scholarly journals Poor concordance between reason for consultation and parental expectations in behavioral referrals

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e56-e57
Author(s):  
Sarah Gander ◽  
Sarah Campbell ◽  
Andrew Borodovski
Keyword(s):  
Primary Care ◽  
Risk Factor ◽  
Low Socioeconomic Status ◽  
Parental Expectations ◽  
Primary Care Providers ◽  
Primary Objective ◽  
Patient Communication ◽  
Care Providers ◽  
Prescribing Practices ◽  
Chi Square Analysis

Abstract BACKGROUND Behavioural conditions such as Attention-deficit/hyperactivity disorder (ADHD) are present in up to 5% of children across the world. This is a common reason for referral from primary care to paediatricians. When a primary care provider refers a patient to a specialist, they often create a set of expectations in the patient. These expectations may have a strong effect on the patient relationship with the specialist. It has been shown that parental expectations can influence prescribing practices in paediatrics. Low socioeconomic status, a risk factor for behavioural conditions is also a risk factor for poor physician-patient communication. If patient expectations set up in primary care are not reflected in the referral question sent to the paediatrician, this may hinder paediatrician-patient communication and impact care. OBJECTIVES The primary objective of this project was to determine the level of concordance between physician referrals and parent expectations in the consultant paediatrician’s office. A secondary objective was to examine demographic and socio-economic trends within this population. DESIGN/METHODS A clinic nurse conducted almost 500 pre-appointment intake interviews of guardians in children with a referral related to a behavioural concern and asked them their expectations for the consultation. The referral question and parental expectations were categorized by question of behavioural diagnosis, learning difficulties, medical complaint or unknown. Chi sqaured analysis was performed to measure concordance. RESULTS Among this population, 70.4% were male, with 54% coming from single parent families. Chi-square analysis indicated a small-moderate level of concordance on issues relating to attention, behaviour and academics, (59.9%, p<0.001; 57.3%, p<0.001; 62.6%, p=0.001), and high concordance but low correlation for social and medical issues (80.1%, p=0.002, 91.6%, p=0.06). CONCLUSION This study demonstrates how we could improve our patient-centered approach by being clear in what is being offered by paediatric consultation. When primary care providers consult paediatrics for behavior referrals there should be clear commnication of the concern at hand and management of the expectations for the visit with the family. This will improve efficiency and lessen dealys or barriers to access to care allowing approriate triage of referrals and patient satisfaction.

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.

scholarly journals 1475. Understanding Prescribing Practices for Uncomplicated Urinary Tract Infections (UTIs) in the Primary Care Setting: A Pilot Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S538-S538
Author(s):  
Mark Pinkerton ◽  
Jahnavi Bongu ◽  
Aimee James ◽  
Michael Durkin
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
Prescribing Practices ◽  
Support Tools ◽  
Tract Infections ◽  
Clinical Decision Support Tools

Abstract Background Uncomplicated urinary tract infections (UTIs) should be treated empirically with a short course of narrow-spectrum antibiotics. However, many clinicians order unnecessary tests and treat with long courses of antibiotics. The objective of this study was to understand how internists clinically approach UTIs. Methods We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018 to 2019 to explore why clinical practices deviate from evidence-based guidelines. Interviews were transcribed, de-identified, and coded by two independent researchers using NVivo qualitative software. A Likert scale was used to evaluate preferences for possible interventions. Results Several common themes emerged. Both providers and residents ordered urine tests to “confirm” presence of urinary tract infections. Antibiotic prescriptions were often based on historical practice and anecdotal experience. Providers were more comfortable treating over the phone than residents and tended to prescribe longer courses of antibiotics. Both providers and residents voiced frustrations with guidelines being difficult to easily incorporate due to length and extraneous information. Preferences for receiving and incorporating guidelines into practice varied. Both groups felt benchmarking would improve prescribing practices, but had reservations about implementation. Pragmatic clinical decision support tools were favored by providers, with residents preferring order sets and attendings preferring nurse triage algorithms. Conclusion Misconceptions regarding urinary tract infection management were common among residents and community primary care providers. Multifaceted interventions that include provider education, synthesis of guidelines, and pragmatic clinical decision support tools are needed to improve antibiotic prescribing and diagnostic testing; optimal interventions to improve UTI management may vary based on provider training level. Disclosures All authors: No reported disclosures.

scholarly journals Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

2021 ◽  
Vol 33 (4) ◽  
pp. 325-344
Author(s):  
Erik D. Storholm ◽  
Allison J. Ober ◽  
Matthew L. Mizel ◽  
Luke Matthews ◽  
Matthew Sargent ◽  
...  
Keyword(s):  
Primary Care ◽  
Claims Data ◽  
Primary Care Providers ◽  
Attitudes And Beliefs ◽  
Care Providers ◽  
Provider Education ◽  
Prescribing Practices ◽  
Sexually Transmitted ◽  
Primary Care Settings ◽  
Exposure Prophylaxis

Increasing access to pre-exposure prophylaxis (PrEP) in primary care settings for patients who may be at risk for HIV could help to increase PrEP uptake, which has remained low among certain key risk populations. The current study conducted interviews with primary care providers identified from national claims data as having either high or low likelihood of serving PrEP-eligible patients based on their prescribing practices for other sexually transmitted infections. The study yielded important information about primary care providers’ knowledge, attitudes, and beliefs about PrEP, as well as the barriers and facilitators to prescribing PrEP. Key recommendations for a provider-focused intervention to increase PrEP prescribing among primary care providers, including increasing patient education to increase demand from providers, enhancing provider education, leveraging technology, and instituting standardized sexual health checks, are provided with the goal of informing network-based interventions.

Reduction in Schedule II opioid prescribing by primary care providers, orthopedic and general surgeons, and pain management specialists following the implementation of a State House Bill and an Institutional Controlled Substance Task Force

2021 ◽  
Vol 17 (2) ◽  
pp. 155-167
Author(s):  
Lisa B. E. Shields, MD ◽  
Timothy A. Johnson, BS ◽  
Michael W. Daniels, MS ◽  
Alisha Bell, MSN, RN, CPN ◽  
Diane M. Siemens, PharmD ◽  
...  
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Primary Care Providers ◽  
The United States ◽  
Prescription Opioid ◽  
Evidence Based ◽  
Care Providers ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
General Surgeons

Objective: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists.Design: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting.Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. Results: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity 90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. Conclusions: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient’s pain without initiating or exacerbating a potentially lethal opioid addiction.

scholarly journals Prevalence and associated factors of the career plateau of primary care providers in Heilongjiang, China: a cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Di Liu ◽  
Xu Yang ◽  
Qinglin Li ◽  
Lei Shi ◽  
Qiaoran Tang
Keyword(s):  
Primary Care ◽  
Sleep Quality ◽  
Associated Factors ◽  
Primary Care Providers ◽  
Heilongjiang Province ◽  
Care Providers ◽  
Effective Response ◽  
Factors Associated ◽  
Career Plateau ◽  
Chi Square Analysis

Abstract Background Primary care providers are pillars of China’s medical and health sectors. However, due to the gap between career expectations and reality, they enter a career plateau phase through excessive pressure. This study aims to examine the prevalence and associated factors of the career plateau of primary care providers in Heilongjiang Province, China, and proposes strategies to improve and promote their career advancement. Methods Based on city-level GDP growth in the province, a questionnaire survey was conducted among 1500 primary care providers (effective response rate = 85.8%). Pearson’s chi-square analysis and binary logistic regression were used to analyse the factors associated with their career plateau. Results The prevalence rate of career plateau was 61.8% among primary care provider respondents. The factors associated with a career plateau included having a spouse (OR = 1.394, 95%CI = 1.056–1.839), working more than 40 h per week (OR = 1.473, 95%CI = 1.146–1.893); working for 11–20 years (OR = 1.607, 95%CI = 1.150–2.246); working for more than 20 years (OR = 2.818, 95%CI = 1.938–4.097); having an average monthly income of 3001–4000 yuan (OR = 1.886, 95%CI = 1.197–2.969) or 4001–5000 yuan (OR = 2.104, 95%CI = 1.256–3.524); and reporting unsatisfactory or very unsatisfactory sleep quality (OR = 1.838, 95%CI = 1.317–2.567). Conclusions Primary care providers in Heilongjiang Province face a high career plateau, with marital status, weekly working hours, number of years employed, monthly average income, and sleep quality considered associated factors. To eliminate negative factors of the career plateau, it is necessary to provide support to primary care providers in four domains: individual, organisation, society, and policy.

scholarly journals Primary care provider prep prescribing practices : southern United States

2021 ◽  
Author(s):  
◽  
Daryl Traylor
Keyword(s):  
Primary Care ◽  
African American ◽  
Patient Adherence ◽  
Stage Of Change ◽  
Primary Care Providers ◽  
Southern United States ◽  
Prior Authorization ◽  
Care Providers ◽  
Prescribing Practices ◽  
Clinical Leadership

The Southern United States (U.S.) accounts for more than half of new HIV cases annually and African Americans make up the majority of new HIV diagnoses in this region. Pre-Exposure Prophylaxis (PrEP) is an effective biomedical HIV prevention strategy that is underutilized. Few studies have examined the PrEP prescribing practices of primary care providers (PCPs), particularly in the Southern U.S. This cross-sectional survey, driven by the Transtheoretical Model (TTM), examined the prescribing practices of Southern U.S. PCPs. Relationships between PCPs personal and practice variables were examined, together with TTM decisional balance variables. Participants (n=223) who had more African American patients in their practice were more likely to be in a higher TTM stage of change (p = .002) and were more likely to have written a PrEP prescription (p = .001). Access to PrEP resources (OR = 1.85, p = .001), streamlined insurance prior authorization processes (OR = 1.52, p = .010), working with staff who have PrEP knowledge (OR = 1.51, p = .033), having PrEP training (OR = 40.26, p < .001) and having patients who are motivated to take PrEP (OR = 2.19, p = .007) were significant facilitators to PrEP prescribing. Significant barriers to PrEP prescribing included a lack of provider PrEP training (OR = 0.43, p = .003), lack of clinical leadership regarding PrEP (OR = 0.65, p = .018), lack of insurance (OR = 2.74, p = .002), and likelihood of low patient adherence to PrEP (OR = 0.53, p = .001). Findings indicate that this sample of PCPs were more likely to be at a higher TTM stage of change and have written a PrEP prescription if they saw more African American patients in their practice. Further, significant facilitators of PrEP prescribing included access to PrEP resources, streamlined insurance prior authorization processes, working with staff who have PrEP knowledge, having PrEP training, and having patients who are motivated to take PrEP. Significant barriers to PrEP prescribing included a lack of PrEP training, a lack of clinical leadership regarding PrEP, patient lack of insurance, and likelihood of low patient adherence. This study contributes to the body of knowledge regarding PCP PrEP prescribing practices. Findings from this study may inform future interventions that aim to enhance PrEP prescribing among primary care providers who serve Southern African American individuals at risk for acquisition of HIV disease.

Decline in primary care providers’ prescribing of Schedule II opioids following the implementation of federal and state guidelines

2019 ◽  
Vol 15 (2) ◽  
pp. 111-118 ◽  
Author(s):  
Lisa B. E. Shields, MD ◽  
Timothy A. Johnson, BS ◽  
James P. Murphy, MD ◽  
Douglas J. Lorenz, PhD ◽  
Alisha Bell, MSN, RN, CPN ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Prescription Opioid ◽  
Care Practice ◽  
Evidence Based ◽  
Care Providers ◽  
Prescribing Practices ◽  
Prescription Opioid Misuse ◽  
Morphine Equivalent

Objective: Prescription opioid misuse represents a social and economic dilemma in the United States. The authors evaluated primary care providers’ (PCPs) prescribing of Schedule II opioids at our institution in Kentucky.Design: Prospective evaluation of PCPs’ prescribing practices over a 3-year period (October 1, 2014 to September 30, 2017) in an outpatient setting.Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards. Special attention focused on Schedule II opioid prescriptions with a quantity 90, Opana/ Oxycontin, and morphine equivalent daily dosage.Results: A statistically significant increase in the total number of PCPs and PCPs who prescribed Schedule II opioids was observed, while there was a concurrent significant decrease in the average number of Schedule II opioid pills prescribed per PCP, Schedule II opioid prescriptions per PCP, Schedule II opioid pills prescribed per patient by PCPs, Schedule II opioid prescriptions with a quantity 90 per PCP, and Opana/Oxycontin prescriptions per PCP. A statistically significant decline in the average morphine equivalent daily dosage of Schedule II opioids per PCP was noted.Conclusions: This study reports the benefit of incorporating federal and state regulations and institutional evidence-based guidelines into primary care practice to decrease the number of Schedule II opioids prescribed. Further preventive measures include selecting alternative treatments to opioids and reducing the rates of opioid nonmedical use and overdose while maintaining access to prescription opioids when indicated.

scholarly journals Knowledge, Attitudes, and PrEP Prescribing Practices of Health Care Providers in Philadelphia, PA

2019 ◽  
Vol 10 ◽  
pp. 215013271987852 ◽  
Author(s):  
Margaret R. Carter ◽  
Erika Aaron ◽  
Tanner Nassau ◽  
Kathleen A. Brady
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Women’S Health ◽  
Women's Health ◽  
Health Care Providers ◽  
Primary Care Providers ◽  
Hiv Care ◽  
Care Providers ◽  
Prescribing Practices ◽  
Biomedical Intervention

Introduction: Preexposure prophylaxis (PrEP) is an effective biomedical intervention that has the potential to dramatically decrease the incidence of HIV but remains an underutilized method of HIV prevention. The Philadelphia Department of Public Health administered an online survey to health care providers in the Philadelphia area with the aim of characterizing PrEP attitudes, knowledge, and prescribing practices. Methods: Online surveys were distributed to 1000 providers who were recruited through distribution lists of Philadelphia medical providers between September and December 2017. A Likert-type response scale was utilized to analyze participant self-reported responses. Participant practice settings included HIV/ID, family and internal medicine, women’s health, and pediatric/adolescent clinics. Results and Discussion: The response rate of the survey was 9%. Of 81 complete responses, 75% (N = 61) felt comfortable providing PrEP and 77% (N = 62) had ever written a PrEP prescription. Compared with primary care providers, HIV care providers were significantly more knowledgeable about required laboratory testing for prescribing PrEP ( P = .03) and were more likely to have prescribed PrEP to more than 10 patients ( P = .006). Women’s health and pediatric providers reported feeling less comfortable providing PrEP to their patients ( P = .0003). Conclusion: The majority of health care providers in the Philadelphia area who responded to the survey reported experience with providing PrEP to their patients. In the present study, HIV care providers were significantly more comfortable and knowledgeable about prescribing PrEP compared with providers in primary care, women’s health, and/or adolescent/pediatric medicine. Results were limited by sampling bias, as providers who responded to the survey may have prior experience with PrEP. Future Health Department educational trainings need to target primary and preventive care providers, providers who have never prescribed PrEP, and providers who see few patients living with HIV.

scholarly journals Perceptions of primary care providers on TB care for migrants: a mixed methods study in Portugal

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A M Tavares ◽  
A C Garcia ◽  
A Gama ◽  
A B Abecasis ◽  
M Viveiros ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Online Survey ◽  
Social Protection ◽  
Close Contact ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Foreign Born ◽  
Structured Interviews

Abstract Background Tuberculosis (TB) is one of the main causes of death worldwide. In 2017, the proportion of TB cases among foreign-born individuals in Portugal was of 19%, and this proportion has been increasing. TB control among migrant populations largely depends on the role of the healthcare providers and their close contact with the patients. We aimed to explore the perspectives of primary care providers on the provision of TB care for migrant patients in Portugal. Methods An online survey and semi-structured interviews were conducted with healthcare providers from primary care settings in Portugal. Overall, 120 participated in the survey, and 17 were interviewed. Data from the survey and interviews were analysed using descriptive statistics and thematic analysis, respectively. Results Many participants (36.9%) considered that migrants arrive at an advanced stage of TB disease, and the main reason referred was migrants’ unawareness of the disease and its symptoms. Moreover, half (50.0%) of the providers considered that migrants frequently interrupt treatment, mainly due to their mobility, which causes difficulties in follow-up, and their social isolation that hampers social support. Overall, three main barriers for migrants’ access and use of TB care were mentioned: migrants’ low socioeconomic status, great bureaucracy required to register at services, and obstacles to benefit from social protection. Providers also suggested more training to improve their cultural competence and updating training on TB care. Conclusions Our study have shown social and economic factors that must be addressed to improve migrants’ access and use of TB care. In addition, increased health literacy for migrants and more training initiatives for providers can also contribute to improve TB care for migrants. Key messages Perspectives from primary care providers in Portugal highlighted social, economic, and administrative obstacles hampering the provision of TB care for migrants. With this work we expected to contribute with evidence to improve TB care for migrant patients in Portugal.

scholarly journals Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009–2016

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Ashley L Fowlkes ◽  
Andrea Steffens ◽  
Carrie Reed ◽  
Jonathan L Temte ◽  
Angela P Campbell ◽  
...  
Keyword(s):  
Primary Care ◽  
Antiviral Treatment ◽  
Multivariable Analysis ◽  
Age Groups ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Prescribing Practices ◽  
Surveillance Network ◽  
Illness Onset

Abstract Background Early influenza antiviral treatment within 2 days of illness onset can reduce illness severity and duration. Reliance on low sensitivity rapid influenza diagnostic tests (RIDTs) to guide antiviral prescribing has been reported. We describe antiviral prescribing practices among primary care providers from a large surveillance network in the United States. Methods From 2009–2016, a network of 36 to 68 outpatient clinics per year collected respiratory specimens and clinical data for patients with influenza-like illness (ILI). Specimens were tested for influenza using polymerase chain reaction (PCR). We used multivariable logistic regression to assess factors influencing antiviral prescribing. Results Among 13 540 patients with ILI, 2766 (20%) were prescribed antivirals. In age groups recommended to receive empiric antiviral treatment for suspected influenza, 11% of children &lt;2 years and 23% of adults ≥65 years received a prescription. Among 3681 patients with a positive PCR test for influenza, 40% tested negative by RIDT. In multivariable analysis, prescription receipt was strongly associated with a positive RIDT (adjusted odds ratio [aOR] 12, 95% CI 11–14) and symptom onset ≤2 days before visit (aOR 4.3, 95% CI 3.8–4.9). Antiviral prescribing was also more frequent among pediatric and private family practice clinics compared with community health centers (aOR 1.9, 95% CI 1.6–2.2, and 1.3, 95% CI 1.1–1.5, respectively). Conclusion Primary care providers were more likely to prescribe antivirals to patients with a positive RIDT, but antivirals were prescribed infrequently even to patients in high-risk age groups. Understanding patient and provider characteristics associated with antiviral prescribing is important for communicating treatment recommendations.

Sign in / Sign up

Export Citation Format

Share Document