scholarly journals 2077. Fluoroquinolone Usage Reduction in the Outpatient Setting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S700-S700
Author(s):  
Kevin Lin ◽  
Yorgo Zahlanie ◽  
Jessica Ortwine ◽  
Norman Mang ◽  
Wenjing Wei ◽  
...  
Keyword(s):  
Inappropriate Prescribing ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Outpatient Setting ◽  
Urgent Care ◽  
System Level ◽  
Outpatient Clinics ◽  
Resistant Organism ◽  
Care Providers ◽  
Provider Education

Abstract Background Fluoroquinolones (FQs) are the third most commonly prescribed outpatient antibiotic due to ease of dosing, broad spectrum of activity, and favorable pharmacokinetics. However, since 2016, the Food and Drug Administration (FDA) has released warnings about adverse effects, concluding that risks outweigh benefits especially for uncomplicated sinusitis, bronchitis, and cystitis. In fall 2016, our antimicrobial stewardship team began an initiative to decrease outpatient FQ usage involving provider education, addition of FDA warnings to oral FQ orders in Epic, and suppression of FQ susceptibilities. This evaluated the effectiveness of these initiatives in decreasing inappropriate outpatient FQ usage. Methods Retrospective chart review of FQ prescription was performed on all outpatient clinic, emergency department (ED), and urgent care emergency center (UCEC) visits during October 2016, 2017, and 2018. Inappropriate use was defined as an indication for cystitis, bronchitis, or sinusitis without a history of Pseudomonas aeruginosa or other multi-drug-resistant organism, or drug allergies precluding the use of non-FQs. Results 1,033 outpatient FQ prescriptions were reviewed. Total FQ prescribing decreased 34% from 405 in October 2016 to 267 in October 2018, with the proportion of inappropriate FQ use decreasing from 53% to 34%. Over 90% of the inappropriate FQ use was for cystitis. Inappropriate prescribing for cystitis and sinusitis decreased by 58% and 33%, respectively, but increased for bronchitis by 25%. The outpatient clinics, ED, and UCEC saw declines in the percentage of inappropriate FQ use of 10%, 15% and 22%, respectively, from October 2016 to October 2018. Despite these decreases, rates of inappropriate FQ utilization for the outpatient clinics, ED, and UCEC were 64%, 25%, and 31%, respectively, at the end of the last study period. Conclusion A multi-modal FQ stewardship initiative effectively reduced the volume of outpatient FQ utilization and inappropriate FQ usage. Continued efforts to educate providers about the risks of FQ use and implement system-level initiatives are likely necessary to improve the rates of appropriate use and sustain the effects demonstrated in this study, especially for primary care providers in the outpatient setting. Disclosures All authors: No reported disclosures.

scholarly journals Pharmacist-Led Provider Education on Inappropriate NSAID Prescribing Rates

2020 ◽  
Vol 52 (8) ◽  
pp. 592-596
Author(s):  
Jangus B. Whitner ◽  
Nicole A. Fabiili ◽  
Jordan Siewart ◽  
Karen Akasaka ◽  
Anna Nelson
Keyword(s):  
High Risk ◽  
Family Medicine ◽  
Inappropriate Prescribing ◽  
High Risk Patient ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Prescribing Patterns ◽  
Care Providers ◽  
Provider Education ◽  
The Impact

Background and Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used pain medications among US adults with about 70 million people regularly taking NSAIDs annually. Despite clear recommendations from current clinical practice guidelines and recent supporting literature, NSAIDs are continually prescribed inappropriately in patients with chronic kidney disease (CKD), hypertension (HTN), and heart failure (HF). The purpose of this project was to determine the impact of direct pharmacist-led education to providers on rates of inappropriate prescribing of NSAIDs in high-risk populations in a family medicine setting. Methods: This study included all adult (aged 18 years or older) patient charts with NSAIDs prescribed, refilled, or recorded within the specified time periods. We defined inappropriate orders as oral and of chronic duration (at least 90 days) with at least one high-risk International Classification of Diseases-10 chart diagnosis (HTN, HF, CKD). This was a single-center, retrospective chart review of prescribing rates during a 3-month period before and after provider education delivered by a pharmacist. Results: We identified a total of 325 charts from preintervention and 489 charts postintervention that met inclusion criteria. Of those, the charts with orders categorized as inappropriate were 90 versus 44, respectively. The rate of inappropriate prescribing of NSAIDs significantly decreased from 27.7% to 9.0% (P<.0001) postintervention. Among chronic NSAID users, both serum creatinine and systolic blood pressure significantly increased following NSAID initiation. Conclusions: A single pharmacist-led education intervention to primary care providers on inappropriate NSAID use in high-risk patient populations had a significant impact on minimizing inappropriate NSAID prescribing patterns within a family medicine outpatient office.

Barriers and Facilitators of Using Telehealth to Identify and Manage Behavioral Health and Substance Use Disorder Conditions in Rural Areas: An Environmental Scan (Preprint)

2020 ◽  
Author(s):  
Naim Naim ◽  
Laura Dunlap
Keyword(s):  
Substance Use ◽  
Behavioral Health ◽  
Substance Use Disorder ◽  
Rural Areas ◽  
Primary Care Providers ◽  
Care Patient ◽  
Direct Patient Care ◽  
Care Providers ◽  
Provider Education ◽  
Opioid Use

BACKGROUND Access to behavioral health services, particularly substance use disorder (SUD) treatment services, is challenging in rural and other underserved areas. Some of the reasons for these challenges include local primary care providers without experience in behavioral health treatment, few specialty providers, and concerns over stigma and lack of privacy for individuals from smaller communities. Telehealth can ease these challenges and support behavioral health, specifically SUD treatment, in a variety of ways, including direct patient care, patient engagement, and provider education. Telehealth is particularly relevant for the growing opioid epidemic, which has profoundly affected rural areas. OBJECTIVE We sought to understand how telehealth is used to support behavioral health and SUDs, with a particular focus on implications for medication-assisted treatment for opioid use disorders. The intent was to understand telehealth implementation and use, financing and sustainability, and impact in the field. The results of this work can be used to inform future policy and practice. METHODS We reviewed literature and interviewed telehealth stakeholders and end users in the field. The team identified a diverse set of participants, including clinical staff, administrators, telehealth coordinators, and information technology staff. We analyzed research notes to extract themes from participant experiences to answer the study questions. RESULTS Organizations varied in how they implemented telehealth services and the services they offered. Common themes arose in implementation, such as planning for technical and organizational impacts of telehealth, the importance of leadership support, and tailoring programs to community needs. CONCLUSIONS Telehealth is used in a variety of ways to expand access to services and extend service delivery. As the policy and reimbursement landscape continues to evolve, there may be corresponding changes in telehealth uptake and services provided. CLINICALTRIAL NA

scholarly journals 145. Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S83-S83
Author(s):  
Shelby J Kolo ◽  
David J Taber ◽  
Ronald G Washburn ◽  
Katherine A Pleasants
Keyword(s):  
Primary Care ◽  
Respiratory Infections ◽  
Primary Care Providers ◽  
The United States ◽  
Delivery Mode ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Care Providers ◽  
Intervention Period ◽  
Provider Education

Abstract Background Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold). Methods This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics. Three distinct intervention phases occurred. Educational interventions included training on appropriate antibiotic prescribing for ARIs. During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion. In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion. In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison. January 2016-July 2017 was used as a pre-intervention baseline period. The primary outcome was the antibiotic prescribing rate for all classifications of ARIs. Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis. Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes. Results Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019). When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant. Conclusion Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates. Disclosures All Authors: No reported disclosures

scholarly journals 142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

Facilitators and Barriers to Clinical Pathway Uptake and Utilization among Primary Care Providers in Saskatchewan – A Qualitative Study

2021 ◽  
Author(s):  
Gary Groot ◽  
Shaliny Ollegasagrem ◽  
Mahasti Khakpour ◽  
Adel Panahi ◽  
Donna Goodridge ◽  
...  
Keyword(s):  
Wound Care ◽  
Clinical Pathways ◽  
Complex Interventions ◽  
Family Physicians ◽  
Standardize Patient ◽  
Primary Care Providers ◽  
System Level ◽  
It Services ◽  
Care Providers ◽  
Facilitators And Barriers

Abstract Background: Clinical Pathways (CPWs) are multidisciplinary, evidence based, complex interventions designed to standardize patient care. In Saskatchewan, development, implementation, and evaluation of seven provincial CPWs (Hip & Knee, Spine, Pelvic Floor, Prostate Assessment, Fertility Care, Lower Extremity Wound Care, and Acute Stroke) present significant challenges, leading to lower uptake and utilization. This study aimed to identify facilitators and barriers to CPW uptake and utilization by Family Physicians in Saskatchewan. Methods: A qualitative interpretive approach was used consisting of eight one-on-one key informant (KI) interviews and five focus groups (FG) in identifying the facilitators and barriers to CPWs. KIs had been involved in the design and implementation of CPWs. FGs were held with 30 Family Physicians in two urban and two rural Saskatchewan cities. All interviews were audio recorded and transcribed. Inductive, thematic analysis of the interviews based on the Theoretical Domain Framework (TDF) for behavioral changes was used to identify facilitators and barriers to CPW uptake and utilization by Family Physicians.Results: KI interviews informed the FG interview guide. From 5 FG discussions, 51 themes emerged and were mapped under 14 TDF domains. Family Physicians notably emphasized the barriers for utilizing CPWs. Major barriers were: system-level (knowledge & communication, social/professional identity, Family Physician engagement and education); objective clarification (goals, belief about consequences of implementing CPW) and technical and resource related (administrative, access to local specialists, enforcement and incentives). The most prominent barrier was lack of systematic CPW promotion and inconsistencies in communication between: organization to practitioner; organization to organization; and practitioner to practitioner. Facilitators were recognized to mitigate barriers and ranged from need for optimized and integrated IT services (i.e. Electronic Medical Records), to optimism towards CPW usage and patient outcomes. Conclusions: Informed by data from KIs and FGs, this exploratory study identified specific improvements required to promote uptake of CPWs based on perceived facilitators and barriers. Recommendations are provided to enhance uptake among FPs. These initial findings will inform the creation of a theory-based, province -wide survey instrument to further evaluate CPWs.

scholarly journals Development of a Cancer Care Summary Through the Electronic Health Record

2016 ◽  
Vol 12 (2) ◽  
pp. e231-e240 ◽  
Author(s):  
Laurie L. Carr ◽  
Pearlanne Zelarney ◽  
Sarah Meadows ◽  
Jeffrey A. Kern ◽  
M. Bronwyn Long ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Cancer Care ◽  
Query Language ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Health Record ◽  
Patient Portal ◽  
Care Providers ◽  
Improvement Project ◽  
Electronic Health

Introduction: Our objective was to improve communication concerning lung cancer patients by developing and distributing a Cancer Care Summary that would provide clinically useful information about the patient’s diagnosis and care to providers in diverse settings. Methods: We designed structured, electronic forms for the electronic health record (EHR), detailing tumor staging, classification, and treatment. To ensure completeness and accuracy of the information, we implemented a data quality cycle, composed of reports that are reviewed by oncology clinicians. The data from the EHR forms are extracted into a structured query language database system on a daily basis, from which the Summaries are derived. We conducted focus groups regarding the utility, format, and content of the Summary. Cancer Care Summaries are automatically generated 4 months after a patient’s date of diagnosis, then every 6 months for those receiving treatment, and on an as-needed basis for urgent care or hospital admission. Results: The product of our improvement project is the Cancer Care Summary. To date, 102 individual patient Summaries have been generated. These documents are automatically entered into the National Jewish Health (NJH) EHR, attached to correspondence to primary care providers, available to patients as electronic documents on the NJH patient portal, and faxed to emergency departments and admitting physicians on patient evaluation. Conclusion: We developed a sustainable tool to improve cancer care communication. The Cancer Care Summary integrates information from the EHR in a timely manner and distributes the information through multiple avenues.

Provider Screening and Counseling for Intimate Partner Violence: A Systematic Review of Practices and Influencing Factors

2016 ◽  
Vol 18 (5) ◽  
pp. 479-495 ◽  
Author(s):  
Carmen Alvarez ◽  
Gina Fedock ◽  
Karen Trister Grace ◽  
Jacquelyn Campbell
Keyword(s):  
Systematic Review ◽  
Intimate Partner Violence ◽  
Influencing Factors ◽  
Health Care Providers ◽  
Partner Violence ◽  
Primary Care Providers ◽  
Intimate Partner ◽  
System Level ◽  
Care Providers ◽  
Screening Practices

Background: Primary care providers have an important role in identifying survivors of intimate partner violence (IPV) and providing safety options. Routine screening rates by providers have been consistently low, indicating a need to better understand providers’ practices to ensure the translation of policy into clinical practice. Aim: This systematic review examines common themes regarding provider screening practices and influencing factors on these practices. Method: A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search focused on research articles which met the following criteria: (1) health-care providers as participants, (2) provider reports on screening and counseling practices for IPV, and (3) were in English or Spanish. Results: A total of 35 studies were included in the review. Across studies, providers commonly acknowledged the importance of IPV screening yet often used only selective screening. Influencing factors on clinic, provider, and patient levels shaped the process and outcomes of provider screening practices. Overall, a great deal of variability exists in regard to provider screening practices. This variability may be due to a lack of clear system-level guidance for these practices and a lack of research regarding best practices. Conclusions: These findings suggest the necessity of more facilitative, clearly defined, and perhaps mandatory strategies to fulfill policy requirements. Future research directions are outlined to assist with these goals.

scholarly journals Left Ventricular Assist Devices 101: Shared Care for General Cardiologists and Primary Care

2019 ◽  
Vol 8 (10) ◽  
pp. 1720 ◽  
Author(s):  
Aditi Singhvi ◽  
Barry Trachtenberg
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Left Ventricular ◽  
Urgent Care ◽  
Ventricular Assist Devices ◽  
Care Providers ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Complex Patients ◽  
Left Ventricular Assist

Ambulatory patients with a left ventricular assist device (LVAD) are increasing in number, and so is their life expectancy. Thus, there is an increasing need for care of these patients by non-LVAD specialists, such as providers in the emergency department, urgent care centers, community-based hospitals, outpatient clinics, etc. Non-LVAD specialists will increasingly come across LVAD patients and should be equipped with the knowledge and skills to provide initial assessment and management for these complex patients. These encounters may be for LVAD-related or unrelated issues. However, there are limited data and guidelines to assist non-LVAD specialists in caring for these complex patients. The aim of our review, targeting primary care providers (both inpatient and outpatient), general cardiologists, and other providers is to describe the current status of durable LVAD therapy in adults, patient selection, management strategies, complications and to summarize current outcome data.

scholarly journals IMPROVING PRIMARY CARE PROVIDER EDUCATION AND SATISFACTION VIA THE CATCH-ON LEARNING COMMUNITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S36-S36
Author(s):  
Erin Emery-Tiburcio ◽  
Magdalena Bednarcyzk ◽  
Febe Wallace ◽  
Michelle Newman
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Learning Communities ◽  
Cost Model ◽  
Healthcare Access ◽  
Primary Care Providers ◽  
Educational Interventions ◽  
Evidence Based ◽  
Care Providers ◽  
Provider Education

Abstract Nationally, there is a shortage of geriatric trained healthcare providers caring for older adults. As the population of older adults grows, health care systems and primary care providers struggle to provide high quality, cost effective care for older adults. Time for training is also limited in busy community health centers. The CATCH-ON Learning Communities (LCs) are telehealth educational interventions based on the ECHO model, modified to be less time intensive, thus decreasing cost to participating clinics. In the LC, geriatric specialists provide evidence-based, best practice training utilizing case discussions to illustrate pertinent learning points via monthly one hour video conferences. Practical, specific behavioral recommendations are offered for immediate implementation in each session. LCs are provided to interprofessional primary care teams. The first LC with a federally-qualified health center (FQHC) yielded consistently high satisfaction from participants, along with a 17% decrease in high risk medication prescriptions and 22% increase in falls screenings. Training the primary care workforce in evidence based geriatric interventions can improve the care of all older adults within each health system, improving healthcare access to help mitigate healthcare inequalities, slow adoption of best practices and rising costs of caring for complex older adults. The CATCH-ON Learning Community is an effective, low cost model of training the primary care work force without geographical or financial constraints that frequently limit access to specialized care.

Use of lumbar ultrasonography to detect occult spinal dysraphism

2012 ◽  
Vol 9 (3) ◽  
pp. 274-279 ◽  
Author(s):  
Joshua J. Chern ◽  
Jennifer L. Kirkman ◽  
Chevis N. Shannon ◽  
R. Shane Tubbs ◽  
Jeffrey D. Stone ◽  
...  
Keyword(s):  
Congenital Anomalies ◽  
Spinal Dysraphism ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Care Providers ◽  
Occult Spinal Dysraphism ◽  
Fetal Ultrasonography ◽  
Tertiary Referral Center ◽  
Private Practitioners ◽  
Skin Tag

Object Various cutaneous stigmata and congenital anomalies are accepted as sufficient reasons to perform lumbar ultrasonography as a screening tool to rule out occult spinal dysraphism (OSD). The purpose of this study was to correlate presenting cutaneous findings with lumbar ultrasonography results based on a large number of lumbar ultrasonography tests obtained by regional primary care providers. Methods Over the course of 5 years, 1273 infants underwent lumbar ultrasonography screening at a major pediatric tertiary referral center. Of these infants, 1116 had adequate documentation for retrospective chart review. Referral sources included urban academic, urban private practice, and surrounding rural private practitioners. Presence of cutaneous stigmata and/or congenital anomalies and lumbar ultrasonography results were reviewed for all patients. When present, surgical findings were reviewed. Results A total of 943 infants were referred for presumed cutaneous stigmata, the most common of which was a sacral dimple (638 patients [68%]) followed by hairy patch (96 patients [10%]). Other reported cutaneous findings included hemangioma, deviated gluteal fold, skin tag, and skin discoloration. In comparison, 173 patients presented with congenital anomalies, such as imperforate anus (56 patients [32%]) and tracheoesophageal fistula/esophageal atresia (37 patients [21%]), most of which were detected prenatally by fetal ultrasonography. A total of 17 infants underwent surgical exploration. Occult spinal dysraphism was diagnosed in 7 infants in the cutaneous stigmata group and in 10 infants in the group with congenital abnormalities. None of the cutaneous stigmata as recorded were found to be indicative of the presence of OSD. Conclusions Cutaneous markers as currently defined by general practitioners are not useful markers for predicting OSD. The vast majority of findings on lumbar ultrasonography studies performed under these circumstances will be negative.

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