scholarly journals A Primary Care Intervention to Increase HIV Pre-Exposure Prophylaxis (PrEP) Uptake in Patients with Syphilis

2022 ◽  
Vol 21 ◽  
pp. 232595822110733
Author(s):  
Ryan Bonner ◽  
Jessica Stewart ◽  
Ashish Upadhyay ◽  
R. Douglas Bruce ◽  
Jessica L. Taylor
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Safety Net ◽  
Care Practice ◽  
Care Providers ◽  
Entire Study ◽  
Safety Net Hospital ◽  
Syphilis Treatment ◽  
Exposure Prophylaxis ◽  
The Impact

Identifying candidates for HIV pre-exposure prophylaxis (PrEP) is a barrier to improving PrEP uptake in priority populations. Syphilis infection is an indication for PrEP in all individuals and can be easily assessed by primary care providers (PCP) and health systems. This retrospective study evaluated the impact of a multidisciplinary provider outreach intervention on PrEP uptake in patients with a positive syphilis test result in a safety-net hospital-based primary care practice. The PCPs of PrEP-eligible patients with a positive syphilis result were notified via the electronic medical record (EMR) about potential PrEP eligibility and institutional HIV PrEP resources. Rates of PrEP offers and prescriptions were compared in the pre (8/1/2018-12/31/2018, n = 60) and post (1/1/2019-5/31/2019, n = 86) intervention periods. Secondary analyzes evaluated receipt of appropriate syphilis treatment and contemporaneous screening for HIV, gonorrhea, and chlamydia. No significant differences in the overall proportion of patients offered (15% vs 19%) and prescribed (7% vs 5%) PrEP were observed between the pre- and post-periods. Overall, 7% of positive tests represented infectious syphilis. The rate of appropriate syphilis treatment was equivalent (57% vs 56%) and contemporaneous screening for other sexually transmitted infections was suboptimal across the entire study period. Although any positive syphilis test may be an easily abstracted metric from the EMR, this approach was inclusive of many patients without current HIV risk and did not increase PrEP uptake significantly. Future research into population health approaches to increase HIV prevention should focus on patients with infectious syphilis and other current risk factors for incident HIV infection.

scholarly journals Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices

2020 ◽  
Vol 17 (6) ◽  
pp. 2154 ◽  
Author(s):  
Sung Eun Choi ◽  
Lisa Simon ◽  
Jane R. Barrow ◽  
Nathan Palmer ◽  
Sanjay Basu ◽  
...  
Keyword(s):  
Primary Care ◽  
Dental Care ◽  
Primary Care Providers ◽  
Care Practice ◽  
First Year ◽  
Dental Practice ◽  
Care Providers ◽  
Net Revenue ◽  
Publicly Insured ◽  
The Impact

Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were −$92,053 (95% CI: −93,054, −91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.

Influence of patient characteristics on provider surveillance for colorectal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10071-10071
Author(s):  
Joanna M. Brell ◽  
Debora S. Bruno ◽  
Steven A Lewis ◽  
John Daryl Thornton
Keyword(s):  
Colorectal Cancer ◽  
Primary Care Providers ◽  
Safety Net ◽  
Categorical Variables ◽  
First Year ◽  
Care Providers ◽  
Specific Patient ◽  
Care Plans ◽  
Safety Net Hospital ◽  
The Impact

10071 Background: The majority of colorectal cancer (CRC) patients present with resectable disease and benefit from future resection of second primary CRC, local recurrence, and oligometastases. Therefore, in addition to colonoscopy one year after diagnosis, American Society of Clinical Oncology (ASCO) offers consensus recommendations to monitor serum CEA and CT scans for early detection. Limited adherence to guidelines has been reported; we explore the impact of specific patient factors related to CRC on provider prescribing in the first year. Methods: At a single urban safety-net hospital, electronic medical records of patients diagnosed with stages I-III CRC from 2002-2014 were reviewed with IRB approval. Chi-square tests determined extent of associations between categorical variables. Two sample t-tests compared means for continuous outcomes across groups. Cut-off for Type 1 error was alpha = 0.05. Due to minimal change in surveillance guidelines, we applied ASCO 2005 recommendations. Results: Records for 357 patients included 52% females and 40% African-Americans. Median age was 63 years, ever tobacco abuse was 69%. BMI > 30 found in 38%, median weight at diagnosis was 79 kg. Incidence of surveillance and associated variables are in the Table. Conclusions: The providers of this young, urban, almost 40% obese population were < 50% compliant with first year colonoscopy and < 60% compliant with CEA tests. Providers did significantly survey patients with co-morbidities, such as higher weight at diagnosis, in this small study. Most patients complied with orders and primary care providers were least compliant (data not shown). The data supports verification in larger study of safety-net hospitals and future comparison regarding influence of new Survivorship Care Plans on guideline adherence. To improve provider compliance, etiology of nonadherence must be addressed. [Table: see text]

scholarly journals Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system

2020 ◽  
Vol 20 ◽  
pp. 101266
Author(s):  
Afiba Manza-A. Agovi ◽  
Ifedioranma Anikpo ◽  
Matthew J. Cvitanovich ◽  
Kevin J. Craten ◽  
Eve O. Asuelime ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Primary Care Providers ◽  
Safety Net ◽  
Care Providers ◽  
Exposure Prophylaxis

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.

scholarly journals Challenging the status quo: results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fitriana Murriya Ekawati ◽  
Ova Emilia ◽  
Jane Gunn ◽  
Sharon Licqurish ◽  
Phyllis Lau
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Primary Care Practice ◽  
Scale Up ◽  
Primary Care Providers ◽  
Care Practice ◽  
Local Health ◽  
Care Providers ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. Methods The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. Results A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. Conclusion The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways’ value in primary care practice.

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.

The Impact of Primary Care Providers’ Bias on Depression Screening for Lesbian Women

2021 ◽  
pp. 152483992110660
Author(s):  
Shuying Sha ◽  
Mollie Aleshire
Keyword(s):  
Primary Care ◽  
Statistical Tests ◽  
Secondary Analysis ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Lesbian Women ◽  
Care Providers ◽  
Explicit Bias ◽  
Implicit And Explicit ◽  
The Impact

Primary care providers’ (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs’ implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs’ implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs ( n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women ( p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers’ awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

scholarly journals A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

2021 ◽  
Vol 53 (10) ◽  
pp. 843-856
Author(s):  
Constance Gundacker ◽  
Tyler W. Barreto ◽  
Julie P. Phillips
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Health Outcomes ◽  
Primary Care Providers ◽  
The United States ◽  
Traumatic Experiences ◽  
Search Term ◽  
Care Providers ◽  
Trauma Informed ◽  
The Impact

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

Improving Primary Care Access to Respirologists Using eConsult

2021 ◽  
Author(s):  
Jean-Grégoire Leduc ◽  
Erin Keely ◽  
Clare Liddy ◽  
Amir Afkham ◽  
Misha Marovac ◽  
...  
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Nurse Practitioners ◽  
Clinical Course ◽  
Primary Care Providers ◽  
Clinical Question ◽  
Care Providers ◽  
Provider Perspectives ◽  
Course Of Action ◽  
The Impact

Abstract Background: Patients and primary care providers (PCP) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7 days. Methods: This is a retrospective review of the Champlain BASETM respirology eConsults from January 2017 to December 2018. The eConsults were categorized by types of question asked by the referring provider, and by the clinical content of the referral. Specialists’ response time and time spent answering the clinical question was analyzed. Referring providers close out surveys were reviewed to assess the impact of the respirology eConsult service on traditional referral rates and clinical course of action. Results: Of the 26,679 cases submitted to the Champlain BASE TM eConsult service 268 were respirology cases (1%). 91% were sent by family physicians, 9% by nurse practitioners. The median time to respond by specialists was 0.8 days, and the median time billed by specialists was 20 minutes. The most common topics were pulmonary nodules and masses (16.4%), cough (10.4%), infective problems (8.6%), COPD (8.6%) and dyspnea NYD (7.8%). The most common types of question asked by PCP were related to investigations warranted (43.1% of cases), general management (17.5%), monitoring (12.6%), need for a respirology referral (12.3%), and drug of choice (6.3%). In 23% of cases the PCP indicated they were planning to refer the patient and no longer need to (avoided referrals) and in 13% of cases the PCP was not going to refer but did after receiving the eConsult advice (prompted referrals). The eConsult led to a new or additional clinical course of action by the PCP in 49% of cases. In 51% of cases the PCP suggested the clinical topic would be well suited to a CME event. Conclusions: Participation in eConsult services can improve timely access to respirologists while potentially avoiding clinic visit and significantly impacting referring PCPs clinical course of action. Using the most common clinical topics and types of question for CME planning should be considered. Future research may include a cost analysis, and provider perspectives on the role of eConsult in respirology care.

Sign in / Sign up

Export Citation Format

Share Document