Adult Asthma Diagnosis: Physician Reported Challenges in Alberta-Based Primary Care Practices

Introduction An estimated 8.1% of Canadians adults have asthma. While there are challenges associated with the use of objective measurement of lung function in the diagnosis of asthma, we are uncertain of the barriers that impact the use of objective measures, and have limited understanding of the challenges experienced by primary care providers in diagnosis of asthma. The objectives of this quality improvement initiative were to identify primary care providers’ methods of diagnosing asthma and to identify challenges with diagnosis. Methods An online survey was disseminated using a snowball methodology. Setting Primary care practices in Alberta, Canada. Participants A total of 84 primary care providers completed the survey. Main Outcome Measures Participants were asked their ideal and sufficient methods for diagnosing asthma and to identify challenges in their practice related to asthma diagnosis. Results They identified full pulmonary function testing (54%), pre- and postbronchodilator spirometry (54%), complete history and physical (42%), peak flow measurement overtime (26%), pulmonary consult (26%), and trial of asthma medication(s) (23%), as ideal methods of diagnosing asthma. The most significant barriers to diagnosis included episodic care–care provided typically during times of worsening symptoms without ongoing preventative/maintenance care (55%), patient follow-up (44%), conflict between clinical impression and pulmonary function results (43%), patient already on asthma medications (43%), and interpreting spirometry/pulmonary function results (39%). Conclusion The results of this survey indicate that the majority of primary care providers would choose full pulmonary function testing or pre- and postbronchodilator spirometry as the ideal methods of diagnosing asthma. However, barriers related to the nature of asthma care, patient factors, and challenges with diagnostic testing create challenges. This study also highlights that primary care providers have adapted to challenges in leveraging objective measurement and may rely upon other methods for diagnosis such as trials of medications.

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A novel continuum-based framework for translating behavioral health integration to primary care settings

Translational Behavioral Medicine ◽

10.1093/tbm/ibz142 ◽

2020 ◽

Vol 10 (3) ◽

pp. 580-589 ◽

Cited By ~ 1

Author(s):

Matthew L Goldman ◽

Ekaterina Smali ◽

Talia Richkin ◽

Harold A Pincus ◽

Henry Chung

Keyword(s):

Primary Care ◽

Behavioral Health ◽

Technical Assistance ◽

New York State ◽

Behavioral Health Care ◽

Primary Care Providers ◽

Care Providers ◽

Behavioral Health Integration ◽

Care Practices ◽

Primary Care Practices

Abstract Although evidence-based behavioral health integration models have been demonstrated to work well when implemented properly, primary care practices need practical guidance on the steps they can take to build behavioral health integration capacities. This is especially true for practice settings with fewer resources. This study is a pilot field test of a framework continuum composed of core components of behavioral health integration that can be used to translate the implementation of behavioral health into diverse clinical settings guided by a practice's priorities and available resources. This framework, in combination with technical assistance by the study team, was piloted in 11 small primary care sites (defined as ≤5 primary care providers) throughout New York State. Surveys were collected at baseline, 6 months, and 12 months. Informal check-in calls and site visits using qualitative semistructured individual and group interviews were conducted with 10 of the 11 sites. A mixed-methods approach was used to incorporate the survey data and qualitative thematic analysis. All practices advanced at least one level of behavioral health integration along various components of the framework. These advances included implementing depression screening, standardizing workflows for positive screens, integrating patient tracking tools for follow-up behavioral health visits, incorporating warm hand-offs to on-site or off-site behavioral health providers, and formalized external referrals using collaborative agreements. Practices reported they had overall positive experiences using the framework and offered feedback for how to improve future iterations. The framework continuum, in combination with technical assistance, was shown to be useful for primary care practices to advance integrated behavioral health care based on their priorities and resource availability. The results combined with feedback from the practices have yielded a revised “Framework 2.0” that includes a new organization as well as the addition of a “Sustainability” domain.

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Beyond BMI: a feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMRs)

Health Promotion and Chronic Disease Prevention in Canada ◽

10.24095/hpcdp.40.1.01 ◽

2020 ◽

Vol 40 (1) ◽

pp. 1-10

Author(s):

Lesley Andrade ◽

Kathy Moran ◽

Susan J. Snelling ◽

Darshaka Malaviarachchi ◽

Joanne Beyers ◽

...

Keyword(s):

Primary Care ◽

Eating Habits ◽

Qualitative Interviews ◽

Primary Care Providers ◽

Early Years ◽

Successful Implementation ◽

Care Providers ◽

Nutrition Risk ◽

Care Practices ◽

Primary Care Practices

Introduction Primary care providers have a role to play in supporting the development of healthy eating habits, particularly in a child’s early years. This study examined the feasibility of implementing the NutriSTEP® screen—a 17-item nutrition risk screening tool validated for use with both toddler and preschooler populations—integrated with an electronic medical record (EMR) in primary care practices in Ontario, Canada, to inform primary care decision-making and public health surveillance. Methods Five primary care practices implemented the NutriSTEP screen as a standardized form into their EMRs. To understand practitioners’ experiences with delivery and assess factors associated with successful implementation, we conducted semi-structured qualitative interviews with primary care providers who were most knowledgeable about NutriSTEP implementation at their site. We assessed the quality of the extracted patient EMR data by determining the number of fully completed NutriSTEP screens and documented growth measurements of children. Results Primary care practices implemented the NutriSTEP screen as part of a variety of routine clinical contacts; specific data collection processes varied by site. Valid NutriSTEP screen data were captured in the EMRs of 80% of primary care practices. Approximately 90% of records had valid NutriSTEP screen completions and 70% of records had both valid NutriSTEP screen completions and valid growth measurements. Conclusion Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration.

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Integrating childhood obesity resources into the patient-centered medical home: Provider perspectives in the United States

Journal of Child Health Care ◽

10.1177/1367493518777308 ◽

2018 ◽

Vol 23 (1) ◽

pp. 63-78 ◽

Cited By ~ 2

Author(s):

Samareh G Hill ◽

Thao-Ly T Phan ◽

George A Datto ◽

Jobayer Hossain ◽

Lloyd N Werk ◽

...

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Primary Care Providers ◽

System Level ◽

Pediatric Primary Care ◽

Care Providers ◽

Obesity Management ◽

Ancillary Staff ◽

Care Practices ◽

Primary Care Practices

Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.

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Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

BMJ Open ◽

10.1136/bmjopen-2021-053222 ◽

2022 ◽

Vol 12 (1) ◽

pp. e053222

Author(s):

Manbinder Sidhu ◽

Jack Pollard ◽

Jon Sussex

Keyword(s):

Primary Care ◽

Vertical Integration ◽

Secondary Care ◽

Primary Care Providers ◽

Health Economy ◽

Service Utilisation ◽

England And Wales ◽

Acute Hospitals ◽

Care Practices ◽

Primary Care Practices

ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales.Design and settingA qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents.ResultsWe interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial.ConclusionsVertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.

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Implementation of Pulmonary Function Testing in Rural Primary Care

The Journal for Nurse Practitioners ◽

10.1016/j.nurpra.2018.12.014 ◽

2019 ◽

Vol 15 (4) ◽

pp. e81-e83

Author(s):

Erin Morgan ◽

Janice Lazear

Keyword(s):

Primary Care ◽

Pulmonary Function ◽

Pulmonary Function Testing ◽

Rural Primary Care ◽

Function Testing

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Primary care providers' bereavement care practices: recommendations for research directions

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4157 ◽

2014 ◽

Vol 29 (12) ◽

pp. 1221-1229 ◽

Cited By ~ 10

Author(s):

Angela R. Ghesquiere ◽

Sapana R. Patel ◽

Daniel B. Kaplan ◽

Martha L. Bruce

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Care Providers ◽

Research Directions ◽

Care Practices ◽

Bereavement Care

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Provider-Related Linkages Between Primary Care Clinics and Community-Based Senior Centers Associated With Diabetes-Related Outcomes

Journal of Applied Gerontology ◽

10.1177/0733464818782853 ◽

2018 ◽

Vol 39 (6) ◽

pp. 635-643

Author(s):

Polly Hitchcock Noël ◽

Chen-Pin Wang ◽

Erin P. Finley ◽

Sara E. Espinoza ◽

Michael L. Parchman ◽

...

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Institute Of Medicine ◽

Management Support ◽

Care Providers ◽

Community Based ◽

Senior Centers ◽

Care Community ◽

Primary Care Clinics ◽

Primary Care Practices

The Institute of Medicine (IOM) suggests that linkages between primary care practices and community-based resources can improve health in lower income and minority patients, but examples of these are rare. We conducted a prospective, mixed-methods observational study to identify indicators of primary care–community linkage associated with the frequency of visits to community-based senior centers and improvements in diabetes-related outcomes among 149 new senior center members (72% Hispanic). We used semistructured interviews at baseline and 9-month follow-up, obtaining visit frequency from member software and clinical assessments including hemoglobin A1c (HbA1c) from colocated primary care clinics. Members’ discussion of their activities with their primary care providers (PCPs) was associated with increased visits to the senior centers, as well as diabetes-related improvements. Direct feedback from the senior centers to their PCPs was desired by the majority of members and may help to reinforce use of community resources for self-management support.

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