Multiple Chronic Conditions and the Aging of America

2011 ◽  
Vol 3 (1) ◽  
pp. 51-56 ◽  
Author(s):  
William S. Pearson ◽  
Kavitha Bhat-Schelbert ◽  
Janice C. Probst
Keyword(s):  
Primary Care ◽  
Healthcare System ◽  
Burden Of Disease ◽  
Chronic Conditions ◽  
Primary Care Physicians ◽  
Cost Effective ◽  
The United States ◽  
Assistive Devices ◽  
Multiple Chronic Conditions ◽  
The Impact

Background: As the United States population ages, chronic conditions are becoming more prevalent and our healthcare system is faced with increasing costs. This aging population with increased multiple chronic conditions coupled with increased burden of disease will provide a challenge to primary care physicians to provide quality care that is cost-effective. Therefore, we examined national data to study the impact of chronic conditions, age and caregiving on lifestyle burden. Methods: Cross-sectional data from the 2009 Behavioral Risk Factor Surveillance System were analyzed for the presence of 9 chronic health conditions, including angina/coronary heart disease (CHD), arthritis, asthma, cancer, diabetes, heart attack, hypertension, obesity, and stroke, and average number of chronic conditions among persons 50 years of age and older. Lifestyle burden, measured by activity limitation, required use of assistive devices, and/or serving in a caregiving capacity was measured and stratified by number of chronic conditions. Results: All conditions except obesity and asthma increased with each age category. By age 70, the majority of adults had hypertension (60.7%) and arthritis (55.0%). Prevalence of activity limitations and use of assistive devices increased as did the numbers of chronic conditions. Discussion: These findings point to a changing population of patients for primary care physicians that will require treatment of multiple chronic conditions as well as increased burden of disease. As this population grows, workloads for primary care physicians will increase and could likely lead to inefficient care and possibly inadequate payment for the required level of management. Therefore, the current challenge facing our healthcare system is to evaluate existing models of care for older patients and to develop new models that are cost-effective while at the same time providing fair reimbursement for increased management.

scholarly journals Managing the transition to non-driving in patients with dementia in primary care settings: facilitators and barriers reported by primary care physicians

2019 ◽  
Vol 32 (12) ◽  
pp. 1419-1428 ◽  
Author(s):  
T. L. Scott ◽  
J. Liddle ◽  
N. A. Pachana ◽  
E. Beattie ◽  
G. K. Mitchell
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Primary Care Physicians ◽  
Management Strategies ◽  
Cost Effective ◽  
Driving Cessation ◽  
Major Life ◽  
The Individual ◽  
Primary Care Practices ◽  
The Impact

ABSTRACTObjectives:This research addresses dementia and driving cessation, a major life event for affected individuals, and an immense challenge in primary care. In Australia, as with many other countries, it is primarily general practitioners (GPs) who identify changes in cognitive functioning and monitor driving issues with their patients with dementia. Qualitative evidence from studies with family members and other health professionals shows it is a complicated area of practice. However we still know little from GPs about how they manage the challenges with their patients and the strategies that they use to facilitate driving cessation.Methods:Data were collected through five focus groups with 29 GPs at their primary care practices in metropolitan and regional Queensland, Australia. A semi-structured topic guide was used to direct questions addressing decision factors and management strategies. Discussions were audio recorded, transcribed verbatim and thematically analyzed.Results:Regarding the challenges of raising driving cessation, four key themes emerged. These included: (i) Considering the individual; (ii) GP-patient relationships may hinder or help; (iii) Resources to support raising driver retirement; and (iv) Ethical dilemmas and ethical considerations. The impact of discussing driving cessation on GPs is discussed.Conclusions:The findings of this study contribute to further understanding the experiences and needs of primary care physicians related to managing driving retirement with their patients with dementia. Results support a need for programs regarding identification and assessment of fitness to drive, to upskill health professionals and particularly GPs to manage the complex issues around dementia and driving cessation, and explore cost-effective and timely delivery of such support to patients.

scholarly journals The impact of physician empathy on patient outcomes: A gender analysis

2021 ◽  
pp. BJGP.2021.0193
Author(s):  
Caroline Surchat ◽  
Valérie Carrard ◽  
Jacques Gaume ◽  
Alexandre Berney ◽  
Carole Clair
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Primary Care Physicians ◽  
Cost Effective ◽  
Relational Quality ◽  
Observational Measures ◽  
Fundamental Frequencies ◽  
Patient Reported ◽  
French Speaking ◽  
The Impact

Background: Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and no study concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions. Aim: To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation’s quality and trust in physician, and to determine whether this relationship is moderated by physician’s gender. Design and setting: Analysis of 61 primary care physicians’ empathy in relation to 244 patient experience questionnaires in French-speaking part of Switzerland. Method: Sixty-one physicians were videotaped with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded arousal. After the consultation, patients indicated their satisfaction, trust, and quality of the consultation. Results: Female physicians self-rated their empathic concern above their male counterparts, whereas male physicians were more synchronised to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was a man. Conclusion: Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes and could be used as a cost-effective proxy of relational quality.

Primary Care Physicians’, Psychiatrists’, and Oncologists’ Coordination While Prescribing Medications for Patients With Multiple Chronic Conditions

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Cassidi C. McDaniel ◽  
Chiahung Chou ◽  
Christina Camp ◽  
Natalie S. Hohmann ◽  
Tessa J. Hastings ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Primary Care Physicians ◽  
Multiple Chronic Conditions

scholarly journals The Impact of an Evidence-Based Multi-component Intervention on Colorectal Cancer Screening in Primary Care at a Healthcare System

2021 ◽  
Author(s):  
◽  
Ahnnya Slaughter
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Healthcare System ◽  
The United States ◽  
The Body ◽  
Average Risk ◽  
Number Of Patients ◽  
The Impact

Practice Problem: Colorectal cancer is the second leading cause of cancer death in the United States; many of the deaths are preventable with early detection. Adherence rates for colorectal cancer screening with fecal immunochemical test kits (FIT) was below the national benchmark at this facility. PICOT: The PICOT question that guided this project was: Among veterans 50 – 75 years old requiring average risk colorectal cancer screening (CRCS) seen in primary care at a veterans affairs healthcare system facility (P), how does the use of a multi-component intervention (I), compared to the usual care (C), affect the number of patients completing CRCS (O) over a period of 12 weeks (T)? Evidence: Review of high-quality studies suggested a multi-component approach, including increasing provider awareness and increasing patient education and outreach, as the most effective approach to increase colorectal screening compliance. Intervention: The multi-component intervention included a standardized CRCS nurse navigation process through standard work which included the teach-back method, patient outreach, and provider feedback. Outcome: There were clinically significant improvements in adherence with returned FIT kits, follow up for abnormal FIT kits, and statistically significant improvements with nursing documentation of patient teaching. The number of patients overdue for CRCS decreased. Conclusion: The multi-component CRCS screening intervention demonstrated significant improvements in the intervention clinics which is consistent with the body of evidence.

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.

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

2020 ◽  
Vol 41 (3) ◽  
pp. 192-197
Author(s):  
Sherry S. Zhou ◽  
Alan P. Baptist
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Electronic Cigarettes ◽  
The United States ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Knowledge And Beliefs ◽  
Tobacco Cigarette ◽  
Number Of Patients ◽  
Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

scholarly journals Impact of the COVID-19 Vaccine on Asymptomatic Infection Among Patients Undergoing Pre-Procedural COVID-19 Molecular Screening

2021 ◽  
Author(s):  
Aaron J Tande ◽  
Benjamin D Pollock ◽  
Nilay D Shah ◽  
Gianrico Farrugia ◽  
Abinash Virk ◽  
...  
Keyword(s):  
United States ◽  
Relative Risk ◽  
Healthcare System ◽  
The United States ◽  
Asymptomatic Infection ◽  
Screening Tests ◽  
Molecular Screening ◽  
Molecular Tests ◽  
Asymptomatic Individuals ◽  
The Impact

Abstract Background Several vaccines are now clinically available under emergency use authorization in the United States and have demonstrated efficacy against symptomatic COVID-19. The impact of vaccines on asymptomatic SARS-CoV-2 infection is largely unknown. Methods We conducted a retrospective cohort study of consecutive, asymptomatic adult patients (n = 39,156) within a large United States healthcare system who underwent 48,333 pre-procedural SARS-CoV-2 molecular screening tests between December 17, 2020 and February 8, 2021. The primary exposure of interest was vaccination with at least one dose of an mRNA COVID-19 vaccine. The primary outcome was relative risk of a positive SARS-CoV-2 molecular test among those asymptomatic persons who had received at least one dose of vaccine, as compared to persons who had not received vaccine during the same time period. Relative risk was adjusted for age, sex, race/ethnicity, patient residence relative to the hospital (local vs. non-local), healthcare system regions, and repeated screenings among patients using mixed effects log-binomial regression. Results Positive molecular tests in asymptomatic individuals were reported in 42 (1.4%) of 3,006 tests performed on vaccinated patients and 1,436 (3.2%) of 45,327 tests performed on unvaccinated patients (RR=0.44 95% CI: 0.33-0.60; p&lt;.0001). Compared to unvaccinated patients, the risk of asymptomatic SARS-CoV-2 infection was lower among those &gt;10 days after 1 st dose (RR=0.21; 95% CI: 0.12-0.37; p&lt;.0001) and &gt;0 days after 2 nd dose (RR=0.20; 95% CI: 0.09-0.44; p&lt;.0001) in the adjusted analysis. Conclusions COVID-19 vaccination with an mRNA-based vaccine showed a significant association with a reduced risk of asymptomatic SARS-CoV-2 infection as measured during pre-procedural molecular screening. The results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.

scholarly journals The Impacts of Discrimination and Filial Caregivers’ Age on Aspects of Physical Health

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 360-360
Author(s):  
Barbara Hodgdon ◽  
Jen Wong
Keyword(s):  
Physical Health ◽  
Family Caregivers ◽  
Family Caregiving ◽  
Chronic Conditions ◽  
The United States ◽  
Life Course Perspective ◽  
Late Adulthood ◽  
Study Results ◽  
The Face ◽  
The Impact

Abstract Filial caregivers (e.g., individuals caring for a parent or parent-in-law) are a part of the growing number of family caregivers in midlife and late adulthood. The responsibilities that filial caregivers navigate in midlife and late adulthood may expose them to multiple types of discrimination that may decrease their physical health, though this relationship has been understudied. As numbers of family caregivers grow, it is important to examine the potential vulnerability of younger and older filial caregivers’ physical health in the context of discrimination. Informed by the life course perspective, this study compares the physical health of younger (aged 34-64) and older (aged 64-74) filial caregivers who experience discrimination. Filial caregivers (N=270; Mage=53; SD=9.37) from the Midlife in the United States (MIDUS-II) Survey reported on demographics, family caregiving, daily discrimination, self-rated physical health, and chronic conditions via questionnaires and phone interviews. Regression analyses showed no differences between younger and older adults’ self-rated physical health or average chronic conditions. However, moderation analyses revealed that younger filial caregivers who experienced greater discrimination reported poorer self-rated physical health than their older counter parts as well as younger and older filial caregivers who experienced less discrimination. Additionally, younger caregivers with greater discrimination exposure exhibited more number of chronic conditions as compared to other caregivers. The study results highlight the impact of the intersection between filial caregivers’ age and discrimination on physical health. Findings have the potential to inform programs that could promote the health of filial caregivers in the face of discrimination.

scholarly journals The Importance of Studying Health Behavior in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 827-827
Author(s):  
Jaime Hughes ◽  
Susan Hughes ◽  
Mina Raj ◽  
Janet Bettger
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Behavior Change ◽  
Chronic Conditions ◽  
Population Level ◽  
Multiple Chronic Conditions ◽  
Prior Work ◽  
Time Changes ◽  
The Impact ◽  
Over Time

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

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