Assessment of Drug-Prescribing Problems in a Multidisciplinary Primary Care Clinic

1996 ◽  
Vol 12 (4) ◽  
pp. 155-159 ◽  
Author(s):  
Jill E Otaguro ◽  
Leann E Kruse
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Primary Care Clinic ◽  
Lipid Lowering ◽  
Patient Specific ◽  
Chronic Obstructive ◽  
Care Clinic ◽  
Drug Classes ◽  
Problematic Drug ◽  
Lipid Lowering Agents

Objective: To identify drug classes prone to prescribing problems in a multidisciplinary primary care clinic in a Department of Veterans Affairs Medical Center. Methods: Over a 10-week study period, the ambulatory care pharmacists reviewed the prescription profiles and medical records of every patient with an appointment in the Comprehensive Health Care Unit primary care clinic. Based on this review, the pharmacists made patient-specific consultations to the providers. They were also available during clinic hours for additional consultations and patient referrals. A standard data collection form was used to document all consultations. Results: The pharmacists made 1,701 consultations concerning 1,665 patients. The most problematic drug classes identified included anticoagulants, lipid-lowering agents, antiulcer agents, antihypertensive/ cardiovascular agents, chronic obstructive pulmonary disease/asthma agents, oral antidiabetic agents, nonsteroidal antiinflammatory drugs, and anticonvulsants. Anticoagulants and lipid-lowering agents were the most problematic drug classes, with most of the consultations related to dosing and monitoring requirements. Consultations had an 88.6% acceptance rate and resulted in a total monthly drug cost avoidance of $1,525. Conclusions: As a result of identifying the most problematic drug classes, computer programs have been developed to streamline the pharmacist review process, and clinical practice guidelines, posters, and educational handouts have been developed to promote appropriate prescribing.

scholarly journals Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications

2021 ◽  
Vol 12 ◽  
pp. 215013272110350
Author(s):  
Pasitpon Vatcharavongvan ◽  
Viwat Puttawanchai
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Study Data ◽  
Patient Specific ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Care Clinic ◽  
Inappropriate Medications

Background Most older adults with comorbidities in primary care clinics use multiple medications and are at risk of potentially inappropriate medications (PIMs) prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected from electronic medical records in a primary care clinic in 2018. Samples were patients aged ≥65 years old with at least 1 prescription. Variables included age, gender, comorbidities, and medications. The list of risk drugs for Thai elderly version 2 was the criteria for PIMs. The prevalence of polypharmacy and PIMs were calculated, and multiple logistic regression was conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively. Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI 2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing unnecessary medications is crucial to prevent negative health outcomes from PIMs. Computer-based clinical decision support, pharmacy-led interventions, and patient-specific drug recommendations are promising interventions to reduce PIMs in a primary care setting.

scholarly journals 0596 Providers Rarely Assess Obstructive Sleep Apnea Symptoms Among Patients with Chronic Obstructive Pulmonary Disease

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A228-A228
Author(s):  
L M Donovan ◽  
T Keller ◽  
N H Stewart ◽  
L J Spece ◽  
D H Au ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Symptom Assessment ◽  
Cross Sectional Study ◽  
Mixed Effects ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Care Clinic ◽  
General Internal ◽  
Obstructive Sleep

Abstract Introduction Professional societies recommend providers assess sleep symptoms in COPD, but it is unclear if this occurs. We aimed to evaluate OSA symptom assessment and documentation among patients with COPD, and the patient and provider characteristics associated with this assessment. Methods We conducted a cross-sectional study of adults aged ≥40 years with clinically diagnosed COPD and no prior diagnosis of OSA. We selected patients receiving care at two academic general internal medicine clinics between 6/1/2011 - 6/1/2013. We abstracted charts to assess how often OSA symptoms such as snoring, somnolence, witnessed apneas, or gasping/choking arousals were documented as present or absent. We performed multivariable mixed-effects logistic regression to assess associations of patient and primary care provider (PCP) factors with assessment of OSA symptoms. Patient factors included demographics, body mass index, comorbidities, healthcare utilization, and severity of COPD, and PCP factors including demographics, degree, and years of experience. Results Of 523 patients with COPD, only 26 (5.0%) had documentation of OSA symptom assessment within a one-year period. In mixed effects models, only referral to general pulmonary clinic was associated with the assessment of OSA symptoms (OR: 4.56, 95% CI 1.28-15.52). Among the 26 individuals who had OSA symptoms assessed, 9 (34.6%) reported snoring, 15 (57.7%) reported daytime somnolence, 2 (7.7%) reported gasping/choking arousals, and 5 (19.2%) reported witnessed apneas. Among those assessed for OSA symptoms, providers referred 11 (42.3%) for formal sleep consultation. Conclusion Providers rarely document OSA symptoms for patients with COPD in primary care clinic, but assessment is greater among those with pulmonary specialty consultation. Given time constraints in primary care, external facilitation of sleep symptom assessment may improve symptom recognition and receipt of appropriate services. Support NIH 5K23HL111116-05, VA Center of Innovation for Veteran-Centered and Value-Driven Care.

scholarly journals Primary care provider approaches to preventive health delivery: a qualitative study

2018 ◽  
Vol 19 (5) ◽  
pp. 464-474
Author(s):  
Hemalatha Murugan ◽  
Clarence Spigner ◽  
Christy M. McKinney ◽  
Christopher J. Wong
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Preventive Health ◽  
Care Providers ◽  
Care Clinic ◽  
Health Delivery

AimThe objective of this study was to seek decision-making insights on the provider level to gain understanding of the values that shape how providers deliver preventive health in the primary care setting.BackgroundThe primary care clinic is a core site for preventive health delivery. While many studies have identified barriers to preventive health, less is known regarding how primary care providers (PCPs) make preventive health decisions such as what services to provide, under what circumstances, and why they might choose one over another.MethodsQualitative methods were chosen to deeply explore these issues. We conducted semi-structured, one-on-one interviews with 21 PCPs at clinics affiliated with an academic medical center. Interviews with providers were recorded and transcribed. We conducted a qualitative analysis to identify themes and develop a theoretical framework using Grounded Theory methods.FindingsThe following themes were revealed: longitudinal care with an established PCP–patient relationship is perceived as integral to preventive health; conflict and doubt accompany non-preventive visits; PCPs defer preventive health for pragmatic reasons; when preventive health is addressed, providers use multiple contextual factors to decide which interventions are discussed; and PCPs desired team-based preventive health delivery, but wish to maintain their role when shared decision-making is required. We present a conceptual framework called Pragmatic Deferral.

Evaluation of clinical pharmacy interventions in a Veterans Affairs medical center primary care clinic

2013 ◽  
Vol 70 (13) ◽  
pp. 1168-1172 ◽  
Author(s):  
Augustus Hough ◽  
Christine M. Vartan ◽  
Julie A. Groppi ◽  
Sonia Reyes ◽  
Nick P. Beckey
Keyword(s):  
Primary Care ◽  
Clinical Pharmacy ◽  
Medical Center ◽  
Primary Care Clinic ◽  
Veterans Affairs ◽  
Care Clinic ◽  
Pharmacy Interventions

Predictors, Barriers, and Facilitators of Lipid-Lowering Medication Use Among African Americans in a Primary Care Clinic

2009 ◽  
Vol 101 (9) ◽  
pp. 944-952 ◽  
Author(s):  
Kendra L. Schwartz ◽  
Rhonda Dailey ◽  
Monina Bartoces ◽  
Juliann Binienda ◽  
Carolyn Archer ◽  
...  
Keyword(s):  
Primary Care ◽  
African Americans ◽  
Primary Care Clinic ◽  
Medication Use ◽  
Barriers And Facilitators ◽  
Lipid Lowering ◽  
Care Clinic

Reducing the Pain Behind Opioid Prescribing in Primary Care

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1377-1384
Author(s):  
José Luis González ◽  
Radhika Prabhakar ◽  
Jennifer Marks ◽  
Cheryl L P Vigen ◽  
Jagruti Shukla ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
High Dose ◽  
Care Clinic ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Primary Care Resident

Abstract Objective To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic. Design Retrospective observational study. Setting Internal medicine primary care resident clinic at a large urban academic medical center. Subjects All patients receiving opioid prescriptions from the primary care clinic. Methods We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed. Results We observed an average monthly reduction of 2.44% (P < 0.001) in the number of prescriptions dispensed and a 1.83% (P < 0.001) monthly reduction in the number of patients receiving prescriptions. Over the two-year period, there was a 74.3% reduction in total MMEs prescribed and a 66.5% reduction in the average MMEs prescribed per patient. Conclusions Our findings demonstrate a significant reduction in opioid prescribing after implementation of a comprehensive initiative. Although our study was observational in nature, we witnessed a nearly threefold decrease in opioid prescribing compared with national trends. Our results offer important insights for other primary care resident clinics hoping to engender safe prescribing practices and curb high-dose opioid prescribing.

The Role of a Community Coalition in the Development of Health Services for the Poor and Uninsured

1996 ◽  
Vol 26 (1) ◽  
pp. 93-110 ◽  
Author(s):  
Daniel L. Bibeau ◽  
Keith A. Howell ◽  
John C. Rife ◽  
Martha L. Taylor
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Primary Care Clinic ◽  
Health Department ◽  
The United States ◽  
Care Clinic ◽  
Local Physician ◽  
Umbrella Organization ◽  
Effective Community ◽  
Diverse Community

Access to primary health care for indigent citizens presents a dilemma for many communities in the United States. In response, communities have developed a variety of strategies to effectively deal with the problem. This article describes the evolution of a small free clinic into a comprehensive primary care clinic developed through the actions of a community-based coalition. The clinic originated within an umbrella organization for indigent residents as free medical service provided at a night shelter by a local physician once a week. Through a coalition of business, religious, medical, hospital, foundation, lay volunteer, county health department, and chamber of commerce representatives, the service was enlarged into a formal clinic operation with a small staff and volunteers providing services for about 3,500 patient visits each year. As the demand for services increased beyond resources, an expanded coalition created Health-Serve Medical Center, a comprehensive primary care clinic operating 40 hours per week. The Health-Serve Board is currently active in supporting service delivery at the clinic, with plans to serve 24,000 medical and dental visits annually by mid-1995. The evolution process was based upon the characteristics of effective community coalitions and the commitment of individuals from diverse community sectors.

Vision Screening Among Primary Care Clinic Patients

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 93A-93A
Author(s):  
Lwbba Chait ◽  
Angeliki Makri ◽  
Rawan Nahas ◽  
Gwen Raphan
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Vision Screening ◽  
Care Clinic
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