377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A150-A150
Author(s):  
Cassandra Godzik ◽  
Adam Sorscher
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Sleep Medicine ◽  
Quality Metrics ◽  
Care Providers ◽  
National Guidelines ◽  
Daytime Functioning ◽  
Care Clinic

Abstract Introduction Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia. Methods We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months. Results Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%). Conclusion Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting. Support (if any) Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553

Abstract P119: Assessment of Cardiovascular Health among Older Women in Primary Care

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Randi E Foraker ◽  
Abigail B Shoben ◽  
Marcelo A Lopetegui ◽  
Albert M Lai ◽  
Philip R Payne ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Health ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Continuous Variables ◽  
Care Providers ◽  
Care Clinic ◽  
Female Patients ◽  
Life’S Simple 7 ◽  
Life's Simple 7

In 2010, the American Heart Association (AHA) launched the groundbreaking Life’s Simple 7™ campaign to improve the cardiovascular health (CVH) of Americans. Five of the 7 [smoking, body mass index (BMI), blood pressure, cholesterol, and glucose] are commonly recorded in electronic medical records (EMRs). Although CVH components are often included in patient-provider discussions, to date there has been no formal attempt to characterize CVH from EMR data. We characterized the CVH of 160 female patients ages 65 and older seen in an Ohio State University primary care clinic from May 1 through July 31, 2013. We defined CVH according to AHA criteria, and assigned each behavior and factor to either an “ideal”, “intermediate”, or “poor” category. We calculated an overall CVH score ranging from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. We calculated means and standard deviations (sd) of continuous variables and report frequencies within CVH categories. Patients were an average of 74.2 (sd=6.7) years old, and 35% were black. Among the 126 (79%) women who had data available on all 5 factors, mean CVH score was 6.0 (sd=1.3). Among all women, the mean fractional score (actual score/maximum possible) was 0.63 (sd=0.14), and it did not differ significantly by race. Greater than 10% of data were missing for BMI (13%) and cholesterol (11%). Figure 1 shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor. We have demonstrated that a majority of Life’s Simple 7™ components are easily queried from EMRs. These data indicate that older female patients seen in the primary care setting have less-than-ideal CVH. There exists great potential to leverage the EMR for patient-provider communication and engagement around CVH. As such, we are implementing an automated assessment of CVH targeted to primary care providers and their older female patients. Following the intervention, CVH values will be compared to these baseline data. Figure 1. Percent of older female patients (n=160) who were seen in a primary care clinic by category of CVH: behaviors and factors*. *Diabetes was defined as either treated by a glucose-lowering medication (intermediate) or not (ideal), since over 90% of data were missing for fasting glucose or hemoglobin A1c.

scholarly journals Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

2020 ◽  
Vol 11 ◽  
pp. 215013272090837
Author(s):  
Elizabeth Gregg ◽  
Carrie Linn ◽  
Emma Nace ◽  
Lillian Gelberg ◽  
Brianna Cowan ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Root Cause ◽  
Preexposure Prophylaxis ◽  
Provider Knowledge ◽  
Improve Access

Objective: Oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV-1 acquisition, yet it is underutilized among at-risk populations. In this pilot quality improvement (QI) initiative, we sought to identify barriers to PrEP implementation and create interventions to improve access to PrEP in a primary care clinic for homeless veterans. Methods: The setting was a large homeless primary care clinic at the Veterans Affairs in an urban area with high HIV prevalence. A root cause analysis was performed to identify barriers to PrEP expansion in the primary care clinic. Targeted interventions to improve provider knowledge and patient access to PrEP were implemented by the QI team. Results: Root cause analysis revealed 3 primary barriers to PrEP expansion in the primary care clinic: institutional limitations for prescribing PrEP, inconsistent screening and recognition of eligible patients by clinic staff, and lack of clinic workflow processes to support PrEP prescription. A multidisciplinary focus group found low levels of PrEP awareness and knowledge, with only 22% of providers reporting comfort discussing PrEP with patients. This improved to 40% of providers following targeted clinic educational interventions. The QI team also developed a pathway for primary care providers to obtain institutional PrEP prescribing privileges and used work groups to develop clinic workflows and protocols for PrEP. At the end of the intervention, at least 50% of primary care providers in the clinic had initiated PrEP in a new patient. Conclusions: We describe a multidisciplinary QI model to implement PrEP within a primary care setting serving Veterans and persons experiencing homelessness. Our program successfully addressed provider knowledge deficits and improved primary care capacity to prescribe PrEP. The primary care clinic can be a viable and important clinical setting to improve access to PrEP for HIV prevention, especially for vulnerable populations.

scholarly journals Reaching Out to Rural Caregivers and Veterans with Dementia Utilizing Clinical Video-Telehealth

2018 ◽  
Author(s):  
James S. Powers ◽  
Jennifer Buckner
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Mental Health Provider ◽  
Care Providers ◽  
Community Based ◽  
Term Care ◽  
Care Clinic

Context: A clinical video telehealth (CVT) program was implemented improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC’s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician – social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of 1 to 2 CVT encounters originating at their local CBOC lasting 20 to 30 minutes. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient-caregiver pairs, followed for a mean of 15 (1-36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of 8 medications, and resided at a distance of 103 (76-148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusion: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas.

How to Diagnose and Manage “Difficult” Patients - Development of a Workshop for Interprofessional Audience

2011 ◽  
Vol 26 (S2) ◽  
pp. 1031-1031
Author(s):  
D. Kljenak
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Community Health Centers ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Pilot Program ◽  
Health Providers ◽  
Care Providers ◽  
Difficult Patients ◽  
Care Clinic

IntroductionMore than 15% of patients who present to a primary care clinic are considered “difficult” yet interprofessional members of primary care clinics receive little training on how to diagnose and manage these patients.ObjectivesBecome familiar with successful method of workshop development on how to diagnose and manage “difficult” patients to interprofessional audience of six community health centers.AimsThe aim of the workshop was to enhance primary care providers’ capacity to diagnose and manage “difficult” patients as well as serve as a pilot program for a larger conference on managing “difficult” patients.MethodsA half-day workshop was designed to fill this perceived need of community health providers to learn how to diagnose and manage “difficult” patients. The workshop consisted of didactic presentation and case based small group learning.This workshop served as a pilot program for the development of larger conference for community providers on managing “difficult” patients.ResultsThe workshop was evaluated by participants. 100% of respondents agreed that the workshop was relevant to their work and 87.5% of respondents reported that the workshop will alter their clinical practice.ConclusionThe workshop has met participants’ perceived learning needs as well as served as a pilot program for a larger conference on managing difficult patients.

scholarly journals Are VA Primary Care Providers Aware of HIV Testing Recommendations for Veterans? Findings at an Urban VA Primary Care Clinic

2013 ◽  
Vol 178 (4) ◽  
pp. e483-e488 ◽  
Author(s):  
Monisha Arya ◽  
Amber L. Bush ◽  
Michael A. Kallen ◽  
Maria C. Rodriguez-Barradas ◽  
Thomas P. Giordano
Keyword(s):  
Primary Care ◽  
Hiv Testing ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic

Validating the Child Trauma Screen Among a Cross-Sectional Sample of Youth and Caregivers in Pediatric Primary Care

2021 ◽  
Vol 60 (4-5) ◽  
pp. 252-258
Author(s):  
Jason M. Lang ◽  
Christian M. Connell ◽  
Susan Macary
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Pediatric Primary Care ◽  
Child Trauma ◽  
Ptsd Symptoms ◽  
Care Providers ◽  
Medical Visit ◽  
Care Clinic ◽  
Reaction Index

Pediatric primary care providers have an important role in addressing the health effects of trauma, yet routine screening is rare. This study evaluated whether the 10-item Child Trauma Screen (CTS) could identify youth experiencing posttraumatic stress disorder (PTSD) symptoms. Participants were 107 caregiver-youth pairs aged 7 to 17 years old, 55.8% male, and 76.4% Hispanic who were recruited at an urban pediatric primary care clinic. Youth and caregivers separately completed the CTS and the UCLA PTSD Reaction Index for DSM-5 (RI-5) prior to their medical visit. Half of youth experienced at least one type of trauma, and one sixth reported elevated PTSD symptoms. The CTS was highly correlated with the RI-5 on PTSD symptom severity, and correctly classified 85% of youth based on likely PTSD diagnosis. The brief CTS can accurately identify youth suffering from PTSD symptoms, and may be particularly feasible to implement in busy primary care practices.

scholarly journals Primary care provider approaches to preventive health delivery: a qualitative study

2018 ◽  
Vol 19 (5) ◽  
pp. 464-474
Author(s):  
Hemalatha Murugan ◽  
Clarence Spigner ◽  
Christy M. McKinney ◽  
Christopher J. Wong
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Preventive Health ◽  
Care Providers ◽  
Care Clinic ◽  
Health Delivery

AimThe objective of this study was to seek decision-making insights on the provider level to gain understanding of the values that shape how providers deliver preventive health in the primary care setting.BackgroundThe primary care clinic is a core site for preventive health delivery. While many studies have identified barriers to preventive health, less is known regarding how primary care providers (PCPs) make preventive health decisions such as what services to provide, under what circumstances, and why they might choose one over another.MethodsQualitative methods were chosen to deeply explore these issues. We conducted semi-structured, one-on-one interviews with 21 PCPs at clinics affiliated with an academic medical center. Interviews with providers were recorded and transcribed. We conducted a qualitative analysis to identify themes and develop a theoretical framework using Grounded Theory methods.FindingsThe following themes were revealed: longitudinal care with an established PCP–patient relationship is perceived as integral to preventive health; conflict and doubt accompany non-preventive visits; PCPs defer preventive health for pragmatic reasons; when preventive health is addressed, providers use multiple contextual factors to decide which interventions are discussed; and PCPs desired team-based preventive health delivery, but wish to maintain their role when shared decision-making is required. We present a conceptual framework called Pragmatic Deferral.

Utilization of a psychiatric clinical pharmacist in an integrated behavioral health program of a community health center

2014 ◽  
Vol 4 (6) ◽  
pp. 287-291 ◽  
Author(s):  
Richard J. Silvia
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Primary Care Providers ◽  
Mental Illnesses ◽  
Care Staff ◽  
Care Providers ◽  
Care Clinic ◽  
Collaborative Practice Agreement ◽  
Follow Up Care

Treatment of mental illnesses has slowly shifted to primary care settings over the past decade. As more patients are identified as needing treatment for a mental illness, the availability of behavioral health (BH) practitioners has become more strained, leading to this shift towards primary care treatment. With more patients receiving psychiatric health care from their primary care providers (PCP), a need for dedicated BH practitioners within the primary care setting was developed. This article describes a novel program where a clinical psychiatric pharmacist is utilized as the primary psychiatric provider within an integrated BH program of a busy primary care clinic in a major metropolitan area. Working under a collaborative practice agreement to prescribe, the pharmacist acts as the initial BH contact for the clinic, as well as a liaison between primary care and BH. Patients referred to the pharmacist from primary care are then evaluated and appropriate medication prescribed for their illness. Most patients are followed prospectively by the pharmacist, with more complex patients (i.e., those not appropriate for primary care-based BH treatment) referred to the BH clinic for follow-up care. The pharmacist serves on the intake committee for the BH clinic, and facilitates patient referrals to their clinicians. Preliminary analysis of the program's effectiveness shows positive results. Within the first two months of the program, 28 patients were referred to the pharmacist (including five referred by BH clinic therapists through primary care). Most patients were referred for depression or anxiety, with attention deficit hyperactivity disorder, substance abuse, bipolar disorder, and psychosis also being treated. As such, antidepressants and anxiolytics were the most common agents prescribed, but most every class of psychotherapeutic agents was utilized. Patient wait times to meet with the pharmacist were generally less than a week, with exceptions being found for patients already being prescribed a psychotherapeutic agent by their PCP and being referred to the pharmacist for follow-up care, or for patients being referred by their existing therapist. Initial reviews of the program by patients, primary care staff, and BH staff have been positive, especially in regards to patient access to specialized BH services.

scholarly journals Premenstrual symptoms and remedies practiced by Malaysian women attending a rural primary care clinic

2009 ◽  
Vol 1 (1) ◽  
Author(s):  
Khairani Omar ◽  
Siti S. Mohsin ◽  
Leelavathi Muthupalaniappen ◽  
Idayu B. Idris ◽  
Rahmah M. Amin ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Physical Symptoms ◽  
Reproductive Age ◽  
Care Providers ◽  
Women Of Reproductive Age ◽  
Premenstrual Symptoms ◽  
Care Clinic ◽  
Rural Primary Care

Background: Premenstrual symptoms affect about 40% of women of reproductive age. In an effort to alleviate premenstrual symptoms, affected women practice various remedial approaches. The aim of this study was to assess the prevalence and severity of premenstrual symptoms experienced by women, the associated factors and the remedial approaches practiced by them.Method: This was a cross-sectional study conducted at a rural primary care clinic situated in Hulu Langat, Malaysia. All women of reproductive age (18 to 44 years old) attending the clinic during the study period and who fit the selection criteria were included. Premenstrual symptoms and severity were assessed using a self-report questionnaire, the Shortened Premenstrual Assessment Form (SPAF). It consists of 10 items that measure changes in mood, behaviour and physical symptoms. The respondents were also asked if they had used any remedy to relieve their symptoms.Results: A total of 158 women were included in the study. The majority of the respondents were Malay (70.3%), followed by Indian (16.5%) and Chinese (10.8%) women. About 75% of the women experienced at least one of the premenstrual symptoms. Approximately 7% of them reported experiencing severe symptoms in all three subscales of the SPAF. The frequently reported symptoms were body ache (75.3%), abdominal pain (75.3%), irritable feeling (63.9%) and breast discomfort (61.4%). The symptom score was higher among Malay women (p = 0.034), and those with a higher household income (p = 0.037) and higher educational level (p = 0.01). There was no significant association between premenstrual symptoms and age, marital status, menstrual cycle and age of menarche. The common remedies used were vitamins (19%), a healthy diet (15.8%) and analgesics (13.3%). Approximately 60% of the women did not use any remedy to reduce their premenstrual symptoms.Conclusion: Premenstrual symptoms were common among women attending the clinic. The symptoms affect them significantly both physically and emotionally. Thus, it is essential for primary care providers to take an active role in identifying, educating and managing premenstrual symptoms among women.

scholarly journals Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Laney K. Jones ◽  
Megan McMinn ◽  
David Kann ◽  
Michael Lesko ◽  
Amy C. Sturm ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Effectiveness ◽  
Primary Care Providers ◽  
Care Providers ◽  
Lipid Levels ◽  
Framework Analysis ◽  
Lipid Clinic ◽  
Adherence Counseling ◽  
Clinically Significant

Abstract Background Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework. Results In 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance). Conclusions Despite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.

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