scholarly journals US Primary Care in 2029: A Delphi Survey on the Impact of Machine Learning

2020 ◽  
Author(s):  
Charlotte Blease ◽  
Anna Kharko ◽  
Cosima Locher ◽  
Catherine M. DesRoches ◽  
Kenneth D. Mandl
Keyword(s):  
Primary Care ◽  
Health Informatics ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Digital Health ◽  
Training Requirements ◽  
Modified Delphi ◽  
Primary Care Workforce ◽  
The Us ◽  
The Impact

AbstractObjectiveTo solicit leading health informaticians’ predictions about the impact of AI/ML on primary care in the US in 2029.DesignA three-round online modified Delphi poll.ParticipantsTwenty-nine leading health informaticians.MethodsIn September 2019, health informatics experts were selected by the research team, and invited to participate the Delphi poll. Participation in each round was anonymous, and panelists were given between 4-8 weeks to respond to each round. In Round 1 open-ended questions solicited forecasts on the impact of AI/ML on: (1) patient care, (2) access to care, (3) the primary care workforce, (4) technological breakthroughs, and (5) the long-future for primary care physicians. Responses were coded to produce itemized statements. In Round 2, participants were invited to rate their agreement with each item along 7-point Likert scales. Responses were analyzed for consensus which was set at a predetermined interquartile range of ≤ 1. In Round 3 items that did not reach consensus were redistributed.ResultsA total of 16 experts participated in Round 1 (16/29, 55%). Of these experts 13/16 (response rate, 81%), and 13/13 (response rate, 100%), responded to Rounds 2 and 3, respectively. As a result of developments in AI/ML by 2029 experts anticipated workplace changes including incursions into the disintermediation of physician expertise, and increased AI/ML training requirements for medical students. Informaticians also forecast that by 2029 AI/ML will increase diagnostic accuracy especially among those with limited access to experts, minorities and those with rare diseases. Expert panelists also predicted that AI/ML-tools would improve access to expert doctor knowledge.ConclusionsThis study presents timely information on informaticians’ consensus views about the impact of AI/ML on US primary care in 2029. Preparation for the near-future of primary care will require improved levels of digital health literacy among patients and physicians.

Abstract 172: Early Impact of a Technology Solution to Transform Care for Cardiometabolic Conditions: Physician Experience and Patient-Centered Outcomes

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Joshua Liberman ◽  
J.B. Jones ◽  
Xiaowei (Sherry) Yan ◽  
Hannah Husby ◽  
Gary Takher ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Digital Health ◽  
Early Experience ◽  
Routine Care ◽  
Cardiometabolic Health ◽  
Structured Interviews ◽  
Disease Case ◽  
The Impact

Objectives: To assess early experience with a digital health solution introduced to primary care. Background: Managing cardiometabolic conditions (diabetes, hypertension, and dyslipidemia) is challenging for patients and physicians. Patients often lack the understanding and motivation to adopt healthy behaviors and adhere to treatment plans. Physicians face the challenge of having limited time to engage and educate patients at the point-of-care. Electronic health records (EHRs) have not solved this problem; in fact, reports suggest that EHRs increase administrative tasks, reducing time with patients and contributing to burnout. To address these issues we developed CM-SHARE, a web-based application that provides physicians and patients a dashboard of critical health information needed at the point of care, actionable cues to address guideline-based care and quality gaps, and visual tools to educate patients. Methods: CM-SHARE was designed with input from practicing primary care physicians (PCPs) and launched in two clinics in April 2016. Physician use of CM-SHARE is voluntary, and regular feedback is elicited for ongoing development. Both quantitative and qualitative measures assess the impact of CM-SHARE. Quantitative measures included use (e.g., number of launches, duration of use, clicks on specific features and functions) and measures of physician efficiency based on the EHR audit file logs. Semi-structured interviews were conducted with both physicians and patients to assess perceptions of CM-SHARE’s impact on physician-patient communication, patients’ knowledge of their conditions and motivations to change health behaviors, as well as value, barriers/facilitators of use, and desired improvements. A pre-post, matched control design was used to assess early experience and impact. Results: From April 27, 2016 to November 1, 2017, CM-SHARE was used in 7,900 encounters for 3,712 patients by 6 PCPs. CM-SHARE was launched in 30% of all encounters, a rate that nearly doubled (to 59%) if cardiometabolic health issues were addressed in the visit. Use of CM-SHARE was associated with a 25%-35% reduction in time spent in the EHR during an encounter and an 11%-20% reduction in the number of EHR clicks during the encounter. Both patients and physicians reported that CM-SHARE enhanced the patient-physician communication, particularly for patients for whom behavior change is necessary to improve clinical measures (e.g., A1c). Following this early experience, CM-SHARE adoption has expanded to 30+ providers, including physicians and an expanded user base of chronic disease case managers and diabetes educators. Conclusions: Digital health solutions such as CM--SHARE can be successfully integrated into routine care settings and favorably influence physician efficiency and patient experience. Further research will explore the impact of CM-SHARE on longer-term health outcomes.

scholarly journals Empathy, burnout, and antibiotic prescribing for acute respiratory infections: a cross-sectional primary care study in the US

2017 ◽  
Vol 67 (661) ◽  
pp. e565-e571 ◽  
Author(s):  
Bob Z Sun ◽  
Alexander Chaitoff ◽  
Bo Hu ◽  
Kathleen Neuendorf ◽  
Mahesh Manne ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Respiratory Infections ◽  
Maslach Burnout Inventory ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Cross Sectional ◽  
The Us ◽  
Physician Empathy ◽  
The Impact

BackgroundThe impact of physician–patient relationship factors, such as physician empathy and burnout, on antibiotic prescribing has not been characterised.AimTo assess associations between physician empathy and burnout and antibiotic prescribing for acute respiratory infections (ARIs) in primary care.Design and settingCross-sectional study of primary care practices in the Cleveland Clinic Health System in the US.MethodPatient and prescribing data were obtained from the medical record. All patients with primary diagnoses of ARIs from 1 January 2012 to 31 December 2013, except those with chronic obstructive pulmonary disease (COPD) or who were immunocompromised, were included. Physician empathy was measured using the Jefferson Scale of Empathy while physician burnout was measured using the Maslach Burnout Inventory. The relationship between empathy and burnout and antibiotic prescribing, adjusted for patient and provider characteristics, was analysed using multiple linear regression.ResultsIn 5937 ARI visits to 102 primary care physicians, the median proportion resulting in antibiotic prescribing was 48.6% (interquartile range [IQR] 24.1% to 70.0%). Neither physician empathy (correlation coefficient [β] 0.005, 95% confidence interval [CI] = −0.001 to 0.010, P = 0.07) nor any burnout measures were significantly associated with antibiotic prescribing: emotional exhaustion (β 0.001, 95% CI = −0.005 to 0.006, P = 0.79), tendency to depersonalise patients (β −0.009, 95% CI = −0.021 to 0.003, P = 0.13), and sense of personal accomplishment (β −0.004, 95% CI = −0.014 to 0.006, P = 0.44).ConclusionThe authors found no significant association between empathy or burnout measures and antibiotic prescribing for ARIs in primary care. Other physician characteristics should be investigated to explain individual variation in antibiotic prescribing.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

scholarly journals Portuguese Primary Care physicians response rate in surveys: A systematic review

2018 ◽  
Vol 64 (3) ◽  
pp. 272-280 ◽  
Author(s):  
Nuno Basílio ◽  
Sara Cardoso ◽  
José Mendes Nunes ◽  
Liliana Laranjo ◽  
Maria da Luz Antunes ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Internal Validity ◽  
Response Rates ◽  
Monetary Incentives ◽  
Average Response ◽  
Average Response Rate ◽  
Effective Strategies ◽  
E Mail

Summary Introduction: Surveys are a useful tool in primary care. However, low response rates can introduce selection bias, impairing both external and internal validity. The aim of this study was to assess the average response rate in surveys with Portuguese general practitioners (GPs). Method: We searched the Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa and the proceedings of conferences of general practice from incepton to December 2016. We included all postal, e-mail, telephone and personal surveys to primary care physicians without language restrictions. We did not assess risk of bias of included studies, since the main outcome was survey response rate. We performed planned subgroup analyses of the use of monetary incentives, the use of non-monetary incentives, survey delivery modes and prior contact with participants. Results: A total of 1,094 papers were identified and 37 studies were included in this review. The response rate in surveys done to Portuguese GPs was 56% (95CI 47-64%). There was substantial heterogeneity among included studies (I2=99%), but subgroup analysis did not explain this heterogeneity. Conclusion: Consistent with other published studies, the average response rate in surveys done with Portuguese GPs was 56%, with substantial variation among studies. Use of monetary incentives, one of the most effective strategies to increase response rates, was not present in any of the included studies.

The impact of a program to enhance the competencies of primary care physicians in caring for patients with AIDS

1986 ◽  
Vol 1 (5) ◽  
pp. 287-294 ◽  
Author(s):  
Charles E. Lewis ◽  
Howard E. Freeman ◽  
Sherrie H. Kaplan ◽  
Christopher R. Corey
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
The Impact

scholarly journals Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Abe ◽  
S. Tsunawaki ◽  
M. Dejonckheere ◽  
C. T. Cigolle ◽  
K. Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Intervention ◽  
Advance Directives ◽  
Primary Care Physicians ◽  
Long Term Care ◽  
Term Care ◽  
Care Services ◽  
The Us ◽  
Diagnosis Of Dementia

Abstract Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.

scholarly journals Primary Care Tracks in Medical Schools

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Maribeth P. Williams ◽  
Denny Fe Agana ◽  
Benjamin J. Rooks ◽  
Grant Harrell ◽  
Rosemary A. Klassen ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Positive Impact ◽  
Medical Schools ◽  
Clerkship Director ◽  
Medicine Clerkship ◽  
Faculty Mentorship

Introduction: With the estimated future shortage of primary care physicians there is a need to recruit more medical students into family medicine. Longitudinal programs or primary care tracks in medical schools have been shown to successfully recruit students into primary care. The aim of this study was to examine the characteristics of primary care tracks in departments of family medicine.  Methods: Data were collected as part of the 2016 CERA Family Medicine Clerkship Director Survey. The survey included questions regarding the presence and description of available primary care tracks as well as the clerkship director’s perception of impact. The survey was distributed via email to 125 US and 16 Canadian family medicine clerkship directors.  Results: The response rate was 86%. Thirty-five respondents (29%) reported offering a longitudinal primary care track. The majority of tracks select students on a competitive basis, are directed by family medicine educators, and include a wide variety of activities. Longitudinal experience in primary care ambulatory settings and primary care faculty mentorship were the most common activities. Almost 70% of clerkship directors believe there is a positive impact on students entering primary care.  Conclusions: The current tracks are diverse in what they offer and could be tailored to the missions of individual medical schools. The majority of clerkship directors reported that they do have a positive impact on students entering primary care.

Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care

2018 ◽  
Vol 32 (1) ◽  
pp. 39-55 ◽  
Author(s):  
Elizabeth Mansfield ◽  
Onil Bhattacharyya ◽  
Jennifer Christian ◽  
Gary Naglie ◽  
Vicky Steriopoulos ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Care Physicians ◽  
Pilot Project ◽  
Models Of Care ◽  
Structured Interviews ◽  
Pilot Projects ◽  
Additional Time ◽  
Content Type ◽  
The Impact

Purpose Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Significant decline in cancer diagnostic testing in U.S. CMS population during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6536-6536
Author(s):  
Dave Smart ◽  
Peter Riccelli ◽  
Keith Kerr ◽  
Jordan Clark ◽  
Susanne Munksted Fosvig ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Diagnosis ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Cancer Control ◽  
Unintended Consequences ◽  
Initial Diagnosis ◽  
Test Volume ◽  
The Us

6536 Background: The COVID-19 pandemic has caused >400,000 infection related deaths in the US to January 2021. Actions taken to limit COVID-19 infection and mortality could potentially lead to unintended consequences, precipitating excess mortality due to other causes. One such cause is delayed cancer diagnosis. Significant decreases in presentation for cancer diagnosis at the primary care level have been noted in the UK. This study aimed to look for evidence of a similar effect in the US. Methods: CMS claims data from JAN18-JUN20 associated with primary diagnosis across 11 cancers (bladder, breast, cervical, colorectal, endometrial, lung, ovarian, pancreatic, prostate, sarcoma and thyroid) were analyzed for use of surgical pathology (SP), a procedure associated with initial diagnosis, and immunohistochemistry (IHC). Test volumes varied widely by test and cancer so were normalized to enable comparison across indications. This was done by dividing the month-on-month difference for the period JAN19-JUN19 vs JAN20-JUN20 by the median monthly test volume for the period JAN18-DEC19 (“pre-COVID period”). Extent and duration of declines in test rates and number of missing patients as the sum of these declines were then determined. The ratio of IHC to SP testing was taken to determine any decline in likely post-initial diagnosis testing. Results: There were significant (>10%) declines in test volumes for SP for all 11 cancers at some time in Q1-Q2 2020. Table. Extent, duration and return to pre-COVID levels for SP testing across 11 cancers Median extent and duration of the decline was 56% (range 41.1%-80.4%) and 2 months (range 1- >4). This equates to 32,192 missing diagnoses across all cancers. SP test volumes for all cancers except lung and breast had returned to around pre-COVID levels by JUN20. There was no significant (>10%) increase in normalized SP test volume after the COVID dip for any cancer. While SP showed decreased test volumes across all cancers at some point during the first half of 2020, test volume ratios of IHC to SP showed increases for most cancers in the same time period. Conclusions: These data highlight that the decline in patients presenting to their primary care physicians with suspicion of cancer for diagnostic investigation was linked to COVID-19 prevention strategies. No evidence for increased, “catch up” testing to address presentational/diagnostic backlog was observed. Thus, it is predicted that these patients may subsequently present with a more advanced cancer. Potential excess morbidity, mortality and cost associated with absent or delayed diagnosis should be factored into cancer control programs going forward.[Table: see text]

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