scholarly journals Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System

2018 ◽  
Vol 62 (8) ◽  
Author(s):  
Nathan R. Shively ◽  
Deanna J. Buehrle ◽  
Cornelius J. Clancy ◽  
Brooke K. Decker
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tract Infection ◽  
Health Care System ◽  
Primary Care Providers ◽  
Acute Respiratory Tract Infection ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Care System

ABSTRACT Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.

scholarly journals A Pilot Assessment of Primary Care Providers’ Knowledge of Adrenal Insufficiency Diagnosis and Management

2019 ◽  
Vol 10 ◽  
pp. 215013271986216 ◽  
Author(s):  
Vinni Makin ◽  
Amy S. Nowacki ◽  
Colleen Y. Colbert
Keyword(s):  
Professional Development ◽  
Primary Care ◽  
Health Care ◽  
Needs Assessment ◽  
Adrenal Insufficiency ◽  
Health Care System ◽  
Primary Care Providers ◽  
Care Providers ◽  
Diagnosis And Management ◽  
Care System

Background and Objectives: Adrenal insufficiency (AI) is one of the most challenging diagnoses in primary care, and misdiagnosis is costly. The aim of this educational needs assessment was to assess primary care physicians’ (PCPs) knowledge of AI diagnosis and management as a preliminary step in developing a professional education module to address knowledge of practice gaps. Methods: We developed a 12-item needs assessment and pretested questionnaire items prior to use to gather validity evidence. The questionnaire contained 4 AI knowledge items, 4 needs assessment items, and 4 demographic items. It was administered to 100 PCPs across a single integrated health care system over a 6-month period. Results: Fifty-one of 100 questionnaires were returned. The majority of respondents believed their knowledge of AI diagnosis and management was “average” when compared with peers. Responses indicated that PCPs were fairly comfortable diagnosing, but not managing AI patients. There was no association between respondents’ clinical knowledge of AI and respondents’ roles as clinical instructors (ie, having trainees assigned to them). A total of 54% of respondents said they utilized online resources to enhance current knowledge of AI and 88% of respondents said they would use a new AI resource, if available. When asked to rank preferences for professional development modalities, 26/38 respondents ranked UpToDate, 21/38 respondents ranked traditional lecture, and 19/38 respondents ranked case discussion among their top 3 choices. Conclusion: Results of this needs assessment showed that PCPs within our health care system both needed and desired professional development targeting AI diagnosis and management. A faculty development session, which included a short lecture and case scenarios, was developed and delivered to PCPs at participating family health centers. Session materials are now available for use by other institutions to meet professional development needs on this important topic.

scholarly journals Quantification of the resilience of primary care networks by stress testing the health care system

2019 ◽  
Vol 116 (48) ◽  
pp. 23930-23935 ◽  
Author(s):  
Donald Ruggiero Lo Sardo ◽  
Stefan Thurner ◽  
Johannes Sorger ◽  
Georg Duftschmid ◽  
Gottfried Endel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Large Scale ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Physician Density ◽  
Care Systems ◽  
Care System

There are practically no quantitative tools for understanding how much stress a health care system can absorb before it loses its ability to provide care. We propose to measure the resilience of health care systems with respect to changes in the density of primary care providers. We develop a computational model on a 1-to-1 scale for a countrywide primary care sector based on patient-sharing networks. Nodes represent all primary care providers in a country; links indicate patient flows between them. The removal of providers could cause a cascade of patient displacements, as patients have to find alternative providers. The model is calibrated with nationwide data from Austria that includes almost all primary care contacts over 2 y. We assign 2 properties to every provider: the “CareRank” measures the average number of displacements caused by a provider’s removal (systemic risk) as well as the fraction of patients a provider can absorb when others default (systemic benefit). Below a critical number of providers, large-scale cascades of patient displacements occur, and no more providers can be found in a given region. We quantify regional resilience as the maximum fraction of providers that can be removed before cascading events prevent coverage for all patients within a district. We find considerable regional heterogeneity in the critical transition point from resilient to nonresilient behavior. We demonstrate that health care resilience cannot be quantified by physician density alone but must take into account how networked systems respond and restructure in response to shocks. The approach can identify systemically relevant providers.

scholarly journals Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for Evaluation of the RESIST Program (Preprint)

2020 ◽  
Author(s):  
Christin Löffler ◽  
Antje Krüger ◽  
Anne Daubmann ◽  
Julia Iwen ◽  
Marc Biedermann ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tract Infection ◽  
Statutory Health Insurance ◽  
Antibiotic Prescription ◽  
Acute Respiratory Tract Infection ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Before And After

BACKGROUND The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. OBJECTIVE The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI. METHODS RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. RESULTS RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020. CONCLUSIONS With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention. CLINICALTRIAL ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505 INTERNATIONAL REGISTERED REPORT RR1-10.2196/18648

scholarly journals Primary health care policy and vision for community pharmacy and pharmacists in Indonesia

2020 ◽  
Vol 18 (3) ◽  
pp. 2085
Author(s):  
Andi Hermansyah ◽  
Luh Wulandari ◽  
Susi A. Kristina ◽  
Sherly Meilianti
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Community Pharmacy ◽  
Health Care Policy ◽  
Primary Care Providers ◽  
Good Evidence ◽  
Care Practice ◽  
Health Coverage ◽  
Care Providers ◽  
Care System

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.

scholarly journals POST-COVID-19HEALTHCARE:TRANSITIONTOANEW NORMAL

2021 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Safia Rehman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Social Media ◽  
Healthcare System ◽  
Health Care System ◽  
World Health ◽  
Care Process ◽  
Care Providers ◽  
Short Period ◽  
Care System

The COVID-19 pandemic has challenged the health care system to face extraordinary circumstances. These challenges bring forth a new era with a certain high point like the transition to the fusion of in person and digital health practice framework. Post COVID-19 there is a lot of sludge in health care, inthe form of administrative processes and requirements that slow down the core activities of providing care. COVID-19 crisis is used as an opportunity to reduce administrative burdens which most of the times made a primary care physician feel demoralized and burned out'. The focus of healthcare has shifted from hospitals to homes using telemedicine technologies which enabled virtual visits and remote care delivery. COVID-19 signified the telemedicine to be an essential component of healthcare delivery. It proved to an effective and safe way of treatment and avoiding nosocomial infections’. Previously, telemedicine was not considered to be a normal consultation method, nowadays it’s part of the normal lives of the patients as well as health care providers. The other big advantage of this great tool is that one can consult doctors even from very remote areas, which is impossible to consult physically. Different technological advancement like Artificial Intelligence-based diagnostics, cloud-based storage of medical records and integration of information in and outside hospitals were explored and adopted in the COVID-19 pandemic. Data is the key to advance research and refine health care process and outcomes for the COVID-19 patients. The digitalization of the health care system can provide significant benefit’. The phenomenon of digitalization of healthcare system is especially benefited for the developing world, because, in the resource-limited environment, a lot of cost and resources can be saved by opting paperless systems. When people were locked down, social media was pivotal in creating awareness and educating people in a short period*. There was a lot of stuff regarding COVID-19 pandemic on social media and most interestingly it was portrayedin a way that one could not be able to neglect the content. Consequently, intentionally or unintentionally many of the users opted some of the measures for prevention of the deadlyinfection. The pandemic has shown us that countries with the more robust public health system, primary care services and a healthier population perform well in the fight against the pandemic. Safeguard of voluntary and community organization is essential’. At the same time the countries with fewer resources and with limited measures for controlling massive disasters, in the form of this pandemic, got exposed. This is an alarming situation for global organizations like the World Health Organization and other health-related global leaders to work together for making sure that health resources be equally provided to all the countries across the globe. The COVID-19 pandemic educated the underdeveloped countries regarding infection control measures like Biosafety and Biosecurity. Health official shifted their resources in maintaining hygienic measures to patients, doctors and support staff. Overall, this led to great impact in revolutionizing patient care and improving quality standards. The deficiency of trained staff in Intensive Care Unit and Accident & Emergency is also highlighted in this pandemic. Hence the focus should be on enabling the existing resources to acquire skill in these specialties. The people started making the right food choice, adapting to healthy physical exercise and ensuring therapies to relieve stress and anxiety’. The pandemic brings changes to the healthcare system, whichis not entirely new, these were introduced by technologists earlier; the system is going back to normal that is stronger, smarter and healthier. Hospitals should ensure that their infrastructure is sufficiently ready to cope with the advent of digitalization.

scholarly journals Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for Evaluation of the RESIST Program

10.2196/18648 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e18648
Author(s):  
Christin Löffler ◽  
Antje Krüger ◽  
Anne Daubmann ◽  
Julia Iwen ◽  
Marc Biedermann ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tract Infection ◽  
Statutory Health Insurance ◽  
Antibiotic Prescription ◽  
Acute Respiratory Tract Infection ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Before And After

Background The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. Objective The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI. Methods RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. Results RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020. Conclusions With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention. Trial Registration ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505 International Registered Report Identifier (IRRID) RR1-10.2196/18648

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A294
Author(s):  
Ivan Vargas ◽  
Alexandria Muench ◽  
Mark Seewald ◽  
Cecilia Livesey ◽  
Matthew Press ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Depression Symptoms ◽  
Care Providers ◽  
Mild Depression ◽  
Significant Depression ◽  
Clinically Significant

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

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