Primary Care Pharmacist Practice Models Shape the Comprehensive Medication Management Process

2021 ◽  
pp. 106002802110420
Author(s):  
Mary Mulrooney ◽  
Marie Smith
Keyword(s):  
Primary Care ◽  
Medication Management ◽  
Primary Care Providers ◽  
Care Providers ◽  
Practice Model ◽  
Team Members ◽  
Primary Care Settings ◽  
Practice Models ◽  
Organizational Needs ◽  
Common Understanding

Pharmacists are well positioned to collaborate with primary care providers (PCPs) to conduct comprehensive medication management (CMM). However, depending on organizational needs and pharmacist staffing resources, different pharmacist practice models have been implemented. In this commentary, we (1) describe 2 common pharmacist practice models in primary care settings, (2) explain variations in the CMM process based on 2 practice models, and (3) outline outcomes and implications of this expanded CMM process. By tailoring the CMM process to their practice model, pharmacists can follow consistent delivery of CMM services to create a common understanding among patients, PCPs, and other care team members.

The assessment and treatment of back and neck pain: an initial investigation in a primary care practice-based research network

2014 ◽  
Vol 16 (05) ◽  
pp. 461-469 ◽  
Author(s):  
Rebecca Fischbein ◽  
Kenelm McCormick ◽  
Brian A. Selius ◽  
Susan Labuda Schrop ◽  
Michael Hewit ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Neck Pain ◽  
Medication Management ◽  
Primary Care Providers ◽  
Research Network ◽  
Care Providers ◽  
Primary Care Settings ◽  
Current Medication ◽  
Practice Based Research

AimThe purpose of this study was to conduct an exploratory examination of the current state of non-malignant acute and chronic back and neck pain assessment and management among primary care providers in a multi-site, practice-based research network.BackgroundAcute and chronic pain are distinct conditions that often require different assessment and management approaches, however, little research has examined assessment and management of acute and chronic pain as separate conditions. The large majority of patients with acute and chronic back and neck pain are managed in primary care settings. Given the differences between acute and chronic pain, it is necessary to identify differences in patient characteristics, practitioner evaluation, treatment and management in primary care settings.MethodsOver a two-week period, 24 practitioners in a multi-site practice-based research network completed 196 data cards about 39 patients experiencing acute back and neck pain and 157 patients suffering from chronic back and neck pain.FindingsThere were significant differences between the patients experiencing acute and chronic pain in regards to practitioner evaluation, current medication management and current treatment for depression. In addition, diagnostics differed between patients experiencing acute versus chronic back and neck pain. Further, primary care providers’ review of online drug monitoring program reports during the current visit was associated with current medication management using short term opioids, long-term opioids or tramadol. Most research examining acute and chronic pain focuses on the low back. Additional research needs to be conducted to explore and compare acute and chronic pain across the whole spine.

scholarly journals Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

2020 ◽  
Vol 11 (04) ◽  
pp. 635-643
Author(s):  
Joan S. Ash ◽  
Dian Chase ◽  
Sherry Baron ◽  
Margaret S. Filios ◽  
Richard N. Shiffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Care Providers ◽  
Technical Feasibility ◽  
Primary Care Settings ◽  
Worker Health ◽  
Operational Issues

Abstract Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center

2021 ◽  
pp. 107839032199416
Author(s):  
Sarah Stalder ◽  
Aimee Techau ◽  
Jenny Hamilton ◽  
Carlo Caballero ◽  
Mary Weber ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Team ◽  
Psychiatric Nurse ◽  
Care Providers ◽  
Team Members ◽  
Task Forces

BACKGROUND: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHOD: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. INTERVENTION: The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

scholarly journals Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fitriana Murriya Ekawati ◽  
Sharon Licqurish ◽  
Jane Gunn ◽  
Shaun Brennecke ◽  
Phyllis Lau
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Delphi Survey ◽  
Care Practice ◽  
Free Text ◽  
Care Providers ◽  
Hypertensive Disorders Of Pregnancy ◽  
Implementation Barriers ◽  
Primary Care Settings ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

Patient Digital Technologies to Support Primary Care across Disorders: Perspectives from Primary Care Providers, Behavioral Health Consultants, and Nurses (Preprint)

2021 ◽  
Author(s):  
Oleg Zaslavsky ◽  
Frances Chu ◽  
Brenna Renn
Keyword(s):  
Primary Care ◽  
Mobile Apps ◽  
Medication Management ◽  
Primary Care Providers ◽  
Health Conditions ◽  
Care Providers ◽  
Health Promoting Behaviors ◽  
Live Video ◽  
Health Promoting ◽  
Clinical Conditions

BACKGROUND Acceptance of digital health technologies among primary care providers and staff for various clinical conditions has not been explored. OBJECTIVE The purpose of this nationwide study was to determine differences between behavioral health consultants (BHCs), primary care providers (PCPs), and nurses in acceptance of mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals to support patient care across clinical conditions. METHODS We surveyed 51 BHCs, 52 PCPs, and 48 nurses embedded in primary care clinics across the United States. We asked respondents to mark technologies they consider appropriate to support patients in: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. RESULTS Respondents were geographically dispersed across the nation, although most (82.9%) practiced in urban and suburban settings. Compared to other personnel, a higher proportion of BHCs endorsed live video. Similarly, a higher proportion of nurses endorsed all other technologies. PCPs had the lowest rates of endorsement across technologies. Within clinical contexts, the highest acceptance rates were 81% and 70% for BHCs and PCPs respectively in live video for common mental health conditions, and 75% for nurses in mobile apps for health-promoting behaviors. The lowest (9%) endorsement rate across providers was in social media for medication management. CONCLUSIONS The survey suggests subtle differences in the way clinicians envision using technologies to support patient care. Future work must attend to provider perceptions to ensure the sustainment of services across conditions and patient populations.

scholarly journals Primary Care Providers Believe That Comprehensive Medication Management Improves Their Work-Life

2019 ◽  
Vol 32 (4) ◽  
pp. 462-473 ◽  
Author(s):  
Kylee A. Funk ◽  
Deborah L. Pestka ◽  
Mary T. Roth McClurg ◽  
Jennifer K. Carroll ◽  
Todd D. Sorensen
Keyword(s):  
Primary Care ◽  
Medication Management ◽  
Primary Care Providers ◽  
Work Life ◽  
Care Providers

scholarly journals Primary Care Providers’ Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions

2021 ◽  
Vol 33 (4) ◽  
pp. 325-344
Author(s):  
Erik D. Storholm ◽  
Allison J. Ober ◽  
Matthew L. Mizel ◽  
Luke Matthews ◽  
Matthew Sargent ◽  
...  
Keyword(s):  
Primary Care ◽  
Claims Data ◽  
Primary Care Providers ◽  
Attitudes And Beliefs ◽  
Care Providers ◽  
Provider Education ◽  
Prescribing Practices ◽  
Sexually Transmitted ◽  
Primary Care Settings ◽  
Exposure Prophylaxis

Increasing access to pre-exposure prophylaxis (PrEP) in primary care settings for patients who may be at risk for HIV could help to increase PrEP uptake, which has remained low among certain key risk populations. The current study conducted interviews with primary care providers identified from national claims data as having either high or low likelihood of serving PrEP-eligible patients based on their prescribing practices for other sexually transmitted infections. The study yielded important information about primary care providers’ knowledge, attitudes, and beliefs about PrEP, as well as the barriers and facilitators to prescribing PrEP. Key recommendations for a provider-focused intervention to increase PrEP prescribing among primary care providers, including increasing patient education to increase demand from providers, enhancing provider education, leveraging technology, and instituting standardized sexual health checks, are provided with the goal of informing network-based interventions.

scholarly journals Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review

10.2196/30479 ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. e30479
Author(s):  
Rhiannon Martel ◽  
Matthew Shepherd ◽  
Felicity Goodyear-Smith
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Risk Behavior ◽  
Primary Care Providers ◽  
Physical Symptoms ◽  
Screening Tools ◽  
Care Providers ◽  
Primary Care Settings ◽  
Behavior Issues ◽  
Sensitive Issues

Background Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods Electronic databases—MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews—were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work.

scholarly journals Primary Care Providers’ Acceptance of Pharmacists’ Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease

2019 ◽  
Vol 35 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Leah L. Zullig ◽  
Shelley A. Jazowski ◽  
Clemontina A. Davenport ◽  
Clarissa J. Diamantidis ◽  
Megan M. Oakes ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Medication Management ◽  
Primary Care Providers ◽  
Care Providers ◽  
Diabetic Kidney

scholarly journals Implementing alcohol use disorder pharmacotherapy in primary care settings: a qualitative analysis of provider-identified barriers and impact on implementation outcomes

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hildi J. Hagedorn ◽  
Jennifer P. Wisdom ◽  
Heather Gerould ◽  
Erika Pinsker ◽  
Randall Brown ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Primary Care Providers ◽  
Relative Advantage ◽  
Implementation Intervention ◽  
Health Administration ◽  
Care Providers ◽  
Implementation Barriers ◽  
Primary Care Settings ◽  
Implementation Outcomes

Abstract Background Despite the high prevalence of alcohol use disorders (AUDs), in 2016, only 7.8% of individuals meeting diagnostic criteria received any type of AUD treatment. Developing options for treatment within primary care settings is imperative to increase treatment access. As part of a trial to implement AUD pharmacotherapy in primary care settings, this qualitative study analyzed pre-implementation provider interviews using the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers. Methods Three large Veterans Health Administration facilities participated in the implementation intervention. Local providers were trained to serve as implementation/clinical champions and received external facilitation from the project team. Primary care providers received a dashboard of patients with AUD for case identification, educational materials, and access to consultation from clinical champions. Veterans with AUD diagnoses received educational information in the mail. Prior to the start of implementation activities, 24 primary care providers (5–10 per site) participated in semi-structured interviews. Transcripts were analyzed using common coding techniques for qualitative data using the CFIR codebook Innovation/Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals domains. Number and type of barriers identified were compared to quantitative changes in AUD pharmacotherapy prescribing rates. Results Four major barriers emerged across all three sites: complexity of providing AUD pharmacotherapy in primary care, the limited compatibility of AUD treatment with existing primary care processes, providers’ limited knowledge and negative beliefs about AUD pharmacotherapy and providers’ negative attitudes toward patients with AUD. Site specific barriers included lack of relative advantage of providing AUD pharmacotherapy in primary care over current practice, complaints about the design quality and packaging of implementation intervention materials, limited priority of addressing AUD in primary care and limited available resources to implement AUD pharmacotherapy in primary care. Conclusions CFIR constructs were useful for identifying pre-implementation barriers that informed refinements to the implementation intervention. The number and type of pre-implementation barriers identified did not demonstrate a clear relationship to the degree to which sites were able to improve AUD pharmacotherapy prescribing rate. Site-level implementation process factors such as leadership support and provider turn-over likely also interacted with pre-implementation barriers to drive implementation outcomes.

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