scholarly journals Understanding primary care-oncology relationships within a changing healthcare environment

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jennifer Tsui ◽  
Jenna Howard ◽  
Denalee O’Malley ◽  
William L. Miller ◽  
Shawna V. Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Transitions ◽  
Formal System ◽  
The United States ◽  
Comparative Case Study ◽  
Health Care Environment ◽  
Optimal Care ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment. Methods Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond. Conclusions With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.

Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky

2016 ◽  
Vol 32 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Selam Wubu ◽  
Laura Lee Hall ◽  
Paula Straub ◽  
Matthew J. Bair ◽  
Jill A. Marsteller ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Organization ◽  
Chronic Pain Management ◽  
Accountable Care ◽  
Care Practices ◽  
Primary Care Practices

Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

scholarly journals Potential COVID-19 vaccination opportunities in primary care practices in the United States

2021 ◽  
Author(s):  
Sanjay Basu ◽  
Rebecca Weintraub ◽  
Ishani Ganguli ◽  
Russell Phillips ◽  
Robert Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Physicians ◽  
Medical Expenditure Panel Survey ◽  
Care Delivery ◽  
The United States ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Care Practices ◽  
Primary Care Practices

AbstractRapid, widespread COVID-19 vaccination is critical to pandemic mitigation and recovery. To help policymakers interested in further enhancing primary care delivery of COVID-19 vaccines, it is important to estimate the absolute number of vaccination opportunities, and identify how these opportunities may fall disproportionately among different communities given the unequal way that COVID-19 falls upon communities of color, low-income, and rural communities. To quantify the potential benefits of greater primary care engagement in vaccination efforts, we estimated the number of potential vaccination opportunities (PVOs) in primary care in the remaining calendar months of year 2021, and the possible uptake if we supplied enough vaccine to primary care practices to fulfill their opportunities. To estimate how many potential vaccination opportunities (PVOs) may occur in primary care, we used three sets of data, analyzing the latest available waves of the following: (i) the National Ambulatory Medical Care Survey (NAMCS, 2016, N = 677 providers); (ii) the National Health Interview Survey (NHIS, 2018, N = 29,839 individuals in 29,839 households); and (iii) the Medical Expenditure Panel Survey (MEPS, 2018, N = 40,025 individuals in 14,500 households). Per the NAMCS data, which provide a nationally-representative sample of ambulatory care visits, primary care physicians normally provide 40.2 million primary care visits per month. The majority of the primary care utilization is absorbed by those aged 16 to 64 years old who are not otherwise priority groups (i.e., not having chronic diseases as defined by ACIP) but the second large group of visits are those with a chronic disease (27.2% of all visits). As compared to the NAMCS data providing an estimate of care from the perspective of providers, the overall sample in NHIS provides a view of primary care access and utilization from a population perspective. Per NHIS, 34% of the civilian US population saw a generalist physician in the prior calendar year, or 109.8 million people. Overall, we would estimate that over the latter half of calendar year 2021, approximately 15 million potential vaccine opportunities per month would be available through US primary care practices.

Opportunities for improving cancer care management through primary care-oncology relationships.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 80-80 ◽  
Author(s):  
Jennifer Tsui ◽  
Jenna Howard ◽  
William L. Miller ◽  
Denalee M. O'Malley ◽  
Shawna V. Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Care Transitions ◽  
The United States ◽  
Care Quality ◽  
Direct Access ◽  
Structured Interviews ◽  
Optimal Care ◽  
Relationship Type ◽  
Primary Care Practices

80 Background: Improvements in the management of care transitions between primary care and oncology are critical for achieving optimal care quality and outcomes for cancer patients and survivors. We examine relationships between innovative PC practices and oncologists to inform and strengthen PC-oncology interfaces in diverse healthcare settings. Methods: Comparative case studies of 14 innovative PC practices throughout the United States examined strategies for providing cancer survivorship care. Field researchers observed each practice for 10-12 days, recording fieldnotes and conducting key informant and formal, semi-structured interviews with clinicians and staff. We extracted all data related to PC-oncology relationships and then collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results: Nine of the 14 practices discussed either formal or informal PC-oncology relationships. Nearly all practices with existing formal PC-oncology relationships were embedded within healthcare systems. Private, independent practices had more informal relationships between individual PC physicians and specific oncologists. Practices with formal relationships noted ease of communication and transfer of patient information, timeliness in patient referrals, and direct access to oncologists; while practices with informal relationships noted the benefits of having close engagement with specific oncologists. Regardless of relationship type, remaining challenges include lack of clarity about roles during cancer treatment and beyond. Conclusions: With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate the strengths of both formal and informal PC-oncology relationships to improve care for cancer patients and survivors.

Uninsured Children With Psychosocial Problems: Primary Care Management

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 930-936 ◽  
Author(s):  
Thomas K. McInerny ◽  
Peter G. Szilagyi ◽  
George E. Childs ◽  
Richard C. Wasserman ◽  
Kelly J. Kelleher
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Mental Health Problems ◽  
Psychosocial Problems ◽  
The United States ◽  
Behavior Study ◽  
Care Practices ◽  
Uninsured Children ◽  
Primary Care Practices

Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of psychosocial problems (19%) and severe psychosocial problems (2%). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified psychosocial and mental health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.psychosocial problems, uninsured children, pediatrics, family medicine, primary care.

Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches

2015 ◽  
Vol 63 (5) ◽  
pp. 963-969 ◽  
Author(s):  
Bruce Leff ◽  
Christine M. Weston ◽  
Sarah Garrigues ◽  
Kanan Patel ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Quality Improvement ◽  
The United States ◽  
Current State ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care Practices ◽  
Primary Care Practices

Nurse Practitioner Autonomy and Complexity of Care in Rural Primary Care

2020 ◽  
pp. 107755872094591
Author(s):  
Hannah T. Neprash ◽  
Laura Barrie Smith ◽  
Bethany Sheridan ◽  
Ira Moscovice ◽  
Shailendra Prasad ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Urban Areas ◽  
The United States ◽  
Rural Primary Care ◽  
Rural And Urban ◽  
Clinical Autonomy ◽  
Care Practices ◽  
Primary Care Practices

The growing ranks of nurse practitioners (NPs) in rural areas of the United States have the potential to help alleviate existing primary care shortages. This study uses a nationwide source of claims- and EHR-data from 2017 to construct measures of NP clinical autonomy and complexity of care. Comparisons between rural and urban primary care practices reveal greater clinical autonomy for rural NPs, who were more likely to have an independent patient panel, to practice with less physician supervision, and to prescribe Schedule II controlled substances. In contrast, rural and urban NPs provided care of similar complexity. These findings provide the first claims- and EHR-based evidence for the commonly held perception that NPs practice more autonomously in rural areas than in urban areas.

scholarly journals Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Patrick Kierkegaard ◽  
Timothy Hicks ◽  
A. Joy Allen ◽  
Yaling Yang ◽  
Gail Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Behaviour Change ◽  
Professional Education ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Behaviour Change Wheel ◽  
Qualitative Interview Study ◽  
Care Practices ◽  
Willingness To Use ◽  
Primary Care Practices

Abstract Background The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians’ attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. Methods We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. Results Several factors underpinned primary care physicians’ attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians’ willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians’ confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians’ perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. Conclusions Improving primary care physicians’ knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.

scholarly journals Room for Improvement: Rates of Birth Cohort Hepatitis C Screening in Primary Care Practices—A WWAMI Region Practice and Research Network Study

2019 ◽  
Vol 10 ◽  
pp. 215013271988429 ◽  
Author(s):  
Allison M. Cole ◽  
Gina A. Keppel ◽  
Laura-Mae Baldwin ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Birth Cohort ◽  
The United States ◽  
Research Network ◽  
Health Record ◽  
Care Practices ◽  
Primary Care Practices

Introduction: An estimated 2.4 million people in the United States live with hepatitis C. Though there are effective treatments for chronic hepatitis C, many infected individuals remain untreated because 40% to 50% of individuals with chronic hepatitis C are unaware of their hepatitis C status. In 2013, the United States Preventive Services Task Force (USPSTF) recommended that adults born between 1945 and 1965 should be offered one-time hepatitis C screening. The purpose of this study is to describe rates of birth cohort hepatitis C screening across primary care practices in the WWAMI region Practice and Research Network (WPRN). Methods: Cross-sectional observational study of adult patients born between 1945 and 1965 who also had a primary care visit at 1 of 9 participating health systems (22 primary care clinics) between July 31, 2013 and September 30, 2015. Data extracted from the electronic health record systems at each clinic were used to calculate the proportion of birth cohort eligible patients with evidence of hepatitis C screening as well as proportions of screened patients with positive hepatitis C screening test results. Results: Of the 32 139 eligible patients, only 10.9% had evidence of hepatitis C screening in the electronic health record data (range 1.2%-49.1% across organizations). Among the 4 WPRN sites that were able to report data by race and ethnicity, the rate of hepatitis C screening was higher among African Americans (39.9%) and American Indians/Alaska Natives (23.2%) compared with Caucasians (10.7%; P < .001). Discussion: Rates of birth cohort hepatitis C screening are low in primary care practices. Future research to develop and test interventions to increase rates of birth cohort hepatitis C screening in primary care settings are needed.

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