days in this subgroup. Treatment of ET pts: 8/34 (24%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 790 days. 17/34 (50%) pts were receiving ASA prior to the initial hematological consultation.  15/34 (44%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 355 days in this subgroup. No thrombotic or major hemorrhagic complications occurred in any PV/ET pts between the time of initial lab abnormality and diagnosis. Discussion This study demonstrates the marked variability in time from lab abnormality to referral and diagnosis for PV/ET pts.  Primary care providers were more likely to promptly refer PV pts than ET pts, and particularly tended to overlook referral and investigation of pts with modestly elevated plt counts of 450-600.  This is a concern, as risk of thrombosis in ET pts is independent of plt count.  Delays were also apparent in wait times for hematology appointments and subsequent diagnostic tests.   The delay in diagnosis led to a delay in initiation of therapy to reduce risk of thrombosis in both PV and ET pts.  Possible strategies to expedite diagnosis include targeted education of primary care physicians focusing on identification of lab features of PV/ET.  Directive comments on lab reports by community hematopathologists may also facilitate prompt referral and investigation. Disclosures: No relevant conflicts of interest to declare.

Inpatient infusion treatments of headache in patients with chronic migraine and a reported history of head trauma and endocrine co-morbidities

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S14.2-S14
Author(s):  
Nina Yakovlevna Riggins ◽  
Henna Sawhney ◽  
Annika Ehrlich ◽  
Mira Parekh ◽  
Morris Levin
Keyword(s):  
Primary Care ◽  
Chronic Migraine ◽  
Head Trauma ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Infusion Therapy ◽  
Case Conference ◽  
Care Providers ◽  
Lifestyle Modifications ◽  
History Of

ObjectiveTo evaluate if inpatient infusion treatments for patients with chronic migraine (CM) and history of head trauma and endocrine abnormalities can lead to headache improvement.BackgroundMany patients with CM and history of head trauma have endocrine co-morbidities that can interfere with successful management of headache. In this study, we evaluated if inpatient infusion treatments improved headache outcomes for this patient population.Design/MethodsRetrospective chart review of patients admitted and treated with 4–5 days of intravenous (IV) Dihydroergotamine (DHE), Chlorpromazine, or Valproate for headache. All cases were presented at the Headache Center Case Conference before admission, and plans for addressing co-morbidities were discussed with appropriate specialists and primary care providers. Co-morbidities addressed included diabetes mellitus, pituitary and thyroid dysfunction and endometriosis. During admission, vital signs and appropriate lab work such as serum glucose, thyroid, liver and renal function were monitored. Lifestyle recommendations provided during admission and appropriate follow ups after discharge were arranged with Headache Clinic, primary care, and specialists, when applicable.Results53 patients with CM were included in the analysis. 12 (22.6%) of the 53 patients had both reported history of head trauma and endocrine comorbidity. Of these 12 patients, 8 (66.7%) had improvement in headache up to 6 weeks after admission. Of the 8 that improved, 6 (75%) received DHE and 2 (25%) received Chlorpromazine.ConclusionsInpatient infusion treatments for patients who have CM with history of head trauma and endocrine abnormalities can lead to headache improvement, potentially due to IV infusion therapy along with holistic approaches which include addressing co-morbidities and education on lifestyle modifications. Future studies are needed to evaluate if specific endocrine system dysfunction can predict outcomes from repetitive infusion therapy for persistent headache in patients with CM and a reported history of head trauma.

scholarly journals Characteristics of men and women with diabetes

2021 ◽  
Author(s):  
Enza Gucciardi ◽  
Shirley Chi-Tyan Wang ◽  
Lisa Amaral ◽  
Donna E. Stewart
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Diabetes Education ◽  
Primary Care Providers ◽  
Self Management ◽  
Care Providers ◽  
Family History Of Diabetes ◽  
Men And Women ◽  
History Of

OBJECTIVE To determine whether men and women with type 2 diabetes have different psychosocial, behavioural, and clinical characteristics at the time of their first visit to a diabetes education centre. DESIGN A questionnaire on psychosocial and behavioural characteristics was administered at participants’ first appointments. Clinical and disease-related data were collected from their medical records. Bivariate analyses (χ2 test, t test, and Mann-Whitney test) were conducted to examine differences between men and women on the various characteristics. SETTING Two diabetes education centres in the greater Toronto area in Ontario. PARTICIPANTS A total of 275 men and women with type 2 diabetes. RESULTS Women were more likely to have a family history of diabetes, previous diabetes education, and higher expectations of the benefits of self-management. Women reported higher levels of social support from their diabetes health care team than men did, and had more depressive symptoms, higher body mass, and higher levels of high-density lipoprotein cholesterol than men did. CONCLUSION The results of this study provide evidence that diabetes prevention, care, and education need to be targeted to men and women differently. Primary care providers should encourage men to attend diabetes self-management education sessions and emphasize the benefits of self-care. Primary care providers should promote regular diabetes screening and primary prevention to women, particularly women with a family history of diabetes or a high body mass index; emphasize the importance of weight management for those with and without diabetes; and screen diabetic women for depressive symptoms.

scholarly journals Characteristics of men and women with diabetes

2021 ◽  
Author(s):  
Enza Gucciardi ◽  
Shirley Chi-Tyan Wang ◽  
Lisa Amaral ◽  
Donna E. Stewart
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Diabetes Education ◽  
Primary Care Providers ◽  
Self Management ◽  
Care Providers ◽  
Family History Of Diabetes ◽  
Men And Women ◽  
History Of

OBJECTIVE To determine whether men and women with type 2 diabetes have different psychosocial, behavioural, and clinical characteristics at the time of their first visit to a diabetes education centre. DESIGN A questionnaire on psychosocial and behavioural characteristics was administered at participants’ first appointments. Clinical and disease-related data were collected from their medical records. Bivariate analyses (χ2 test, t test, and Mann-Whitney test) were conducted to examine differences between men and women on the various characteristics. SETTING Two diabetes education centres in the greater Toronto area in Ontario. PARTICIPANTS A total of 275 men and women with type 2 diabetes. RESULTS Women were more likely to have a family history of diabetes, previous diabetes education, and higher expectations of the benefits of self-management. Women reported higher levels of social support from their diabetes health care team than men did, and had more depressive symptoms, higher body mass, and higher levels of high-density lipoprotein cholesterol than men did. CONCLUSION The results of this study provide evidence that diabetes prevention, care, and education need to be targeted to men and women differently. Primary care providers should encourage men to attend diabetes self-management education sessions and emphasize the benefits of self-care. Primary care providers should promote regular diabetes screening and primary prevention to women, particularly women with a family history of diabetes or a high body mass index; emphasize the importance of weight management for those with and without diabetes; and screen diabetic women for depressive symptoms.

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.

Pediatric primary care providers’ reported likelihood to refer to mental health specialists.

2018 ◽  
Vol 36 (3) ◽  
pp. 410-414 ◽  
Author(s):  
Emma L. Peterson ◽  
Anne E. Pidano ◽  
Lisa Honigfeld
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Care Providers ◽  
Pediatric Primary Care ◽  
Care Providers

804-P: How Barriers Affect Primary Care Providers’ Referral to the National Diabetes Prevention Program Lifestyle Change Program

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 804-P
Author(s):  
XUANPING ZHANG ◽  
MICHAEL CANNON ◽  
KUNTHEA NHIM ◽  
TAMKEEN KHAN
Keyword(s):  
Primary Care ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Lifestyle Change ◽  
Primary Care Providers ◽  
Care Providers
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