scholarly journals Pharmacist-Driven Spirometry Screening to Target High-Risk Patients in a Primary Care Setting

2019 ◽  
Vol 10 ◽  
pp. 215013271988971
Author(s):  
Jangus B. Whitner ◽  
Lisa A. Mueller ◽  
Alexa Sevin Valentino
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Care Setting ◽  
Primary Care Setting ◽  
Intervention Site ◽  
High Risk Patients ◽  
Vaccine Recommendations ◽  
Number Of Patients ◽  
Risk Patients ◽  
And Control

Objectives: The primary objective of this study is to determine the effect of proactive pharmacist identification of high-risk patients eligible for diagnostic spirometry testing on the percentage of appropriate spirometry referrals ordered and the percentage of spirometry tests completed in those that qualify. Methods: This prospective study compares spirometry referrals ordered and tests completed between an intervention site and control site within a federally qualified health center (FQHC) where pharmacists provide spirometry services. At both sites, all patients who had a primary care provider (PCP) appointment and qualified for spirometry screening on the designated intervention dates during a 12-week period were included in this study. At the intervention site, the pharmacist recommended a spirometry screening to the PCP prior to identified high-risk patients’ appointments. At both sites, a chart review was completed to determine if referrals were ordered and tests were completed for patients who qualified. Results: The number of patients eligible for diagnostic spirometry testing at the intervention and control sites was 190 (n = 125 vs n = 65, respectively). Among eligible patients, the percentage of referrals ordered was significantly higher at the intervention site (47.2% vs 7.7%, P < .001). Among patients who qualified, completion of spirometry testing was significantly higher in the intervention site (23.2% vs 3.1%, P < .001). Conclusion: Results of this study suggest that pharmacists proactively identifying high-risk patients for spirometry screenings within an FQHC increases appropriate referrals ordered by PCPs and tests completed by high-risk patients. Pharmacists in the primary care setting can aid the PCP in the management of chronic obstructive pulmonary disease through significantly increased spirometry referrals and therapeutic clinical assessments and recommendations. They also can provide face-to-face motivational counseling for smoking cessation, inhaler education, and vaccine recommendations. This population health approach to spirometry testing represents an emerging role for pharmacists and could be adopted in other primary care settings.

scholarly journals P0842MANAGEMENT OF RENAL RISK PATIENTS AND THERAPEUTIC CHANGES AFTER DIAGNOSIS OF KIDNEY DISEASE IN PRIMARY CARE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Emanuel Zitt ◽  
Hannelore Sprenger-Mähr ◽  
Karl Lhotta
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
High Risk ◽  
Kidney Disease ◽  
Statin Therapy ◽  
Care Setting ◽  
Primary Care Setting ◽  
Pressure Control ◽  
Risk Patients ◽  
Ras Blockers

Abstract Background and Aims Screening for chronic kidney disease (CKD) is proposed in high risk groups. Whether a new CKD diagnosis in general practice leads to improved patient management, is largely unknown. Method To answer this question and evaluate the kidney disease specific pharmacological care in renal risk patients, a screening study in patients at high risk for kidney disease was performed in the primary care setting in ten general practices in the state of Vorarlberg, Austria. General practitioners were provided with guidelines for the management of CKD with a focus on blood pressure control, RAS inhibition and use of statins. Results In total, 434 patients between age 35 and 77 were included (61% males, mean age 56±7 years, eGFR 86±15 ml/min, body mass index 31±6 kg/m, blood pressure 135±16/83±10 mmHg), of whom 80% had hypertension, 43% had diabetes and 42% were obese. RAS-blockers were already taken by 64% of patients, statins by 39%. A diagnosis of CKD (stage ≥G3 and/or ≥A2) was established in 73 patients (17%), 60% of them had diabetes. Compared to patients without CKD, CKD patients were already treated more often with RAS-blockers (78% vs 61%, p=0.005), whereas statin usage was comparable (44% vs 38%, p=0.3347). After CKD diagnosis, medical therapy was changed in 13 patients (18%). A RAS-blocker was initiated in two out of the 16 patients without a preexisting RAS-blocker (12.5%), the dosage was increased in one patient. Antihypertensive therapy was intensified adding amlodipine in seven patients (10%), and a statin was begun in six (15%) out of 41 statin-naive patients. In those without CKD after the screening, therapy was changed in 40 patients (11%). Compared to patients with CKD, fewer patients started a statin therapy (5% vs 15%, p=0.012) and were additionally treated with amlodipine (3% vs 10%, p=0.021) to optimize blood pressure control. Conclusion This study shows that in the primary care setting a great proportion of CKD patients are already on RAS-blockers, whereas the prescription rate for statins is low. A diagnosis of CKD led to a moderate increase in statin therapy, which leaves further opportunity for improvement. The reasons for this rather low use of statins in CKD patients need to be determined.

scholarly journals 24-Months Cluster-Randomized Intervention Trial of a Targeted Fall Prevention Program in a Primary Care Setting

2021 ◽  
Author(s):  
Christian Hentschke ◽  
Martin Halle ◽  
Barbara Geilhof ◽  
Peter Landendoerfer ◽  
Wolfgang Blank ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Fall Prevention ◽  
Care Setting ◽  
Primary Care Setting ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Risk Of Falling ◽  
Injurious Falls ◽  
Cluster Randomized

Abstract Background Falls and fall-related injuries are common in community-dwelling older persons. Longitudinal data on effective fall prevention programs are rare. Objective Therefore, we evaluated a 4-months multi-component exercise fall prevention program in a primary care setting on long-term effects over 24 months on falls and concomitant injuries in older community-dwelling persons with high risk of falling. Design and Setting In the Prevention of Falls (PreFalls) study, forty general practitioners in Germany were cluster-randomized (1:1) into an intervention group (IG) or control group (CG). Three hundred seventy-eight independently living people with high risk of falling (78.1 ± 5.9 years, 75% women) were assigned to IG (n = 222) or CG (n = 156). Intervention and Measurements Patients in IG took part in a 4-months multi-component exercise program comprising strength and balance exercises (28 sessions); patients in CG received no intervention. Primary outcome measure was number of falls over 24 months, analyzed by a patient-level, linear mixed Poisson model. Secondary endpoints were number of fall-related injuries, changes in physical function, fear of falling, and mortality. Results After 24 months, the IG demonstrated significantly fewer falls (IRR = 0.63, p = 0.021), injurious falls (IRR = 0.69, p = 0.034), and less fear of falling (p = 0.005). The mortality rate was 5.0% in IG and 10.3% in CG (HR = 0.51, 95% CI: 0.24 to 1.12; p = 0.094). Conclusions In older community-dwelling persons with high risk of falling, a short-term multi-component exercise intervention reduced falls and injurious falls, as well as fear of falling over 24 months.

Treatment pattern changes in high-risk patients newly initiated on statin monotherapy in a managed care setting

2013 ◽  
Vol 7 (5) ◽  
pp. 399-407 ◽  
Author(s):  
Ross J. Simpson ◽  
Kaan Tunceli ◽  
Dena R. Ramey ◽  
David R. Neff ◽  
David M. Kern ◽  
...  
Keyword(s):  
High Risk ◽  
Managed Care ◽  
Care Setting ◽  
Treatment Pattern ◽  
High Risk Patients ◽  
Statin Monotherapy ◽  
Risk Patients

Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

2021 ◽  
Vol 17 (2) ◽  
pp. 109-113
Author(s):  
Julienne K. Kirk, PharmD, CDE, BCPS ◽  
Matthew Q. Tran, PharmD ◽  
Samantha Pelc, PharmD ◽  
Katherine G. Moore, PharmD, BCPS, BCACP
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Family Medicine ◽  
Quality Improvement Intervention ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Support Person ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

Using mHealth tools to improve access, coverage and treatment of uninsured people with high cardiovascular disease risk in Argentina: a study protocol for a pragmatic cluster randomised trial

2018 ◽  
Vol 4 (3) ◽  
pp. 135-141 ◽  
Author(s):  
Shafika Abrahams-Gessel ◽  
Andrea Beratarrechea ◽  
Vilma Irazola ◽  
Laura Gutierrez ◽  
Daniela Moyano ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
High Risk ◽  
Randomised Trial ◽  
Text Messages ◽  
Cluster Randomised Trial ◽  
Cvd Risk ◽  
High Risk Patients ◽  
Cluster Randomised ◽  
Risk Patients

IntroductionCardiovascular disease (CVD) accounts for approximately one-third of Argentina’s deaths. Despite government provision of free primary care health services to the uninsured population, with a focus on non-communicable diseases, screening and management of those with high CVD risk at primary care clinics (PCCs) remain low.Methods and analysisThis pragmatic cluster randomised trial will take place in two provinces of Argentina and will recruit 740 participants. Eight PCCs will be randomised to either the intervention or current practice arm. Community health workers (CHWs) in the intervention arm will be trained to use a set of integrated mHealth tools (a validated risk screening tool mobile application; electronic scheduling system using wireless access to PCCs; and educational text messages) to screen for CVD and to schedule appointments with primary care providers for persons with high CVD risk (≥10%). The primary aims of this study are to determine if the use of mHealth tools will (1) increase attendance of first appointments scheduled by CHWs for persons determined to have high risk for CVD during screening and, (2) lead to an increase in follow-up visits at PCCs by high risk patients. Secondary outcomes include assessing the proportion of high-risk patients receiving appropriate medications and a cost-effective analysis of the intervention.Ethics and disseminationThis study has been approved by the Institutional Review Boards at Partners/Brigham and Women’s Hospital (USA) and the Hospital Italiano de Buenos Aires (Argentina). The open-source software for the mHealth tools will be made publicly available at the end of the study.Trial registration numberNCT02913339.

scholarly journals Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

2019 ◽  
Vol 30 (3) ◽  
pp. 402-407
Author(s):  
Daphne M Stol ◽  
Monika Hollander ◽  
Ilse F Badenbroek ◽  
Mark M J Nielen ◽  
François G Schellevis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Newly Diagnosed ◽  
Additional Risk ◽  
High Risk Patients ◽  
Detection Program ◽  
Risk Patients

Abstract Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

Clinical assessment for high-risk patients with non-alcoholic fatty liver disease in primary care and diabetology practices

2020 ◽  
Vol 52 (3) ◽  
pp. 513-526 ◽  
Author(s):  
Zobair M. Younossi ◽  
Kathleen E. Corey ◽  
Naim Alkhouri ◽  
Mazen Noureddin ◽  
Ira Jacobson ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
High Risk ◽  
Fatty Liver ◽  
Clinical Assessment ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
High Risk Patients ◽  
Risk Patients ◽  
Alcoholic Fatty Liver Disease

scholarly journals The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Katrien Danhieux ◽  
Veerle Buffel ◽  
Anthony Pairon ◽  
Asma Benkheil ◽  
Roy Remmen ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Qualitative Study ◽  
Chronic Care ◽  
Self Management ◽  
Management Support ◽  
High Risk Patients ◽  
Risk Patients ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

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