Primary Care Providers’ Attitudes Related to LGBTQ People: A Narrative Literature Review

2018 ◽  
Vol 20 (2) ◽  
pp. 173-187 ◽  
Author(s):  
Mollie E. Aleshire ◽  
Kristin Ashford ◽  
Amanda Fallin-Bennett ◽  
Jennifer Hatcher
Keyword(s):  
Primary Care ◽  
Health Disparities ◽  
Primary Care Providers ◽  
Population Based ◽  
Significant Heterogeneity ◽  
Care Providers ◽  
Research Education ◽  
Lgbtq Health ◽  
Narrative Literature Review ◽  
The Individual

The purpose of this article is to review the current literature describing primary care providers’ (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs’ actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies’ purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs’ attitudes toward LGBTQ people were positive, but a minority of each studies’ participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.

scholarly journals The many faces of depression in primary care

2009 ◽  
Vol 18 (1) ◽  
pp. 155-164 ◽  
Author(s):  
Kathy Hegadoren ◽  
Colleen Norris ◽  
Gerri Lasiuk ◽  
Denise Guerreiro Vieira da Silva ◽  
Kaitlin Chivers-Wilson
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Care Providers ◽  
Experienced Nurses ◽  
Practice Nurses ◽  
Client Population ◽  
Pervasive Health ◽  
The Many ◽  
The Individual

Depression is a serious global health problem. It creates a huge economic burden on society and on families and has serious and pervasive health impacts on the individual and their families. Specialized psychiatric services are often scarce and thus the bulk of care delivery for depression has fallen to primary care providers, including advanced practice nurses and experienced nurses who work in under-serviced regions. These health professionals require advanced knowledge about the many faces that depression can display. This article reviews some of the faces of depression seen by primary care providers in their practices. Considering depression as a heterogeneous spectrum disorder requires attention to both the details of the clinical presentation, as well as contextual factors. Recommendations around engagement and potential interventions will also be discussed, in terms of the client population as well as for the practitioner who may be isolated by geography or discipline.

The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities

2017 ◽  
Vol 18 (2) ◽  
pp. 84-94 ◽  
Author(s):  
Lusine Poghosyan ◽  
J. Margo Brooks Carthon
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Disparities ◽  
Ethnic Minorities ◽  
Nurse Practitioner ◽  
Care Delivery ◽  
Ethnic Disparities ◽  
Primary Care Providers ◽  
Care Providers ◽  
Racial And Ethnic Minorities

The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs’ potential and ability to narrow or eliminate health disparities. We found that restrictive state scope of practice regulations, disparate reimbursement policies, lack of NP workforce diversity, and poor organizational structures in NP practices may limit NPs’ contributions to current efforts to reduce disparities. Our results led to the development of the nurse practitioner health disparities model which identifies barriers to and opportunities for optimal use of NPs in reducing racial and ethnic disparities. State and federal policymakers and administrators in health-care settings should take actions to remove legislative and organizational barriers to enable NPs to deliver high-quality care to racial and ethnic minorities. Researchers can use the nurse practitioner health disparities model to produce empirical evidence to reduce health disparities and improve population health.

scholarly journals Successful childhood obesity management in primary care in Canada: what are the odds?

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1327 ◽  
Author(s):  
Stefan Kuhle ◽  
Rachel Doucette ◽  
Helena Piccinini-Vallis ◽  
Sara F.L. Kirk
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Secondary Prevention ◽  
Weight Management ◽  
Systems Approach ◽  
Primary Care Providers ◽  
Canadian Community Health Survey ◽  
Population Based ◽  
Care Providers ◽  
Obesity Management

Background.The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada.Methods.Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada.Results.We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process.Conclusions.In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.

Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: A Qualitative Formative Evaluation of a Web-Based Tool (Preprint)

2021 ◽  
Author(s):  
Sarah Javier ◽  
Justina Wu ◽  
Donna L. Smith ◽  
Fahisa Kanwal ◽  
Lindsey A. Martin ◽  
...  
Keyword(s):  
Primary Care ◽  
Management System ◽  
Formative Evaluation ◽  
Primary Care Providers ◽  
Population Based ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Clinical Workflow ◽  
Web Based

BACKGROUND Cirrhosis, or scarring of the liver, is a debilitating condition affecting millions of U.S. adults. Early identification, linkage to care, and retention in care are critical to preventing severe complications from cirrhosis and death. OBJECTIVE The purpose of this study was to conduct a pre-implementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management. METHODS Semi-structured interviews were conducted with frontline providers in liver disease and primary care clinics at three Veterans Health Administration medical centers. The Consolidated Framework for Implementation Research guided the development of interview guides. Inductive consensus coding was used to analyze transcribed interviews and abstracted coded passages elucidated themes and insights. RESULTS Ten providers were interviewed, including eight physicians and mid-level providers from liver-related specialty clinics and two primary care providers who managed patients with cirrhosis. Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability. CONCLUSIONS P-CIMS shows promise as a powerful tool for identifying, linking, and retaining in care patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in chronic disease populations.

Depression in primary care: part 2—management

BMJ ◽  
2019 ◽  
pp. l835 ◽  
Author(s):  
Parashar Ramanuj ◽  
Erin K Ferenchick ◽  
Harold Alan Pincus
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Organizational Level ◽  
Psychological Interventions ◽  
Care Providers ◽  
Individual Level ◽  
Treatment Of Depression ◽  
The Individual

AbstractDepression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. The first review outlined an approach to screening and diagnosing depression in primary care. This second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.

Depression in primary care: part 1—screening and diagnosis

BMJ ◽  
2019 ◽  
pp. l794 ◽  
Author(s):  
Erin K Ferenchick ◽  
Parashar Ramanuj ◽  
Harold Alan Pincus
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Organizational Level ◽  
Current Evidence ◽  
Evidence Based ◽  
Care Providers ◽  
Individual Level ◽  
Treatment Of Depression ◽  
The Individual ◽  
Evidence Based Guidelines

AbstractDepression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. In this first of two reviews, we outline an approach to screening and diagnosing depression in primary care that evaluates current evidence based guidelines and applies the recommendations to clinical practice. The second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.

Pediatric Collections: LGBTQ+: Support and Care (Part 2: Health Concerns and Disparities)

2021 ◽  
Author(s):  
Keyword(s):  
Primary Care ◽  
Health Disparities ◽  
Medical Home ◽  
Primary Care Providers ◽  
Healthy Adults ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Health Concerns

Although most lesbian, gay, bisexual, transgender, and questioning youths are quite resilient and emerge from adolescence as healthy adults, the effects of stigma and heterosexism can contribute to health disparities. Part 2 of this first-of-its-kind 3-part series can help pediatric primary care providers become stronger allies for TGD patients and their families in the clinic, community, and beyond, providing the promise of both a medical home and a future that celebrates people for being true to themselves. https://shop.aap.org/pediatric-collections-lgbtq-support-and-care-part-2-health-concerns-and-disparities-paperbac/

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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