What primary care clinicians need to know about pilonidal disease

BackgroundPrehabilitation prior to major surgery mandates cross-sector working. Utilising the preoperative window from referral requires clinician engagement. Awareness of perioperative risk factors is crucial. A national survey uncovered gaps in knowledge and understanding.AimCreate an open-access, online educational resource for primary care clinicians.MethodOur multidisciplinary team developed a focused CPD resource targeting lifestyle factors and chronic health conditions influencing perioperative risk (www.prepwell.co.uk).ResultsPREP highlights seven risk factors influencing perioperative risk: Smoking, alcohol, inactivity, anaemia, cognitive impairment, frailty and low BMI. A case study frames each factor alongside perioperative impact and prehabilitation strategies.ConclusionPREP is the first educational resource of its type. Early evaluation through local clinicians, the RCGP and RCOA has resulted in very positive feedback. We are working with Royal College representatives to gain formal endorsement and facilitate wider scale rollout, a major step towards raised clinician awareness and enhanced collaboration for improved perioperative outcomes.

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Do Primary-Care Clinicians Think That Nonspecific Low Back Pain Is One Condition?

Spine ◽

10.1097/00007632-200405010-00015 ◽

2004 ◽

Vol 29 (9) ◽

pp. 1022-1031 ◽

Cited By ~ 107

Author(s):

Peter Kent ◽

Jenny Keating

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Primary Care Clinicians

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How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

Journal of Opioid Management ◽

10.5055/jom.2021.0684 ◽

2021 ◽

Vol 17 (6) ◽

pp. 499-509

Author(s):

Elizabeth C. Danielson, PhD ◽

Christopher A. Harle, PhD ◽

Sarah M. Downs, MPH ◽

Laura Militello, MA ◽

Olena Mazurenko, MD, PhD

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Treatment Decisions ◽

Healthcare Organizations ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Prevention Guideline ◽

Multistep Process ◽

Primary Care Clinicians ◽

Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

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Herbal Remedies and Children: Do They Work? Are They Harmful?

PEDIATRICS ◽

10.1542/peds.112.s1.240 ◽

2003 ◽

Vol 112 (Supplement_1) ◽

pp. 240-246 ◽

Cited By ~ 2

Author(s):

Alan D. Woolf

Keyword(s):

Primary Care ◽

Herbal Medicine ◽

Herbal Medicines ◽

Good Health ◽

Herbal Remedies ◽

Herbal Products ◽

Safety And Efficacy ◽

Primary Care Clinicians

More parents are considering the use of herbal remedies to maintain their children’s good health and to treat their illnesses. They look to pediatricians and other primary care clinicians for advice concerning the safety and efficacy of herbal products for children. This article reviews principles for the clinician to keep in mind while investigating the literature on herbal medicine and addressing the use of herbal medicines with parents.

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Primary Care Clinicians’ Willingness to Care for Transgender Patients

The Annals of Family Medicine ◽

10.1370/afm.2298 ◽

2018 ◽

Vol 16 (6) ◽

pp. 555-558 ◽

Cited By ~ 9

Author(s):

Deirdre A. Shires ◽

Daphna Stroumsa ◽

Kim D. Jaffee ◽

Michael R. Woodford

Keyword(s):

Primary Care ◽

Primary Care Clinicians

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Diagnostic and classification tools for chronic headache disorders: A systematic review

Cephalalgia ◽

10.1177/0333102418806864 ◽

2018 ◽

Vol 39 (6) ◽

pp. 761-784 ◽

Cited By ~ 3

Author(s):

Rachel Potter ◽

Katrin Probyn ◽

Celia Bernstein ◽

Tamar Pincus ◽

Martin Underwood ◽

...

Keyword(s):

Primary Care ◽

Chronic Headache ◽

Tension Type Headache ◽

Primary Headaches ◽

Headache Disorders ◽

Headache Classification ◽

Headache Type ◽

Expert Clinician ◽

Primary Care Clinicians ◽

Type Headache

Background or aim Despite guidelines and the International Classification of Headache Disorders (ICHD-III beta) criteria, the diagnosis of common chronic headache disorders can be challenging for non-expert clinicians. The aim of the review was to identify headache classification tools that could be used by a non-expert clinician to classify common chronic disorders in primary care. Methods We conducted a systematic literature review of studies validating diagnostic and classification headache tools published between Jan 1988 and June 2016 from key databases: MEDLINE, ASSIA, Embase, Web of Knowledge and PsycINFO. Quality assessment was assessed using items of the Quality of Diagnostic Accuracy Studies (QUADAS-2). Results The search identified 38 papers reporting the validation of 30 tools designed to diagnose, classify or screen for headache disorders; nine for multiple headache types, and 21 for one headache type only. We did not identify a tool validated in a primary care that can be used by a non-expert clinician to classify common chronic headache disorders and screen for primary headaches other than migraine and tension-type headache in primary care. Conclusions Despite the availability of many headache classification tools we propose the need for a tool that could support primary care clinicians in diagnosing and managing chronic headache disorders within primary care, and allow more targeted referral to headache specialists.

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