scholarly journals Adoption of a laboratory EMR system and inappropriate laboratory testing in Ontario: a cross-sectional observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nadine Chami ◽  
Silvy Mathew ◽  
Sharada Weir ◽  
James G. Wright ◽  
Jasmin Kantarevic
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Laboratory Testing ◽  
Penetration Rate ◽  
Geographical Area ◽  
Laboratory Data ◽  
Ordinary Least Squares ◽  
Physician Payment ◽  
Payment Model ◽  
The Impact

Abstract Background Electronic medical record (EMR) systems have the potential to facilitate appropriate laboratory testing. We examined three common medical tests in primary care—hemoglobin A1c (HbA1c), lipid, and thyroid stimulating hormone (TSH)— to assess whether adoption of a laboratory EMR system in Ontario had an impact on the rate of inappropriate testing among primary care physicians. Methods We used FY2016–17 population-level laboratory data to estimate the association between adoption of a laboratory EMR system and the rate of inappropriate testing. Inappropriate testing was assessed based on recommendations for screening, monitoring, and follow-up that take into account risk factors related to patient age and certain clinical conditions. To overcome the problem of potential endogeneity of physician choice to use the EMR, the EMR penetration rate in the physician’s geographical area of practice was used as an instrumental variable in an ordinary least squares (OLS) regression. We then simulated the change in the rate of inappropriate testing, by physician payment model, as the EMR penetration rate increased from the baseline percentage. Results The simulation models showed that an increase in the rate of EMR penetration from a baseline average was associated with a statistically significant decrease in inappropriate hbA1c and lipid testing, but a statistically insignificant increase in inappropriate TSH testing. The impact of EMR penetration also varied by payment model. Conclusions This study demonstrated a positive association between availability of an EMR system and appropriate service utilization. Varying impacts of the EMR system availability by primary care payment model may be reflective of different incentives or attributes inherent in payment models. Policies to encourage physicians to increase their use of laboratory EMR systems could improve the quality and continuity of patient care.

The impact of a program to enhance the competencies of primary care physicians in caring for patients with AIDS

1986 ◽  
Vol 1 (5) ◽  
pp. 287-294 ◽  
Author(s):  
Charles E. Lewis ◽  
Howard E. Freeman ◽  
Sherrie H. Kaplan ◽  
Christopher R. Corey
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
The Impact

Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care

2018 ◽  
Vol 32 (1) ◽  
pp. 39-55 ◽  
Author(s):  
Elizabeth Mansfield ◽  
Onil Bhattacharyya ◽  
Jennifer Christian ◽  
Gary Naglie ◽  
Vicky Steriopoulos ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Care Physicians ◽  
Pilot Project ◽  
Models Of Care ◽  
Structured Interviews ◽  
Pilot Projects ◽  
Additional Time ◽  
Content Type ◽  
The Impact

Purpose Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Severity and Criteria Based Prompting for Treatment of Depressed Patients

2005 ◽  
Vol 35 (2) ◽  
pp. 149-159 ◽  
Author(s):  
Donald E. Nease ◽  
Michael S. Klinkman ◽  
James E. Aikens
Keyword(s):  
Primary Care ◽  
Symptom Severity ◽  
Primary Care Physicians ◽  
Routine Care ◽  
Future Research ◽  
Binomial Regression ◽  
Care Appointment ◽  
Depressive Symptom Severity ◽  
Primary Care Practices ◽  
The Impact

Purpose: Primary care physicians (PCPs) often do not respond to prompts based upon criteria-based depression screens, perhaps because these prompts do not account for depression severity. We conducted this pilot study to determine the feasibility of prompting for both diagnostic criteria and severity and to assess whether depression would be more attended to with positive “dual prompts” than prompts based on either criteria or symptom severity alone. Methods: Immediately prior to a routine care appointment, 87 adults from three primary care practices completed the PRIME-MD Clinician Evaluation Guide Mood Module (PRIME-MD; assesses depression criteria) and the Brief Depression Rating (BDR; assesses depressive symptom severity), and their results were issued in a salient PCP prompt on the chart. Immediately afterwards, patients reported the impact of the screening results upon treatment decisions during the encounter. Data were analyzed by χ2, analysis of variance, and binomial regression. Results: Compared to subjects screening positive on either depression criteria or severity alone ( n = 10), those patients on both ( n = 17) were more likely to report discussing depression, and agreement that the physician and patient decided treatment was needed and initiated or continued. There were no differences in patient satisfaction based on screening results. After accounting for PRIME-MD results, BDR scores predicted agreement with the physician and patient decided treatment was needed (OR = 22.03; 95% CI: 2.05–236.46). Conclusions: Supplementary severity-based depression screening is feasible, and might overcome the limitations of criteria-based screening alone. Future research could test this hypothesis in a large randomized trial.

Physician speciality and pain reduction in patients with depressive symptoms under treatment with venlafaxine

2010 ◽  
Vol 25 (8) ◽  
pp. 455-460 ◽  
Author(s):  
S. Begré ◽  
M. Traber ◽  
M. Gerber ◽  
R. von Känel
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Depressive Symptomatology ◽  
Pain Reduction ◽  
Integrated Treatment ◽  
Medical Speciality ◽  
Iatrogenic Complications ◽  
The Impact

AbstractObjectivesExcessive pain perception may lead to unnecessary diagnostic testing or invasive procedures resulting in iatrogenic complications and prolonged disability. Naturalistic studies on patients with chronic pain and depressive symptoms investigating the impact of medical speciality on treatment outcome in a primary care setting are lacking.MethodsIn this observational study, we examined whether the magnitude of pain reduction in 444 patients with depressive symptomatology under venlafaxine would relate differently to the medical speciality of the 122 treating physicians, namely psychiatrists (n = 110 patients), general practitioners (n = 236 patients), and internists (n = 98 patients).ResultsIndependent of age, gender, patient's region of origin, comorbidity, severity and duration of pain, and depressive symptoms at study entry, patients seemed to benefit significantly less in terms of pain reduction (p < 0.001) and of reduction in severity of depressive symptomatology by psychiatrists as compared to general practitioners (p < 0.019) and internists (p < 0.002).ConclusionsThe findings suggest that patients referred to psychiatrists are more difficult to treat than those referred to general practitioners and internists, and might not have been adequately prepared for psychiatric interventions. A supporting cooperation and networking between psychiatrists and primary care physicians may contribute to an integrated treatment concept and therefore, may lead to a better outcome in this challenging patient group.

scholarly journals Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians

2021 ◽  
Author(s):  
Dorothy Y. Hung ◽  
Gabriela Mujal ◽  
Anqi Jin ◽  
Su-Ying Liang
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Office Visits ◽  
Interrupted Time Series Analysis ◽  
Work Time ◽  
Lean Implementation ◽  
Daily Work ◽  
The Impact ◽  
Physician Work

Abstract Purpose To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day. Methods This observational study was based on 92 million time-stamped Epic® EHR access logs captured among 317 primary care physicians in a large ambulatory care delivery system. Seventeen clinic facilities housing 46 primary care departments were included for study. We conducted interrupted time series analysis to monitor changes in physician work patterns over 6 years. Key measures included total daily work time; time spent on “desktop medicine” outside the exam room; time spent with patients during office visits; time still working after clinic, i.e., after seeing the last patient each day; and remote work time. Results The amount of time that physicians spent on desktop EHR activities throughout the day, including after clinic hours, decreased by 10.9% (95% CI: −22.2, −2.03) and 8.3% (95% CI: −13.8, −2.12), respectively, during the first year of Lean implementation. Total daily work hours among physicians, which included both desktop activity and time in office visits, decreased by 20% (95% CI: −29.2, −9.60) by the third year of Lean implementation. Conclusions These findings suggest that Lean redesign may be associated with time savings for primary care physicians. However, since this was an observational analysis, further study is warranted (e.g., randomized trial) —to determine the impact of Lean interventions on physician work experiences.

scholarly journals Determining the impact of usability issues of primary care physicians by expertise when using an electronic health record

2015 ◽  
Author(s):  
◽  
Martina A. Clarke
Keyword(s):  
Primary Care ◽  
Performance Measures ◽  
Primary Care Physicians ◽  
Learning Curves ◽  
Time On Task ◽  
Usability Tests ◽  
Resident Physicians ◽  
System Usability Scale ◽  
Task Success ◽  
The Impact

Background: EHRs with poor usability present steep learning curves for new resident physicians, who are already overwhelmed in learning a new specialty. This may lead to error prone use of EHR in medical practice by new resident physicians. The goal of this study is to identify usability-related and performance-related differences that arise between primary care physicians by expertise when using an EHR. Methods: We compared usability measures after three rounds of usability tests Lab-based usability tests using video analyses were conducted to analyze learnability gaps between novice and expert physicians. Physicians completed nineteen tasks, based on an artificial but typical patient visit note. We used a mixed methods approach including quantitative performance measures (percent task success, time on task, mouse activities), a survey instrument: system usability scale (SUS), qualitative narrative feedback during the debriefing session, subtask analysis, and debriefing session with physicians. Results: Geometric mean values of percent task success rates, time on task, and mouse activities were compared between the two physician groups across three rounds. Our findings show that there were mixed changes in performance measures and expert physicians were more proficient than novice physicians on some performance measures. Thirty-one common and four unique usability issues were identified between the two physician groups across three rounds. Five themes emerged during analysis: six usability issues were related to inconsistencies, nine issues concerning user interface issues, six issues in relation to structured data issues, seven ambiguous terminology issues, and six issues in regards to workarounds. Discussion and Conclusion: This study found differences in novice and expert physicians' performance, demonstrating that physicians' proficiency did increase with EHR experience. Future directions include identifying usability issues faced by physicians when using the EHR through a more granular task analysis to recognize subtle usability issues that would have otherwise been unnoticed. Also, exploring associations between performance measures and usability issues will also be studied. Training physicians to use the EHR may decrease difficulty of completing tasks in the EHR. Improving physician training may reduce the amount of workarounds created that may lead to workflow problems. These results highlight the areas of difficulty resident physicians with different experience levels are currently facing, which may potentially improve the EHR training program and increase physicians' performance when using an EHR.

scholarly journals US Primary Care in 2029: A Delphi Survey on the Impact of Machine Learning

2020 ◽  
Author(s):  
Charlotte Blease ◽  
Anna Kharko ◽  
Cosima Locher ◽  
Catherine M. DesRoches ◽  
Kenneth D. Mandl
Keyword(s):  
Primary Care ◽  
Health Informatics ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Digital Health ◽  
Training Requirements ◽  
Modified Delphi ◽  
Primary Care Workforce ◽  
The Us ◽  
The Impact

AbstractObjectiveTo solicit leading health informaticians’ predictions about the impact of AI/ML on primary care in the US in 2029.DesignA three-round online modified Delphi poll.ParticipantsTwenty-nine leading health informaticians.MethodsIn September 2019, health informatics experts were selected by the research team, and invited to participate the Delphi poll. Participation in each round was anonymous, and panelists were given between 4-8 weeks to respond to each round. In Round 1 open-ended questions solicited forecasts on the impact of AI/ML on: (1) patient care, (2) access to care, (3) the primary care workforce, (4) technological breakthroughs, and (5) the long-future for primary care physicians. Responses were coded to produce itemized statements. In Round 2, participants were invited to rate their agreement with each item along 7-point Likert scales. Responses were analyzed for consensus which was set at a predetermined interquartile range of ≤ 1. In Round 3 items that did not reach consensus were redistributed.ResultsA total of 16 experts participated in Round 1 (16/29, 55%). Of these experts 13/16 (response rate, 81%), and 13/13 (response rate, 100%), responded to Rounds 2 and 3, respectively. As a result of developments in AI/ML by 2029 experts anticipated workplace changes including incursions into the disintermediation of physician expertise, and increased AI/ML training requirements for medical students. Informaticians also forecast that by 2029 AI/ML will increase diagnostic accuracy especially among those with limited access to experts, minorities and those with rare diseases. Expert panelists also predicted that AI/ML-tools would improve access to expert doctor knowledge.ConclusionsThis study presents timely information on informaticians’ consensus views about the impact of AI/ML on US primary care in 2029. Preparation for the near-future of primary care will require improved levels of digital health literacy among patients and physicians.

scholarly journals Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with chronic kidney disease: a randomized controlled trial

2019 ◽  
Author(s):  
Patrick Saudan ◽  
Belen Ponte ◽  
Nicola Marangon ◽  
Chantal Martinez ◽  
Lena Berchtold ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Randomised Trial ◽  
Dialysis Initiation ◽  
The Impact

Abstract Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCP) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups . Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD.

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