Narcolepsy: Clinical Decision Making for the Primary Care Physician

2009 ◽  
Vol 102 (12) ◽  
pp. 1246-1252 ◽  
Author(s):  
Faisal Khan ◽  
Ribhi Hazin ◽  
Mohsin Iqbal
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Primary Care Physician ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Physician

Primary care physician decision making regarding referral for bariatric surgery: a national survey

2017 ◽  
Vol 13 (5) ◽  
pp. 807-813 ◽  
Author(s):  
Charlotte Røn Stolberg ◽  
Nicola Hepp ◽  
Anna Julie Aavild Juhl ◽  
Deepti B.C ◽  
Claus B. Juhl
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Decision Making ◽  
Primary Care Physician ◽  
National Survey ◽  
Care Physician ◽  
Physician Decision Making

scholarly journals Medical professionalism: Navigating modern challenges

2021 ◽  
pp. 175573802110526
Author(s):  
Nicola Cooper-Moss ◽  
Helen Hooper ◽  
Kartina A. Choong ◽  
Umesh Chauhan
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
General Practice ◽  
Professional Practice ◽  
Clinical Decision Making ◽  
Medical Profession ◽  
Clinical Decision ◽  
Medical Professionalism ◽  
The Public ◽  
General Practice Training

Medical professionalism is an evolving entity, requiring continual development according to shifting societal priorities. The public trust that underpins the medical profession is imperative for maintaining effective partnerships with patients, their families and the wider community. This article provides an overview of what constitutes medical professionalism, including the current protocols and assessments for general practice training. The aim is to improve understanding of the current issues surrounding professionalism in primary care. Fictional case scenarios are used to illustrate modern professional dilemmas and to promote reflection on the complex interacting factors that influence professional practice and clinical decision-making.

scholarly journals Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Breda H. F. Eubank ◽  
Sebastian W. Lackey ◽  
Mel Slomp ◽  
Jason R. Werle ◽  
Colleen Kuntze ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shoulder Pain ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Rapid Review ◽  
Diagnosis And Management ◽  
Joint Health ◽  
Decision Making Tool

Abstract Background Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. Methods First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. Conclusions This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors.

scholarly journals A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making

2019 ◽  
Vol 29 (1) ◽  
pp. 1-8
Author(s):  
Khadijah E. Abdallah ◽  
Kathleen A. Calzone ◽  
Jean F. Jenkins ◽  
Melissa E. Moss ◽  
Sherrill L. Sellers ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Decision Making ◽  
Genetic Variation ◽  
Nurse Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
General Internal

Objective: The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study in­vestigates primary care providers’ use of race in clinical practice.Methods: Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial At­tributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers’ knowledge of human genetic variation.Results: In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians’ score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67).Conclusions: Physicians had more knowl­edge of genetic variation and used patients’ race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further explora­tion of these differences is needed, including examination of physicians’ and NPs’ beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care dispari­ties.Ethn Dis.2019;29(1):1-8; doi:10.18865/ ed.29.1.1.

scholarly journals Rapid A1c Availability Improves Clinical Decision-Making in an Urban Primary Care Clinic

Diabetes Care ◽  
2003 ◽  
Vol 26 (4) ◽  
pp. 1158-1163 ◽  
Author(s):  
C. D. Miller ◽  
C. S. Barnes ◽  
L. S. Phillips ◽  
D. C. Ziemer ◽  
D. L. Gallina ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Primary Care Clinic ◽  
Clinical Decision ◽  
Care Clinic

scholarly journals Primary Care Physician Designation and Response to Clinical Decision Support Reminders

2016 ◽  
Vol 07 (02) ◽  
pp. 248-259
Author(s):  
Paul Gorman ◽  
Jeffrey Weinfeld
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Electronic Health Record ◽  
Primary Care Physician ◽  
Clinical Decision Support ◽  
Preventive Care ◽  
Response Rates ◽  
Clinical Decision ◽  
Care Physician ◽  
Health Record

SummaryClinical decision support (CDS) has been shown to improve process outcomes, but overalerting may not produce incremental benefits. We analyzed providers’ response to preventive care reminders to determine if reminder response rates varied when a primary care provider (PCP) saw their own patients as compared with a partner’s patients. Secondary objectives were to describe variation in PCP identification in the electronic health record (EHR) across sites, and to determine its accuracy.We retrospectively analyzed response to preventive care reminders during visits to outpatient primary care sites over a three-month period where an EHR was used. Data on clinician requests for reminders, viewing of preventive care reminders, and response rates were stratified by whether the patient visited their own PCP, the PCP’s partner, or where no PCP was listed in the EHR. We calculated the proportion of PCP identification across sites and agreement of identified PCP with an external standard.Of 84,937 visits, 58,482 (68.9%) were with the PCP, 10,259 (12.1%) were with the PCP’s partner, and 16,196 (19.1%) had no listed PCP. Compared with PCP partner visits, visits with the patient’s PCP were associated with more requested reminders (30.9% vs 22.9%), viewed reminders (29.7% vs 20.7%), and responses to reminders (28.7% vs 12.6%), all comparisons p<0.001. Visits with no listed PCP had the lowest rates of requests, views, and responses. There was good agreement between the EHR-listed PCP and the provider seen for a plurality of visits over the last year (D = 0.917).A PCP relationship during a visit was associated with higher use of preventive care reminders and a lack of PCP was associated with lower use of CDS. Targeting reminders to the PCP may be desirable, but further studies are needed to determine which strategy achieves better patient care outcomes.primary care physician (PCP), clinical decision support (CDS), electronic health record (EHR), National Provider Identifier (NPI)

Primary Care Physician Specialty Referral Decision Making: Patient, Physician, and Health Care System Determinants

2006 ◽  
Vol 26 (1) ◽  
pp. 76-85 ◽  
Author(s):  
Christopher B. Forrest ◽  
Paul A. Nutting ◽  
Sarah von Schrader ◽  
Charles Rohde ◽  
Barbara Starfield
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Primary Care Physician ◽  
Health Care System ◽  
Care Physician ◽  
Physician Specialty ◽  
Referral Decision ◽  
Care System
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