scholarly journals Primary Care Provider Continuity Is Associated With Improved Preventive Service Ordering During Brief Visits for Acute Symptoms

2019 ◽  
Vol 6 ◽  
pp. 233339281982626 ◽  
Author(s):  
John C. Matulis ◽  
Jason J. Schilling ◽  
Frederick North
Keyword(s):  
Primary Care ◽  
Acute Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Preventive Services ◽  
Preventive Service ◽  
Secondary Outcome ◽  
Entire Cohort ◽  
Medical Diagnoses ◽  
To Receive

Background: If a patient presents for an acute care visit and sees their assigned primary care provider (PCP), they may be more likely to receive preventive and other services than a patient not seeing their assigned PCP. Methods: After exclusion of 2 visits with insufficient information, we reviewed 98 consecutive, outpatient internal medicine 15-minute acute care visits comparing patients seeing their assigned PCP with those seeing a non-PCP provider. The primary outcome, preventive service ordering, was measured in 2 ways: percentage of patient visits with any preventive service ordered and the total number of preventive services ordered as a proportion of all preventive service items due for each entire cohort. The secondary outcome of other work completed was assessed by comparing tests and consults ordered, and by counting the number of physical examination elements and discrete medical diagnoses documented. Results: The PCPs were significantly more likely than non-PCPs to order any preventive service 45% versus 17% ( P = .005; odds ratio [OR]: 4.16, 95% confidence interval [CI]: 1.45-12.0). The PCP cohort ordered a higher proportion of the total number of preventive services due compared with the non-PCP cohort (30% vs 11%; P = .002; OR: 3.4, CI: 1.5-7.7). The PCPs also addressed more medical diagnoses (2.3 vs 1.4; P = .008) and more frequently ordered tests outside the reason for that visit (40% vs 13%; P = .003; OR: 4.27, CI: 1.5-11.8). Conclusion: Patients seeing their assigned PCP in brief, acute visits have higher rates of preventive and other service ordering compared to those not seeing their assigned PCP.

scholarly journals Having a Primary Care Provider and Receipt of Recommended Preventive Care Among Men in New York City

2010 ◽  
Vol 5 (3) ◽  
pp. 225-235 ◽  
Author(s):  
John P. Jasek
Keyword(s):  
Primary Care ◽  
New York ◽  
New York City ◽  
Care Provider ◽  
York City ◽  
Primary Care Provider ◽  
Seasonal Influenza ◽  
Pneumococcal Vaccination ◽  
Preventive Services ◽  
Insurance Status

To assess the role of having a primary care provider (PCP) in men’s up-to-date receipt of recommended preventive services (colonoscopy, pneumococcal and seasonal influenza vaccination, cholesterol and blood pressure screenings), data from the 2005 and 2006 New York City Community Health Surveys ( N = 3,728 [2006], 2,810 [2005]) were analyzed. PCP prevalence and men’s uptake of each service, overall and by age, race/ethnicity, education, income, insurance status, marital status, and nativity, were evaluated. After controlling for insurance status and other factors, having a PCP significantly predicted receipt of each service (adjusted prevalence ratio from 1.12 [1.08, 1.16] to 1.72 [1.35, 2.22]) and total services. Colonoscopy and seasonal influenza and pneumococcal vaccination receipt were below 70% with or without a PCP. Efforts to increase the proportion of men having a PCP are needed to improve receipt of recommended services. Maximizing awareness and provision of low-use preventive services may be useful.

scholarly journals The Effect of Medicaid Primary Care Provider Reimbursement on Access to Early Childhood Caries Preventive Services

2014 ◽  
Vol 50 (1) ◽  
pp. 136-160 ◽  
Author(s):  
Jill Boylston Herndon ◽  
Scott L. Tomar ◽  
Frank A. Catalanotto ◽  
W. Bruce Vogel ◽  
Elizabeth A. Shenkman
Keyword(s):  
Primary Care ◽  
Early Childhood ◽  
Care Provider ◽  
Primary Care Provider ◽  
Early Childhood Caries ◽  
Preventive Services ◽  
Childhood Caries

scholarly journals Paging the eCardiologist: insights into referral behaviour of primary care physicians from qualitative analysis of a cardiology eConsult service

2018 ◽  
Vol 4 ◽  
pp. 205520761879214
Author(s):  
Elizabeth Chan ◽  
Christopher B Johnson ◽  
Clare Liddy ◽  
Erin Keely ◽  
Nadine Gauthier ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Analysis ◽  
Care Provider ◽  
Primary Care Provider ◽  
Primary Care Physicians ◽  
Positive Family History ◽  
Primary Care Providers ◽  
Secondary Outcome ◽  
Care Providers ◽  
Convenience Sample

Objective The purpose of this study is to investigate determinants of primary care physician cardiology referrals by performing qualitative analysis of questions asked by primary care physicians in cardiology electronic consultation services (eConsults). Setting A health region in eastern Ontario, Canada, where primary care providers have had access to an eConsult service since 2010. Participants We included all consecutive cardiology eConsults initiated by registered primary care provider users of our eConsult service and who initiated one or more eConsult between July 2014 and January 2015. We excluded eConsults in which the primary care provider attached a document without asking a question. A convenience sample of 100 consecutive eConsults initiated by 61 primary care providers was analysed after excluding 14 eConsults. Primary and secondary outcome measures: Primary care provider eConsult questions are categorised into thematic categories based on the constant comparison method of qualitative analysis with external validation by content experts. Secondary outcomes include sample primary care provider eConsult questions to illustrate each theme and any emergent subthemes. Results Thematic saturation occurred after analysis of 30 eConsults. An additional 70 eConsults were coded with no new emergent themes. Themes include exceptions to clinical guidelines ( n=13), non-cardiac treatment in a cardiac patient ( n=13), specific investigation/management ( n=18), interpretation of diagnostic testing ( n=46), clinical concerns despite normal testing ( n=4) and screening for positive family history ( n=6). Subthemes include multiple comorbidities and mild abnormalities on cardiac tests. Conclusions We report categories of clinical questions that drive primary care provider cardiology eConsults. Multimorbidity leads to cardiology eConsults as primary care providers try to apply treatment guidelines in medically complex patients. Mild test abnormalities unrelated to clinical problems commonly lead to cardiology eConsult requests. Further research is needed to determine how guidelines can better account for multimorbidity, and how cardiologists can better communicate with primary care providers to put cardiac test results in clinical context.

scholarly journals Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Tarika Srinivasan ◽  
Erica J. Sutton ◽  
Annika T. Beck ◽  
Idali Cuellar ◽  
Valentina Hernandez ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Patient Care ◽  
Health Center ◽  
Care Provider ◽  
Primary Care Provider ◽  
Genomic Sequencing ◽  
Community Based ◽  
Genomic Screening

Introduction: Minority communities have had limited access to advances in genomic medicine. Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, partnered to assess the feasibility of offering genomic screening to Latino patients receiving care at a community-based health center. We examined primary care provider (PCP) experiences reporting genomic screening results and integrating those results into patient care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other members of the health care team charged with supporting patients who received positive genomic screening results. Interviews were recorded, transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results indicating a genetic variant that warranted clinical management. PCPs felt genomic screening was valuable to patients and their families, and that genomic research should strive to include underrepresented minorities. Providers identified multiple challenges integrating genomic sequencing into patient care, including difficulties maintaining patient contact over time; arranging follow-up medical care; and managing results in an environment with limited genetics expertise. Providers also reflected on the ethics of offering genomic sequencing to patients who may not be able to pursue diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing advances in precision medicine to community-based health centers serving under-resourced populations. By proactively considering patient support needs, and identifying financial assistance programs and patient-referral mechanisms to support patients who may need specialized medical care, PCPs and other health care providers can help to ensure that precision medicine lives up to its full potential as a tool for improving patient care.

Interventions to improve primary care provider management of atopic dermatitis: A systematic review

2021 ◽  
Author(s):  
Emily A. Croce ◽  
Fabiana C. P. S. Lopes ◽  
Jennifer Ruth ◽  
Jonathan I. Silverberg
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Atopic Dermatitis ◽  
Care Provider ◽  
Primary Care Provider

Parent and Primary Care Provider Priorities for Wellness in Early Childhood: A Discrete Choice Experiment

2021 ◽  
Author(s):  
Stephanie L. Mayne ◽  
Chloe Hannan ◽  
Jennifer Faerber ◽  
Rupreet Anand ◽  
Ella Labrusciano-Carris ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Childhood ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Care Provider ◽  
Primary Care Provider ◽  
Choice Experiment

scholarly journals The Digital Divide: A Retrospective Survey of Digital Rectal Examinations during the Workup of Rectal Cancers

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 855
Author(s):  
Omar Farooq ◽  
Ameer Farooq ◽  
Sunita Ghosh ◽  
Raza Qadri ◽  
Tanner Steed ◽  
...  
Keyword(s):  
Primary Care ◽  
Rectal Cancer ◽  
Care Provider ◽  
Primary Care Provider ◽  
Demographic Data ◽  
Significant Proportion ◽  
Digital Rectal Examination ◽  
Patient Questionnaire ◽  
Rectal Examination ◽  
Rectal Cancers

Background: Digital rectal examination (DRE) is considered an important part of the physical examination. However, it is unclear how many patients have a DRE performed at the primary care level in the work-up of rectal cancer, and if the absence of a DRE causes a delay to consultation with a specialist. Methods: A retrospective patient questionnaire was sent to 1000 consecutive patients with stage II or stage III rectal cancer. The questionnaire asked patients to recall if they had a DRE performed by their general practitioner (GP) when they first presented with symptoms or a positive FIT test. Demographic data, staging data, and time to consultation with a specialist were also collected. Results: A thousand surveys were mailed out, and a total of 262 patients responded. Of the respondents, 46.2% did not recall undergoing a digital rectal examination by their primary care provider. Women were less likely to undergo a DRE than men (28.6% vs. 44.3%, p = 0.019). While there was a trend towards longer times to specialist consultation in patients who did not undergo a DRE (27.0 vs. 12.2 weeks), this was not statistically significant (p = 0.121). Conclusion: A significant proportion of patients who are FIT positive or have symptomatic rectal bleeding do not recall having a DRE by their primary care provider. Barriers may include lack of comfort with performing DRE or lack of time. Clearer guidelines and more support for GP’s may increase uptake of DRE.

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