scholarly journals Implementation outcomes of Humanwide: integrated precision health in team-based family practice primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cati G. Brown-Johnson ◽  
Nadia Safaeinili ◽  
Juliana Baratta ◽  
Latha Palaniappan ◽  
Megan Mahoney ◽  
...  
Keyword(s):  
Primary Care ◽  
Digital Health ◽  
Financial Burden ◽  
Primary Care Providers ◽  
Health Coaching ◽  
High Tech ◽  
Care Providers ◽  
Care Clinic ◽  
Implementation Outcomes ◽  
Precision Health

Abstract Background Humanwide was precision health embedded in primary care aiming to leverage high-tech and high-touch medicine to promote wellness, predict and prevent illness, and tailor treatment to individual medical and psychosocial needs. Methods We conducted a study assessing implementation outcomes to inform spread and scale, using mixed methods of semi-structured interviews with diverse stakeholders and chart reviews. Humanwide included: 1) health coaching; 2) four digital health tools for blood-pressure, weight, glucose, and activity; 3) pharmacogenomic testing; and 4) genetic screening/testing. We examined implementation science constructs: reach/penetration, acceptability, feasibility, and sustainability. Chart reviews captured preliminary clinical outcomes. Results Fifty of 69 patients (72%) invited by primary care providers participated in the Humanwide pilot. We performed chart reviews for the 50 participating patients. Participants were diverse overall (50% non-white, 66% female). Over half of the participants were obese and 58% had one or more major cardiovascular risk factor: dyslipidemia, hypertension, diabetes. Reach/penetration of Humanwide components varied: pharmacogenomics testing 94%, health coaching 80%, genetic testing 72%, and digital health 64%. Interview participants (n=27) included patients (n=16), providers (n=9), and the 2 staff who were allocated dedicated time for Humanwide patient intake and orientation. Patients and providers reported Humanwide was acceptable; it engaged patients holistically, supported faster medication titration, and strengthened patient-provider relationships. All patients benefited clinically from at least one Humanwide component. Feasibility challenges included: low provider self-efficacy for interpreting genetics and pharmacogenomics; difficulties with data integration; patient technology challenges; and additional staffing needs. Patient financial burden concerns surfaced with respect to sustainability. Conclusion This is the first report of implementation of a multi-component precision health model embedded in team-based primary care. We found acceptance from both patients and providers; however, feasibility barriers must be overcome to enable broad spread and sustainability. We found that barriers to implementation of precision health in a team-based primary care clinic are mundane and straightforward, though not necessarily easy to overcome. Future implementation endeavors should invest in basics: education, workflow, and reflection/evaluation. Strengthening fundamentals will enable healthcare systems to more nimbly accept the responsibility of meeting patients at the crossroads of innovative science and routinized clinical systems.

scholarly journals SCREENING FOR MILD COGNITIVE IMPAIRMENT: THERE IS THE WILL BUT IS THERE A WAY?

2020 ◽  
pp. 1-2
Author(s):  
J.E. Galvin
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Burden Of Illness ◽  
Financial Burden ◽  
Fold Increase ◽  
Primary Care Providers ◽  
Care Providers ◽  
Eligibility Determination ◽  
The Will

Alzheimer’s disease (AD) currently affect over 5.8 million Americans and over 35 million people worldwide (1). The number of AD cases is expected to increase as the number of people over age 65 grow by 62% and the number over age 85 is expected to grow by 84% (1, 2). More than one in eight adults over age 65 has dementia, and current projections indicate a three-fold increase by 2050. Thus, the prevalence, incidence, morbidity, and mortality for AD (3) and its prodromal state of Mild Cognitive Impairment due to AD (MCI-AD) (4) will increase dramatically and the societal financial burden of illness and dependency will expand exponentially. Primary care providers are often responsible for the detection, diagnosis, and treatment of AD as the number of dementia specialists (neurologists, psychiatrists, and geriatricians) and specialty centers is not sufficient to meet the growing demands (2, 5). The inability to detect MCI and ADRD may affect eligibility determination for care and services and impede case ascertainment and recruitment in clinical research.

Abstract P119: Assessment of Cardiovascular Health among Older Women in Primary Care

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Randi E Foraker ◽  
Abigail B Shoben ◽  
Marcelo A Lopetegui ◽  
Albert M Lai ◽  
Philip R Payne ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Health ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Continuous Variables ◽  
Care Providers ◽  
Care Clinic ◽  
Female Patients ◽  
Life’S Simple 7 ◽  
Life's Simple 7

In 2010, the American Heart Association (AHA) launched the groundbreaking Life’s Simple 7™ campaign to improve the cardiovascular health (CVH) of Americans. Five of the 7 [smoking, body mass index (BMI), blood pressure, cholesterol, and glucose] are commonly recorded in electronic medical records (EMRs). Although CVH components are often included in patient-provider discussions, to date there has been no formal attempt to characterize CVH from EMR data. We characterized the CVH of 160 female patients ages 65 and older seen in an Ohio State University primary care clinic from May 1 through July 31, 2013. We defined CVH according to AHA criteria, and assigned each behavior and factor to either an “ideal”, “intermediate”, or “poor” category. We calculated an overall CVH score ranging from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. We calculated means and standard deviations (sd) of continuous variables and report frequencies within CVH categories. Patients were an average of 74.2 (sd=6.7) years old, and 35% were black. Among the 126 (79%) women who had data available on all 5 factors, mean CVH score was 6.0 (sd=1.3). Among all women, the mean fractional score (actual score/maximum possible) was 0.63 (sd=0.14), and it did not differ significantly by race. Greater than 10% of data were missing for BMI (13%) and cholesterol (11%). Figure 1 shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor. We have demonstrated that a majority of Life’s Simple 7™ components are easily queried from EMRs. These data indicate that older female patients seen in the primary care setting have less-than-ideal CVH. There exists great potential to leverage the EMR for patient-provider communication and engagement around CVH. As such, we are implementing an automated assessment of CVH targeted to primary care providers and their older female patients. Following the intervention, CVH values will be compared to these baseline data. Figure 1. Percent of older female patients (n=160) who were seen in a primary care clinic by category of CVH: behaviors and factors*. *Diabetes was defined as either treated by a glucose-lowering medication (intermediate) or not (ideal), since over 90% of data were missing for fasting glucose or hemoglobin A1c.

scholarly journals Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

2020 ◽  
Vol 11 ◽  
pp. 215013272090837
Author(s):  
Elizabeth Gregg ◽  
Carrie Linn ◽  
Emma Nace ◽  
Lillian Gelberg ◽  
Brianna Cowan ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Root Cause ◽  
Preexposure Prophylaxis ◽  
Provider Knowledge ◽  
Improve Access

Objective: Oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV-1 acquisition, yet it is underutilized among at-risk populations. In this pilot quality improvement (QI) initiative, we sought to identify barriers to PrEP implementation and create interventions to improve access to PrEP in a primary care clinic for homeless veterans. Methods: The setting was a large homeless primary care clinic at the Veterans Affairs in an urban area with high HIV prevalence. A root cause analysis was performed to identify barriers to PrEP expansion in the primary care clinic. Targeted interventions to improve provider knowledge and patient access to PrEP were implemented by the QI team. Results: Root cause analysis revealed 3 primary barriers to PrEP expansion in the primary care clinic: institutional limitations for prescribing PrEP, inconsistent screening and recognition of eligible patients by clinic staff, and lack of clinic workflow processes to support PrEP prescription. A multidisciplinary focus group found low levels of PrEP awareness and knowledge, with only 22% of providers reporting comfort discussing PrEP with patients. This improved to 40% of providers following targeted clinic educational interventions. The QI team also developed a pathway for primary care providers to obtain institutional PrEP prescribing privileges and used work groups to develop clinic workflows and protocols for PrEP. At the end of the intervention, at least 50% of primary care providers in the clinic had initiated PrEP in a new patient. Conclusions: We describe a multidisciplinary QI model to implement PrEP within a primary care setting serving Veterans and persons experiencing homelessness. Our program successfully addressed provider knowledge deficits and improved primary care capacity to prescribe PrEP. The primary care clinic can be a viable and important clinical setting to improve access to PrEP for HIV prevention, especially for vulnerable populations.

scholarly journals A Primary Care-based Collaborative Hepatitis C Clinic: Clinical Structure and Virologic Outcomes with Direct Acting Antiviral Therapy

2016 ◽  
Vol 3 (1) ◽  
pp. 70-78
Author(s):  
Samuel B. Ho ◽  
Adrian Dollarhide ◽  
Hilda Thorisdottir ◽  
James Michelsen ◽  
Christine Perry ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Adverse Events ◽  
Nurse Practitioners ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Number Of Patients ◽  
Direct Acting ◽  
Collaborative Primary Care

Background: Currently 4 million persons in the US have active hepatitis C virus (HCV) infection and most have never successfully completed antiviral treatment. Newer therapies herald potential for wider uptake and acceptance of treatment, but the number of hepatology specialists is limited and newer models are needed to increase access to care. The aim of this study is to describe a collaborative primary care-based clinic for HCV treatment. Methods: Retrospective analysis of a collaborative primary care clinic developed for the evaluation and treatment of patients with chronic hepatitis C at one VA medical center. A half-day clinic was organized with 4 primary care MDs, 2 hepatologists, 2 nurse practitioners, and a co-located psychiatrist, pharmacist and nurse case manager. Clinic productivity and outcomes related to the number of patients who initiated and completed treatment with direct acting antivirals (DAA) and pegylated interferon and ribavirin were evaluated. Results: In this 18 month period, the clinic had 1890 confirmed HCV registry patients and 1690 clinic visits. 74 HCV genotype 1 patients initiated DAA therapy. Primary care providers treated 47 patients (32% cirrhotic) and hepatologists treated 27 patients (48% cirrhotic). Final SVR rate was 54.6% (39.2% cirrhotics vs. 65.2% noncirrhotics). SVR rates were higher in patients with primary care providers (61.7%) vs. hepatologists (44.4%). Despite numerous adverse events, early treatment termination for adverse events occurred in 5.3% vs. 21.3% for virologic non-response. Multivariate analysis revealed no significant differences between primary care and hepatology for SVR and treatment discontinuations. Conclusion: This clinic demonstrated effectiveness and safety with DAA therapy. This illustrates potential for a primary care based collaborative clinic, which will be crucial for expanding access to effective HCV care.

scholarly journals Reaching Out to Rural Caregivers and Veterans with Dementia Utilizing Clinical Video-Telehealth

2018 ◽  
Author(s):  
James S. Powers ◽  
Jennifer Buckner
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Mental Health Provider ◽  
Care Providers ◽  
Community Based ◽  
Term Care ◽  
Care Clinic

Context: A clinical video telehealth (CVT) program was implemented improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC’s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician – social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of 1 to 2 CVT encounters originating at their local CBOC lasting 20 to 30 minutes. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient-caregiver pairs, followed for a mean of 15 (1-36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of 8 medications, and resided at a distance of 103 (76-148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusion: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas.

scholarly journals Implementing alcohol use disorder pharmacotherapy in primary care settings: a qualitative analysis of provider-identified barriers and impact on implementation outcomes

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hildi J. Hagedorn ◽  
Jennifer P. Wisdom ◽  
Heather Gerould ◽  
Erika Pinsker ◽  
Randall Brown ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Primary Care Providers ◽  
Relative Advantage ◽  
Implementation Intervention ◽  
Health Administration ◽  
Care Providers ◽  
Implementation Barriers ◽  
Primary Care Settings ◽  
Implementation Outcomes

Abstract Background Despite the high prevalence of alcohol use disorders (AUDs), in 2016, only 7.8% of individuals meeting diagnostic criteria received any type of AUD treatment. Developing options for treatment within primary care settings is imperative to increase treatment access. As part of a trial to implement AUD pharmacotherapy in primary care settings, this qualitative study analyzed pre-implementation provider interviews using the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers. Methods Three large Veterans Health Administration facilities participated in the implementation intervention. Local providers were trained to serve as implementation/clinical champions and received external facilitation from the project team. Primary care providers received a dashboard of patients with AUD for case identification, educational materials, and access to consultation from clinical champions. Veterans with AUD diagnoses received educational information in the mail. Prior to the start of implementation activities, 24 primary care providers (5–10 per site) participated in semi-structured interviews. Transcripts were analyzed using common coding techniques for qualitative data using the CFIR codebook Innovation/Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals domains. Number and type of barriers identified were compared to quantitative changes in AUD pharmacotherapy prescribing rates. Results Four major barriers emerged across all three sites: complexity of providing AUD pharmacotherapy in primary care, the limited compatibility of AUD treatment with existing primary care processes, providers’ limited knowledge and negative beliefs about AUD pharmacotherapy and providers’ negative attitudes toward patients with AUD. Site specific barriers included lack of relative advantage of providing AUD pharmacotherapy in primary care over current practice, complaints about the design quality and packaging of implementation intervention materials, limited priority of addressing AUD in primary care and limited available resources to implement AUD pharmacotherapy in primary care. Conclusions CFIR constructs were useful for identifying pre-implementation barriers that informed refinements to the implementation intervention. The number and type of pre-implementation barriers identified did not demonstrate a clear relationship to the degree to which sites were able to improve AUD pharmacotherapy prescribing rate. Site-level implementation process factors such as leadership support and provider turn-over likely also interacted with pre-implementation barriers to drive implementation outcomes.

377 Insomnia Treatment Practices of Primary Care Providers in Primary Care Settings

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A150-A150
Author(s):  
Cassandra Godzik ◽  
Adam Sorscher
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Sleep Medicine ◽  
Quality Metrics ◽  
Care Providers ◽  
National Guidelines ◽  
Daytime Functioning ◽  
Care Clinic

Abstract Introduction Insomnia is highly prevalent in adult populations, with rates found to be between 10% and 40% as reported in a metanalysis conducted by Zhang et al. (2019). Insomnia is associated with worsened health outcomes and increased healthcare utilization. Primary care providers (PCPs) are the first point of contact for most people seeking treatment for insomnia. The American Academy of Sleep Medicine has proposed six quality metrics for the evaluation and treatment of insomnia (Edinger et al., 2015). In this study, we investigate how often primary care providers meet these quality metrics when they encounter a patient with a new complaint of insomnia. Methods We reviewed the charts of adult patients seen in our primary care clinic department with a new presenting complaint of insomnia between 2014–2016. The clinic notes were scored to see if any of the six metrics of quality care for insomnia as proposed by the AASM were addressed in the index appointment (T1) and in follow up appointments (T2) within three months. Results Demographic variables were analyzed (N=155; 48 males, 107 females); mean age 64 years (range 24–98). We found that PCPs documented the following: at T1, assessment of sleep quality (68%), evidence-based treatment provided (82%), daytime functioning assessed (19%), and adverse side effects assessed (11%). 29% of subjects returned for a follow up visit with 3 months. At T2, there was an assessment of sleep satisfaction/quality (40%), and of improved daytime functioning (87%). Conclusion Presently, evaluation and treatment of insomnia by PCPs is not standardized. By identifying how providers address insomnia in practice, we can develop interventions to help promote adherence to the national guidelines for treatment of insomnia in a non-sleep medicine healthcare setting. Support (if any) Dr. Cassandra M. Godzik’s Postdoctoral Research Fellowship: NIMH - T32 MH073553

How to Diagnose and Manage “Difficult” Patients - Development of a Workshop for Interprofessional Audience

2011 ◽  
Vol 26 (S2) ◽  
pp. 1031-1031
Author(s):  
D. Kljenak
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Community Health Centers ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Pilot Program ◽  
Health Providers ◽  
Care Providers ◽  
Difficult Patients ◽  
Care Clinic

IntroductionMore than 15% of patients who present to a primary care clinic are considered “difficult” yet interprofessional members of primary care clinics receive little training on how to diagnose and manage these patients.ObjectivesBecome familiar with successful method of workshop development on how to diagnose and manage “difficult” patients to interprofessional audience of six community health centers.AimsThe aim of the workshop was to enhance primary care providers’ capacity to diagnose and manage “difficult” patients as well as serve as a pilot program for a larger conference on managing “difficult” patients.MethodsA half-day workshop was designed to fill this perceived need of community health providers to learn how to diagnose and manage “difficult” patients. The workshop consisted of didactic presentation and case based small group learning.This workshop served as a pilot program for the development of larger conference for community providers on managing “difficult” patients.ResultsThe workshop was evaluated by participants. 100% of respondents agreed that the workshop was relevant to their work and 87.5% of respondents reported that the workshop will alter their clinical practice.ConclusionThe workshop has met participants’ perceived learning needs as well as served as a pilot program for a larger conference on managing difficult patients.

scholarly journals Are VA Primary Care Providers Aware of HIV Testing Recommendations for Veterans? Findings at an Urban VA Primary Care Clinic

2013 ◽  
Vol 178 (4) ◽  
pp. e483-e488 ◽  
Author(s):  
Monisha Arya ◽  
Amber L. Bush ◽  
Michael A. Kallen ◽  
Maria C. Rodriguez-Barradas ◽  
Thomas P. Giordano
Keyword(s):  
Primary Care ◽  
Hiv Testing ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic

scholarly journals Clinical and Socioeconomic Predictors of Palliative Care Utilization

2021 ◽  
Author(s):  
Rohan Tummala ◽  
Andrew de Jesus ◽  
Natasha Tillett ◽  
Jeffrey Nelson ◽  
Christine Lamey
Keyword(s):  
Primary Care ◽  
Socioeconomic Status ◽  
Palliative Care ◽  
Primary Care Providers ◽  
Care Utilization ◽  
Care Providers ◽  
Lower Systolic Blood Pressure ◽  
Care Clinic ◽  
Hospital Referral ◽  
Primary Care Patients

INTRODUCTION: Palliative care continues to gain recognition among primary care providers, as patients suffering from chronic conditions may benefit from use of this growing service. OBJECTIVES: This single-institution quality improvement study investigates the clinical characteristics and socioeconomic status (SES) of palliative care patients and identifies predictors of palliative care utilization. METHODS: Retrospective chart review was used to compare clinical and SES parameters for three groups of patients: (1) palliative care patients who attended at least one visit since the inception of the University Clinical Health Palliative Care Clinic in Memphis, TN in October 2018 (n = 61), (2) palliative care patients who did not attend any appointments (n = 19), and (3) a randomized group of age-matched primary care patients seen by one provider from May 2018 to May 2019 (n = 36). A Poisson regression model with backward conditional variable selection was used to determine predictors of palliative care utilization. RESULTS: Patients across the three care groups did not differ in demographic parameters. Compared to palliative care-referred non-users and primary care patients, palliative care patients tended to have lower health risk (p < 0.001). Palliative care patients did not differ from primary care patients in socioeconomic status but did differ in comorbidity distribution, having a higher prevalence of cancer (𝜒2 = 14.648, df = 7, p = 0.041). Chance of 10-year survival did not differ across risk categories for palliative care patients but was significantly lower for very high-risk compared to moderate-risk primary care patients (30% vs. 78%, p = 0.019). Significant predictors of palliative care use and their corresponding incidence rate ratios (IRR) were hospital referral (IRR = 1.471; p = 0.039), higher number of prescribed medications (IRR = 1.045; p = 0.003), lower Charlson Comorbidity Index (IRR = 0.907; p = 0.003), and lower systolic blood pressure (IRR = 0.989; p = 0.004). CONCLUSIONS: Patients who are expected to benefit from and of being high utilizers of palliative care may experience greater clinical benefit from earlier referral to this service.

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