A Patient-Oriented Approach to the Development of a Primary Care Physical Activity Screen for Embedding into Electronic Medical Records

2020 ◽  
Author(s):  
Rebecca E Clark ◽  
James Milligan ◽  
Maureen C Ashe ◽  
Guy Faulkner ◽  
Carolyn Canfield ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Primary Care Providers ◽  
Activity Levels ◽  
Care Providers ◽  
Structured Interviews ◽  
Physical Activity Counseling ◽  
Limited Opportunity ◽  
Activity Screening ◽  
Activity Questionnaires

Physical activity questionnaires exist, but effective implementation in primary care remains an issue. We sought to develop a physical activity screen (PAS) for electronic medical record (EMR) integration by: 1) identifying healthcare professionals’ (HCPs), patients’ and stakeholders’ barriers to and preferences for physical activity counseling in primary care; and 2) using the information to co-create the PAS. We conducted semi-structured interviews with primary care HCPs, patients and stakeholders, and used content and thematic analyses to inform iterative co-design of the PAS. Interviews with 38 participants (mean age 41 years) resulted in two themes: 1) HCPs are willing to conduct physical activity screening, but acknowledge they don’t do it well; and 2) HCPs have limited opportunity and capacity to discuss physical activity, and need a streamlined process for EMR that goes beyond quantifying physical activity. HCPs, patients and stakeholders co-designed a physical activity screen for integration into the EMR that can be tested for feasibility and effects on HCP behaviour and patients’ physical activity levels. Novelty: • EMR-integration of physical activity screening needs to go beyond just asking about physical activity minutes. • Primary care professionals have variable knowledge and time, and need physical activity counselling prompts and resources. • We co-developed a physical activity EMR tool with patients and primary care providers.

Insights From an Usability Review of an Electronic Medical Record–Integrated Physical Activity Counseling Tool for Primary Care

2020 ◽  
pp. 106480462098214
Author(s):  
Bobby Neudorf ◽  
Lora Giangregorio ◽  
Plinio Morita
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Primary Care Providers ◽  
Care Plan ◽  
Care Providers ◽  
Physical Activity Counseling ◽  
Activity Counseling ◽  
Workflow Integration

This study assessed primary care providers’ (PCPs) perceptions of the usability of an electronic medical record tool to support physical activity counseling in primary care. Our analyses revealed that usability improved when the electronic medical record tool followed a PCP’s natural workflow and when the tool could assist in engaging in a discussion about physical activity. Poor usability was associated with the presence of large amounts of text on the screen and technological aspects that required additional learning. Overall, efficiency, workflow integration, and the inclusion of a care plan were vital in a physical activity counseling tool for a primary care setting.

Project LIFE: A Partnership to Increase Physical Activity in Elders with Multiple Chronic Illnesses

2006 ◽  
Vol 14 (3) ◽  
pp. 324-343 ◽  
Author(s):  
Miriam C. Morey ◽  
Carola Ekelund ◽  
Megan Pearson ◽  
Gail Crowley ◽  
Matthew Peterson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Usual Care ◽  
High Intensity ◽  
Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Significant Group ◽  
Physical Activity Counseling ◽  
Activity Counseling

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group × Time interaction (p= .041) for physical activity frequency and a similar effect for caloric expenditure (p= .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.

Nutrition for the Healthy Adult

2018 ◽  
Author(s):  
Marijane G. Staniec
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Weight Gain ◽  
Chronic Diseases ◽  
Health Care Providers ◽  
Primary Care Providers ◽  
Healthy Adults ◽  
Dietary Guidelines ◽  
Care Providers ◽  
Added Sugars

Many of today’s healthy adults will be plagued by chronic diseases, such as obesity, hypertension, heart disease, and diabetes, and be robbed of the quality of life they desire. According to the 2015–2020 Dietary Guidelines for Americans, about half of all American adults have one or more diet-related chronic diseases. The question, “What should healthy adults eat to stay healthy?” may seem simple. However, many primary care providers feel vulnerable answering questions about nutrition. This review serves as a summary of the most up-to-date guidelines about added sugars, sodium, types of fat, and cholesterol for healthy adults and a refresher for health care providers caring for them. Other important related issues, such as the latest recommendations for physical activity, the problem of adult weight gain, the need for adiposity screening, the powerful role of the primary care provider, and suggestions nutrition-focused primary care, are discussed. This review contains 5 Figures, 5 Tables and 137 references Key words: weight gain, cholesterol, Dietary Guidelines, sugar-sweetened beverages, adiposity, added sugar, hydrogenated oils, physical activity, waist-to-height ratio, nutrition-focused, Primary Care

Understanding Adolescent Expressions of Sadness: A Qualitative Exploration

2020 ◽  
Vol 34 (4) ◽  
pp. 321-339
Author(s):  
Daniela A. Terrizzi ◽  
Huma A. Khan ◽  
Allison Paulson ◽  
Zach Abuwalla ◽  
Nitza Solis ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Depressive Disorder ◽  
Primary Care Providers ◽  
Epidemiologic Studies ◽  
Empirical Literature ◽  
Subthreshold Depression ◽  
Care Providers ◽  
Structured Interviews ◽  
Risk For Depression

PurposePrimary care providers are positioned to identify adolescents at risk for depression and prevent major depressive disorder. To identify subthreshold depression, we examined the language adolescents use to describe their symptoms.MethodsAdolescents ages 13–18 with elevated levels on the Center for Epidemiologic Studies Depression (CES-D) scale and/or a history of depression who were part of a large randomized clinical trial to prevent depressive disorder were included. We used content analysis to analyze transcripts of semi-structured interviews.ResultsSaturation was reached at 37 interviews. Adolescents self-identified as African American (N = 15), Hispanic (N = 10), and White (N = 21). Three domains were revealed; external sources of stress, adolescent expressions of sadness, and seeking help and care. Within these domains, 12 distinct themes emerged contextualizing these domains. No variations in the expression of the themes identified for subthreshold depression were found between the three ethno-cultural groups.Implications for PracticeOur study identifies, in adolescents' own words, how adolescents with subthreshold depression express feelings and cope with symptoms, and may guide primary care providers to recognize subthreshold depression early. These findings are a step toward filling the gap in the empirical literature needed to improve identification of adolescents at risk for depression in nonspecialist settings.

scholarly journals Physical Activity Types and Programs Recommended by Primary Care Providers Treating Adults With Arthritis, DocStyles 2018

2021 ◽  
Vol 18 ◽  
Author(s):  
Dana Guglielmo ◽  
Kristina A. Theis ◽  
Louise B. Murphy ◽  
Michael A. Boring ◽  
Charles G. Helmick ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Activity Types

Physical Activity Assessment and Recommendation for Adults With Arthritis by Primary Care Providers—DocStyles, 2018

2020 ◽  
pp. 089011712098137
Author(s):  
Dana Guglielmo ◽  
Louise B. Murphy ◽  
Kristina A. Theis ◽  
Charles G. Helmick ◽  
John D. Omura ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Nurse Practitioners ◽  
High Volume ◽  
Primary Care Providers ◽  
Physical Activity Assessment ◽  
Care Providers ◽  
Provider Education ◽  
Cross Sectional ◽  
Activity Assessment

Purpose: To examine primary care providers' (PCPs) physical activity assessment and recommendation behaviors for adults with arthritis. Design: Cross-sectional. Setting: 2018 DocStyles online national market research survey of US physicians and nurse practitioners. Sample: 1,389 PCPs seeing adults with arthritis. Measures: 2 independent behaviors (assessment and recommendation) as 3 non-mutually exclusive groups: “always assesses,” “always recommends,” and “both” (“always assesses and recommends”). Analysis: Calculated percentages of each group (overall and by PCP characteristics), and multivariable-adjusted prevalence ratios (PRs) using binary logistic regression. Results: Among PCPs, 49.2% always assessed and 57.7% always recommended physical activity; 39.7% did both. Across all 3 groups, percentages were highest for seeing ≥20 adults with arthritis weekly (“both”: 56.4%; “always assesses”: 66.7%; “always recommends”: 71.3%) and lowest among obstetrician/gynecologists (“both”: 26.9%; “always assesses”: 36.8%; “always recommends”: 40.7%). Multivariable-adjusted associations were strongest for seeing ≥20 adults with arthritis weekly (referent: 1-9 adults) and each of “always assesses” (PR = 1.5 [95% confidence interval (CI): 1.3−1.8] and “both” (PR = 1.6 [95% CI: 1.4−1.9]). Conclusions: Approximately 40% of PCPs sampled always engaged in both behaviors (assessing and recommending physical activity) with adults with arthritis; seeing a high volume of adults with arthritis was consistently related to engaging in each behavior. Evidence-based approaches to support PCP counseling include offering provider education and training, raising awareness of available resources, and using health system supports.

Abstract P077: Missed Opportunities for Behavioral Counseling by Primary Care Providers

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
John D Omura ◽  
Susan A Carlson ◽  
Prabasaj Paul ◽  
Kathleen B Watson ◽  
Fleetwood Loustalot ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
At Risk ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Counseling ◽  
The Metabolic Syndrome ◽  
Patients At Risk ◽  
Risk Patients ◽  
Counseling Practices

Background: In 2014, the US Preventive Services Task Force recommended adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Hypothesis: We hypothesized that primary care providers (PCPs) who discussed physical activity with most of their at risk patients would have a higher prevalence of offering select components than PCPs who discussed physical activity less frequently. Methods: DocStyles 2015, a Web-based panel survey of 1251 PCPs (response rate=76.8%), assessed physical activity counseling practices with patients at risk for CVD (overweight or obese and with hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome). Results: Overall, 55.9% (SE=1.4) of PCPs discussed physical activity with most of their patients at risk for CVD. Among respondents who discussed physical activity with any at risk patients (N=1244), the prevalence of components offered when they counseled ranged from 92.6% encouraging increased physical activity to 15.8% referring to intensive behavioral counseling (Table). PCPs who discussed physical activity with most at risk patients had a higher prevalence of offering all counseling components assessed than PCPs who discussed physical activity less frequently, except for referring to intensive behavioral counseling where no difference was found. Of all PCPs, 8.4% both discussed physical activity with most of their at risk patients and referred them to intensive behavioral counseling. Conclusion: Just over half of PCPs surveyed discussed physical activity with most patients at risk for CVD. These PCPs more frequently offered select components when they counseled with the exception of referral to intensive behavioral counseling. Both the low levels of counseling and referral to intensive behavioral counseling present important opportunities for improving counseling practices.

Abstract P379: Features to Increase Primary Care Provider Referrals to Intensive Behavioral Counseling for Cardiovascular Disease Prevention

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
John D Omura ◽  
Kathleen B Watson ◽  
Fleetwood V Loustalot ◽  
Janet E Fulton ◽  
Susan A Carlson
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
At Risk ◽  
Task Force ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Counseling ◽  
Patients At Risk ◽  
Risk Patients

Background: The US Preventive Services Task Force recommends adults with certain cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling to promote a healthful diet and physical activity for CVD prevention. However, only 1 in 12 primary care providers (PCPs) currently follow this recommendation. This study assessed system and programmatic features PCPs reported would increase their likelihood of referring patients at risk for CVD to intensive behavioral counseling and whether this varied by the percentage of at-risk patients with whom they discuss physical activity. Methods: DocStyles 2018, a web-based panel survey of PCPs, assessed the percentage of at-risk patients with whom PCPs discuss physical activity and the degree to which select features would increase their likelihood of referring to intensive behavioral counseling. Results: Overall, 60.8% of PCPs discussed physical activity with most of their at-risk patients; 21.8% did so with many and 17.4% with few or some. The proportion of PCPs identifying features as increasing their likelihood of referring to intensive behavioral counseling by a great extent ranged from 24.1% for an automated referral in electronic health records, 35.3% for patient progress reports, 41.5% for the program being accredited or evidence-based, to 67.2% for the program having no cost to the patient (Table). These proportions increased for each feature as the percentage of at-risk patients with whom they discuss physical activity increased. Conclusion: PCPs identified programmatic features (i.e. being accredited and of no cost) as having the greatest influence on their likelihood of referring patients at risk for CVD to intensive behavioral counseling, although this varied by the percentage of at-risk patients with whom they discuss physical activity. Findings suggest that the effectiveness of strategies to improve behavioral counseling referrals by PCPs may depend on their current physical activity counseling practices.

scholarly journals What do primary care providers think about implementing breast cancer survivorship care?

2018 ◽  
Vol 25 (3) ◽  
pp. 196 ◽  
Author(s):  
M. Luctkar-Flude ◽  
A. Aiken ◽  
M.A. McColl ◽  
J. Tranmer
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Survivorship Care ◽  
Care Providers ◽  
Structured Interviews ◽  
Educational Preparation ◽  
Care Guidelines

Purpose As cancer centres move forward with earlier discharge of stable survivors of early-stage breast cancer (bca) to primary care follow-up, it is important to address known knowledge and practice gaps among primary care providers (pcps). In the present qualitative descriptive study, we examined the practice context that influences implementation of existing clinical practice guidelines for providing such care. The purpose was to determine the challenges, strengths, and opportunities related to implementing comprehensive evidence-based bca survivorship care guidelines by pcps in southeastern Ontario.Methods Semi-structured interviews were conducted with 19 pcps: 10 physicians and 9 nurse practitioners.Results Thematic analysis revealed 6 themes within the broad categories of knowledge, attitudes, and resources. Participants highlighted 3 major challenges related to providing bca survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described 3 major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles.Conclusions We identified several important challenges to implementation of comprehensive evidence-based survivorship care for bca survivors, as well as several strengths and opportunities that could be built upon to address those challenges. Findings from our research could inform targeted knowledge translation interventions to provide support and education for pcps and bca survivors.

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