scholarly journals Lost in Transition: Pharmacist Roles in Identifying and Evaluating Medication-Related Problems During Hospital Discharge Follow-up Visits in a Primary Care Setting

2020 ◽  
Vol 11 ◽  
pp. 215013272091729
Author(s):  
Alexis Dellogono ◽  
Aimee Dawson ◽  
Marisa Piers-Gamble ◽  
Jerril Varghese ◽  
Lori Lewicki
Keyword(s):  
Primary Care ◽  
Hospital Discharge ◽  
Care Setting ◽  
Adverse Drug Events ◽  
Primary Care Setting ◽  
Health Care Team ◽  
Care Team ◽  
Transitions Of Care ◽  
Primary Care Settings

Objectives: The objective of this study was to identify and evaluate medication-related problems (MRPs) found during hospital discharge transitions of care visits in a primary care setting. Design, Settings, and Participants: This retrospective cohort took place within a federally qualified health center (FQHC) where pharmacists are part of the interprofessional transitions of care team to help patients transition back to primary care after being discharged from the hospital. Pharmacists utilized standardized forms to document MRPs, potential and adverse drug events, and interventions made during the visit. This study quantifies the role that pharmacists can have by conducting medication reconciliation during postdischarge primary care visits. Patients included in this study were 18 years and older with at least 5 medications. Outcome Measures: The outcomes of this study include the number and type(s) of MRPs, number and severity of potential adverse drug events (pADEs) and adverse drug events (ADEs) that were identified, as well as the number and type of recommendations or interventions made by the pharmacist. The MRP types and pADE/ADE severity were classified and stratified using predetermined definitions. Results: During the 4-month study period from October 1, 2018 to February 4, 2019, 134 visits were completed. Outcomes included a total of 454 MRPs, with an average of 3 identified per visit. The most common MRPs were medication list in electronic health record inaccurate (79.1% of visits), poor adherence (32.1% of visits), and refills needed (30.6% of visits). A total of 72 pADEs and 27 ADEs were identified, with 524 recommendations made. Conclusion: Pharmacists serve a unique role during transitions of care by identifying MRPs. Pharmacists are an integral part of a patient’s health care team by making recommendations or interventions related to these MRPs. FQHCs and other primary care settings should consider integrating pharmacists into a collaborative transitions of care team.

Evaluation of Adverse Drug Events and Medication Discrepancies in Transitions of Care Between Hospital Discharge and Primary Care Follow-Up

2014 ◽  
Vol 29 (2) ◽  
pp. 132-137 ◽  
Author(s):  
Becky L. Armor ◽  
Avery J. Wight ◽  
Sandra M. Carter
Keyword(s):  
Primary Care ◽  
Hospital Discharge ◽  
Medication Reconciliation ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Transitions Of Care ◽  
Therapeutic Monitoring ◽  
Medication List ◽  
Medication Discrepancies

Approximately two-thirds of adverse events posthospital discharge are due to medication-related problems. Medication reconciliation is a strategy to reduce medication errors and improve patient safety. Objective: To evaluate adverse drug events (ADEs), potential ADEs (pADEs), and medication discrepancies occurring between hospital discharge and primary care follow-up in an academic family medicine clinic. Adult patients recently discharged from the hospital were seen by a pharmacist for medication reconciliation between September 1, 2011, and November 30, 2012. The pharmacist identified medication discrepancies and pADEs or ADEs from a best possible medication history obtained from the electronic medical record (EMR) and hospital medication list. In 43 study participants, an average of 2.9 ADEs or pADEs was identified ( N = 124). The most common ADEs/pADEs identified were nonadherence/underuse (18%), untreated medical problems (15%), and lack of therapeutic monitoring (13%). An average of 3.9 medication discrepancies per participant was identified (N = 171), with 81% of participants experiencing at least 1 discrepancy. The absence of a complete and accurate medication list at hospital discharge is a barrier to comprehensive medication management. Strategies to improve medication management during care transitions are needed in primary care.

scholarly journals Clinicoepidemiological profile and practices to manage dizziness in primary care setting: results from an Indian registry

2021 ◽  
Vol 7 (2) ◽  
pp. 320
Author(s):  
Divya Prabhat ◽  
Ganga Kiran
Keyword(s):  
Primary Care ◽  
Management Practices ◽  
Care Setting ◽  
Primary Care Setting ◽  
Treatment Approach ◽  
Study Data ◽  
Common Symptom ◽  
Primary Care Settings ◽  
Concomitant Medications

<p class="abstract"><strong>Background:</strong> Dizziness is a common symptom encountered in primary care settings by general physicians and specialists. This study evaluated the clinicoepidemiological profile and management practices in patients with dizziness in an Indian primary care setting.</p><p class="abstract"><strong>Methods:</strong> This prospective, multicentric, observational study was conducted between November 2018 and June 2019. Patients aged≥18 years presenting with clinical features of dizziness were eligible. The study data included demographics and socioeconomic details, complete medical history, medication and concomitant medication use, and the cause and pattern of dizziness. Patients had a baseline visit and two follow-up visits at weeks 1 and 4.   </p><p class="abstract"><strong>Results:</strong> Overall, 1000 patients with a mean age of 45.1 years were included (women: 51.5%; men: 48.5%). Of these, 762 reported dizziness as a primary complaint; whereas, 238 reported it as a complaint associated with nausea, vomiting and light-headedness on visit 1, which reduced on subsequent visits. Around 34% of the patients were unemployed and 59% belonged to the upper-middle class. The most common co-morbidities were hypertension and diabetes mellitus (n=132, each). More than 50% of the patients presented with vestibular cause (n=577), followed by neurologic (n=179), metabolic (n=84) and psychiatric (n=61) etiologies. Betahistine (n=581) and prochlorperazine (n=312) were the commonly prescribed medicines for primary and associated complaints. The most commonly used concomitant medications were telmisartan (n=53), glimepiride plus metformin (n=40), metformin (n=32) and ondansetron (n=29).  </p><p class="abstract"><strong>Conclusions:</strong> Dizziness has a multifactorial origin necessitating a multifactorial treatment approach. Betahistine and prochlorperazine were the most commonly prescribed drugs in the primary care setting (CTRI/2018/11/016408).  </p>

Combined Hemimandibular Hyperplasia and Elongation: the Orthodontic-Surgical Management

2020 ◽  
Vol 13 (3) ◽  
pp. 134-140
Author(s):  
Ciarán Devine ◽  
Anna Sayan ◽  
Velupillai Ilankovan
Keyword(s):  
Primary Care ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Clinical Relevance ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diagnostic Techniques ◽  
Mandibular Asymmetry ◽  
Contemporary Management

Patients commonly present to orthodontists with complaints of facial and/or mandibular asymmetry. It is important that all asymmetry complaints are taken seriously and further investigated. Orthodontists play an important role in the diagnosis, management and follow-up of these conditions. For condylar hyperactivity, management is generally in a multidisciplinary setting. Clinicians who practice orthodontics in a primary care setting need to be aware of the correct terminology and the appropriate investigations required for diagnosis and the management of this condition. This paper aims to describe the contemporary management of condylar hyperactivity and presents a case of combined orthodontic-surgical treatment. CPD/Clinical Relevance: Condylar hyperactivity can lead to severe orofacial deformities and severe malocclusions. The orthodontist must understand the terminology, diagnostic techniques and treatment of this condition in order to offer the most appropriate management. The entire dental team may be involved in cases of condylar hyperactivity from diagnosis through to follow-up. Increased awareness may therefore improve diagnosis and ensure appropriate early referrals are made, thus potentially improving outcomes.

Efficacy of Using Physical Activity Mentors to Increase the Daily Steps of Older Adults in the Primary Care Setting: A Pilot Study

2014 ◽  
Vol 22 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Karen A. Croteau ◽  
Vijiayurani Suresh ◽  
Elanna Farnham
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Primary Care ◽  
Pilot Study ◽  
Repeated Measures ◽  
Care Setting ◽  
Primary Care Setting ◽  
Chronic Illnesses ◽  
Main Effects

The purpose of this pilot study was to determine if using physical activity (PA) mentors has any additional impact on daily steps of older adults participating in the Maine in Motion (MIM) program in the primary care setting. Participants were randomly assigned to a MIM-only group (n= 14) or a MIM+ mentor group (n= 14). The MIM intervention lasted 6 months with follow-up at 12 months. Average age of participants was 64 ± 8.8 years and most participants had multiple chronic illnesses. At baseline, mean body mass index (BMI) was 32.2 ± 5.1 and average daily steps were 4,236 ± 2,266. Repeated-measures ANOVA revealed significant main effects for steps,F(2.324, 59.104) = 4.168,p= .015, but no main effects for group,F(1, 25) = 2.988,p= .096, or time-by-group interaction,F(2.324, 59.104) = 0.905,p= .151. All participants significantly increased daily steps over the course of the intervention, with MIM+ participants maintaining increases at follow-up. No significant findings were found for BMI.

Screening Younger Individuals in a Primary Care Setting Flags Putative Dementia Cases and Correlates Gastrointestinal Diseases with Poor Cognitive Performance

2016 ◽  
Vol 43 (1-2) ◽  
pp. 15-28 ◽  
Author(s):  
Ilka M. Rosa ◽  
Ana Gabriela Henriques ◽  
Liliana Carvalho ◽  
Joana Oliveira ◽  
Odete A.B. da Cruz e Silva
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Gastrointestinal Disease ◽  
Gastrointestinal Diseases ◽  
Diagnostic Tools ◽  
Clinical Dementia Rating ◽  
Dementia Prevalence ◽  
Dementia Screening ◽  
Primary Care Settings

Background/Aims: Diagnosing dementia is challenging in many primary care settings, given the limited human resources and the lack of current diagnostic tools. With this in mind, a primary care-based cohort was established in the Aveiro district of Portugal. Methods: A total of 568 participants were evaluated using cognitive tests and APOE genotyping. Results: The findings revealed a dementia prevalence of 12%. A strong correlation between increasing Clinical Dementia Rating (CDR) scores and education was clearly evident. Other highly relevant risk factors were activities of daily living (ADL), instrumental ADL, aging, depression, gender, the APOE ε4 allele, and comorbidities (depression as well as gastrointestinal, osteoarticular, and neurodegenerative diseases). A hitherto unreported, significant correlation between gastrointestinal disease and high CDR score was clearly observable. Conclusions: This study shows the merit of carrying out a dementia screening on younger subjects. Significantly, 71 subjects in the age group of 50-65 years were flagged for follow-up studies; furthermore, these cases with a potentially early onset of dementia were identified in a primary care setting.

scholarly journals Impact of a diabetes disease management program on quality of care and costs: propensity score-matched real-world data from Switzerland.

2020 ◽  
Author(s):  
Maria Carlander ◽  
Marc Hoeglinger ◽  
Maria Trottmann ◽  
Birgitta Rhomberg ◽  
Cornelia Caviglia ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Propensity Score ◽  
Guideline Adherence ◽  
Care Setting ◽  
Primary Care Setting ◽  
Management Program ◽  
Control Group

Objectives Structured treatment programs have been recommended for management of patients with chronic conditions to overcome ill-coordinated care. We aimed to evaluate a disease management program (DMP) with for diabetes mellitus in Switzerland. Methods We performed a prospective observational study with a propensity score-matched usual care control group from a claims database. We included type-1 and type-2 diabetes patients from a primary care setting. The DMP (intervention) comprised a structured treatment approach with an individual treatment plan, treatment goals and an interprofessional team approach. Our outcome comprehensive measures included quality of life (QOL: EQ-5D-5L), pre-defined indicators for diabetes guideline adherence, number of used services and direct medical costs. We applied a difference-in-difference (DID) approach to compare DMP with usual care (follow-up 1 year). Costs were calculated with non-parametric bootstrapping (2017 Swiss Francs, CHF; conversion rate to Euros: 0.85) from a third-party payer perspective (Swiss health care insurance). Results QOL in a sub-sample of 80 patients did not change during follow-up (mean utility 0.89 at baseline and follow-up; p=0.94). Guideline adherence showed slight improvements for DMP. For example, non-adherence (baseline DMP: 19%) decreased in the DMP group by -3 %-points (DID; 95%-CI: -0.07 to 0.01) but not in the control group. A general trend emerged, though mostly not statistically significant, with less used services in the DMP group compared to the control group. Costs increased in both groups during follow-up, but the increase was higher in the control group (DID, mean total costs per patient per year: CHF -950.00 [95%-CI: -1959.53 to 59.56]). Such a negative difference-in-difference estimate in favor of DMP also emerged for cost sub-categories (e.g. costs for inpatient and outpatient care). Conclusions The structured treatment program under evaluation is a promising approach to improve diabetes care in a Swiss primary care setting but more follow-up data are needed.

scholarly journals Reduction of corticosteroid use in outpatient treatment of exacerbated COPD – Study protocol for a randomized, double-blind, non-inferiority study (The “RECUT”-Trial)

2019 ◽  
Author(s):  
Pascal Urwyler ◽  
Maria Boesing ◽  
Kristin Abig ◽  
Marco Cattaneo ◽  
Thomas Dieterle ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Day Treatment ◽  
Corticosteroid Treatment ◽  
Double Blind ◽  
Corticosteroid Dose ◽  
Copd Exacerbations ◽  
Copd Patients

Abstract Background Chronic obstructive pulmonary disease (COPD) is a major public health issue affecting approximately four to seven percent of the Swiss population. According to current inpatient guidelines, systemic corticosteroids are important in the treatment of acute COPD exacerbations and should be given for five to seven days. Several studies suggest that corticosteroids accelerate the recovery of the FEV1 (forced expiratory volume in one second), enhance oxygenation, decrease duration of hospitalization and improve clinical outcome. However, the additional therapeutic benefit on FEV1 recovery appears to be most apparent in the first three to five days. No data are available on the minimal necessary corticosteroid dose and treatment duration in primary care patients with acute COPD exacerbations. Given that many COPD patients are treated on an outpatient basis, there is an urgent need to improve evidence about COPD management in this setting. The aim of this study is to investigate whether a three-day treatment with orally administered corticosteroids is non-inferior to a five-day treatment in acute exacerbations of COPD in a primary care setting. Methods The proposed study is a prospective, double-blind, randomized controlled trial conducted in a primary care setting, including an anticipated number of 470 patients with acutely exacerbated COPD. Participants are randomised to receive systemic corticosteroid treatment of 40 mg prednisone daily for five days (conventional arm, n = 235), or for three days, followed by two days of placebo (experimental arm, n = 235). Antibiotic treatment for seven days is given to all patients with CRP ≥ 50 mg/l, known diagnosis of bronchiectasis, or presenting with Anthonisen Type-I exacerbation. Additional treatment after inclusion is left at the discretion of the treating general practitioner. Follow-up visits are performed on days three and seven by the treating general practitioners, followed by telephone interviews on days 30, 90 and 180 after inclusion into the study. Primary endpoint is the time to next exacerbation during a six-months follow-up period, which includes re-exacerbation during index exacerbation. Discussion This study is designed to assess whether a three-day course of corticosteroid treatment is not inferior to the current conventional five-day treatment course in outpatients with exacerbated COPD regarding time to next exacerbation. Depending on the results, this trial might lead to a further reduction of cumulative corticosteroid dose in COPD patients.

scholarly journals Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jessica Vandenhaute ◽  
Elyonore Tsakeu ◽  
Pierre Chevalier ◽  
Manjiri Pawaskar ◽  
Goran Benčina ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Medication Management ◽  
Antibiotic Use ◽  
Related Complication ◽  
Patient Database ◽  
Gp Visits ◽  
Using Data

Abstract Background Varicella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur. Objectives The objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits. Methods The study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period. Results 3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP. Conclusions This study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use.

scholarly journals Wellness Coaching to Improve Lifestyle Behaviors Among Adults With Prediabetes: Patients’ Experience and Perceptions to Participation

2018 ◽  
Vol 5 (4) ◽  
pp. 314-319 ◽  
Author(s):  
Ramona S DeJesus ◽  
Matthew M Clark ◽  
Lila J Finney Rutten ◽  
Julie C Hathaway ◽  
Patrick M Wilson ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Health Care Team ◽  
Lifestyle Behaviors ◽  
Health And Wellness ◽  
Coaching Relationship ◽  
Wellness Coaching ◽  
Behavior Strategies ◽  
Patients Experience

Background: Health and Wellness Coaching has been shown to enhance treatment outcomes in the primary care setting. However, little is known about the experience and perceptions of patients who worked with a wellness coach as an integrated member of their primary health-care team. Objective: This project assessed patients’ experience and obtained their perceptions on barriers and facilitators to participation in a primary care–based wellness coaching program. Method: A survey was mailed to 99 primary care patients with prediabetes who participated in a 12-week wellness coaching program. Results: Sixty-two (63%) completed the survey; responders felt that participation in the wellness coaching program helped move them toward healthier lifestyle behavior and created a personal vision of wellness. Major themes associated with participation were supportive coaching relationship, increased self-accountability, increased goal-setting, and healthy behavior strategies. No significant barrier to participation was reported. Conclusion: Participants reported highly positive experience with the program; how to best integrate health and wellness coaching into the primary care setting needs to be explored.

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