scholarly journals Informing Proactive integrated virtual healthcare resource use in primary care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jolie N. Haun ◽  
Bridget A. Cotner ◽  
Christine Melillo ◽  
Vanessa Panaite ◽  
William Messina ◽  
...  
Keyword(s):  
Primary Care ◽  
Best Practices ◽  
Cultural Change ◽  
Information Exchange ◽  
Healthcare Resource ◽  
Medical Center ◽  
Implementation Strategies ◽  
Self Report ◽  
Coordinated Care ◽  
Cross Sectional

Abstract Background Proactive integrated virtual healthcare resource (VHR) use can improve efficiency, maximize resource capacity for delivering optimal coordinated care and improve patient outcomes. Proactive integrated VHR use is vital for delivering high quality care. Our objectives were to identify proactive integrated VHR use among primary care teams, best practices and targeted implementation strategies to promote proactive integrated VHR use. Methods This is a mixed-method descriptive study. We employed a community-based participatory approach to collect data and the Consolidated Framework for Implementation Research to analyze and contextualize findings. A cross-sectional sample of primary care team members (n = 65) from a Department of Veterans Affairs medical center participated in focus groups, follow-up interviews (n = 16), and respond to self-report surveys. Operational subject matter experts (n = 15) participated in informant interviews. Results Survey data described current use and factors that influenced singular VHR use and were convergent with qualitative findings. Focus group and interview data described no evidence of proactive integrated VHR use. Differences and similarities were identified between both utilization groups, such as facilitators and barriers, recommendations, patient education and preferred implementation strategies. All groups reported issues around VHR availability knowledge and access and functionality. Participants identified the need for best practices that are specific to care tasks and performance measures. Expert informant interviews identified a list of VHR tools that could be proactively integrated across the healthcare continuum. Conclusions Health systems are leveraging technologies to proactively integrate VHR to maximize information exchange, clinical decision support and patient engagement. VHR is critical during global pandemics, such as COVID-19, to maintain access to care coordination and delivery while abiding by public health recommendations. Though recent requirements for reducing contact create an intrinsic motivation, cultural change through education and best practices of proactive integrated use across the healthcare continuum is needed to create a culture of VHR super users.

734 Prevalence and Correlates of Insomnia in Veterans with and without Military Sexual Trauma Receiving Care within a VA Med Center

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A286-A287
Author(s):  
Karen Makar ◽  
Louis Rivera ◽  
Rena Mazur ◽  
Taylor Aguiar ◽  
Ryan Krouse ◽  
...  
Keyword(s):  
Sexual Trauma ◽  
Depressive Symptomatology ◽  
Medical Center ◽  
Well Being ◽  
Severity Index ◽  
Self Report ◽  
Bivariate Analysis ◽  
Military Sexual Trauma ◽  
Multivariable Model ◽  
Cross Sectional

Abstract Introduction A prior study showed a higher prevalence of insomnia among younger Veterans with military sexual trauma (MST) before receiving care at a VA Medical Center (VAMC). We extend the literature to investigate the prevalence and correlates of insomnia in male Veterans with and without MST currently receiving care within a VAMC. Methods We evaluated cross-sectional data from a survey within the Philadelphia VAMC (N=138) using the following instruments: Insomnia Severity Index (ISI) total score for insomnia; Sexual Harassment Scale (DRRI-2) to screen for MST; PTSD checklist for DSM-5 (PCL-5) PTSD symptoms; Quick Inventory of Depressive Symptomatology-Self report (QIDS-SR) to evaluate depressive symptoms; Alcohol Use Disorder Identification Test (AUDIT-C) to assess for harmful drinking; and, the nightmare question from the PCL-5 scale to screen for persistent nightmares. The association between ISI total score and variables were assessed separately in individuals with and without MST, using bivariate and multivariable analyses. Results The mean(SD) age was 55.2(12.8) years. They were likely to identify themselves as African-American (44.2%), and had a high school diploma (39.1%). MST was endorsed by 31.9% of the Veterans. Insomnia was more prevalent in those with MST [N=42(95.4%)] than those without [N=77(81.9%)]. Individuals with MST had higher ISI (19.9±5.0 Vs 16.7±7.2) and PCL-5 (48.4±14.4 Vs 38.1±19.7) total scores, than individuals without. Among those with MST, the bivariate analysis showed significant associations with PCL-5 (β=0.2, p<0.0001), QIDS (β=0.5, p=0.01), AUDIT-C (β=0.5, p=0.008), and nightmares (β=3.9, p=0.03). In the multivariable model, ISI total score was only associated with the PCL-5 total score (β=0.3, R2=0.18, p=0.0005). Among those without MST, the bivariate analysis showed significant associations between ISI total score and age (β=-0.1, p=0.02), total scores on the PCL-5 (β=0.2, p<0.0001), QIDS (β=0.9, p<0.00001), and nightmare (β=6.7, p<0.0001). In the multivariable model (R2=0.5, p<0.00001), the ISI total score was associated with PCL-5 (β=0.1, p=0.01), and QIDS (β=0.7, p=<0.0001) total scores. Conclusion There is a higher prevalence of insomnia among Veterans with MST currently receiving care within the VHA. Treatment of insomnia and PTSD is critical to improve their well-being and prevent complications. Support (if any) The study was supported by VA grant IK2CX000855 (S.C.).

scholarly journals Exploring the Relationship Between Serum Magnesium, Inflammation, and Chronic Pain in a Vermont Primary Care Population

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1821-1821
Author(s):  
Benjamin Littenberg ◽  
Thomas Ahern ◽  
Emily Tarleton
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Medical Center ◽  
Primary Care Patient ◽  
Serum Magnesium ◽  
Random Noise ◽  
Univariate Analysis ◽  
Care Patient ◽  
Cross Sectional ◽  
The Relationship

Abstract Objectives We sought to describe the relationship between serum magnesium, inflammation, and chronic pain in adult primary care patient. Methods We sought to describe this relationship utilizing a cross-sectional analysis of medical records from 5639 adults (mean age 59 years; 42% men) seen in The University of Vermont Medical Center primary care clinics between 2015 and 2018. Patients with at least one serum magnesium level, C-reactive protein (CRP, a measure of inflammation) level, and chronic pain score (self-reported visual analogue scale) were included. Results Univariate analysis confirmed the relationship between serum magnesium and chronic pain (−0.31 points/mg/dL; 95% CI −0.47, −0.14; P < 0.001). However, when serum magnesium and CRP were both included in the model, the relationship with pain is unclear (N = 1345; CI −0.003, 0.002; P = 0.69). Conclusions For adults seen in primary care, lower serum magnesium levels are associated with chronic pain. This inverse relationship is not explained by random noise, including age and gender. The complex relationship between serum magnesium, CRP, and pain is complex requires further exploration. Funding Sources None.

Development and validation of a short form of the Geriatric Anxiety Inventory – the GAI-SF

2010 ◽  
Vol 23 (1) ◽  
pp. 125-131 ◽  
Author(s):  
Gerard J. Byrne ◽  
Nancy A. Pachana
Keyword(s):  
Primary Care ◽  
Older People ◽  
Short Form ◽  
Community Sample ◽  
Anxiety Symptoms ◽  
Self Report ◽  
Cross Sectional ◽  
Medical Settings ◽  
Epidemiological Surveys ◽  
Dsm Iv

ABSTRACTBackground: Anxiety symptoms and anxiety disorders are highly prevalent among older people and are associated with considerable disability burden. While several instruments now exist to measure anxiety in older people, there is a need for a very brief self-report scale to measure anxiety symptoms in epidemiological surveys, in primary care and in acute geriatric medical settings. Accordingly, we undertook the development of such a scale, based on the Geriatric Anxiety Inventory.Methods: This is a cross-sectional study of randomly selected, community-residing, older women (N = 284; mean age 72.2 years) using receiver operating characteristic (ROC) analyses. DSM-IV diagnostic interviews were undertaken using the Mini International Diagnostic Interview, fifth edition (MINI-V).Results: We developed a 5-item version of the Geriatric Anxiety Inventory, which we have termed the Geriatric Anxiety Inventory – Short Form (GAI-SF). We found that a score of three or greater was optimal for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in this community sample. At this cut-point, sensitivity was 75%, specificity was 87%, and 86% of participants were correctly classified. GAI-SF score was not related to age, MMSE score, level of education or perceived income adequacy. Internal consistency was high (Cronbach's α = 0.81) and concurrent validity against the State-Trait Anxiety Inventory was good (rs = 0.48, p < 0.001).Conclusions: The GAI-SF is a short form of the Geriatric Anxiety Inventory, which we recommend for use in epidemiological studies. It may also be useful in primary care and acute geriatric medical settings.

scholarly journals Abusive experiences and psychiatric morbidity in women primary care attenders

2003 ◽  
Vol 183 (4) ◽  
pp. 332-339 ◽  
Author(s):  
Jeremy Coid ◽  
Ann Petruckevitch ◽  
Wai-Shan Chung ◽  
Jo Richardson ◽  
Stirling Moorey ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Substance Misuse ◽  
Psychiatric Morbidity ◽  
Self Report ◽  
Post Traumatic Stress ◽  
Cross Sectional ◽  
Health Measures ◽  
Post Traumatic ◽  
Mental Health Effects

BackgroundAbusive experiences in childhood and adulthood increase risks of psychiatric morbidity in women and independently increase risks of further abuse over the lifetime. It is unclear which experiences are most damaging.AimsTo measure lifetime prevalence of abusive experiences and psychiatric morbidity, and to analyse associations in women primary care attenders.MethodA cross-sectional, self-report survey of 1207 women attending 13 surgeries in the London borough of Hackney, UK. Independent associations between demographic measures, abusive experiences and psychiatric outcome were established using logistic regression.ResultsChildhood sexual abuse had few associations with adult mental health measures, in contrast to physical abuse. Sexual assault in adulthood was associated with substance misuse; rape with anxiety, depression and post-traumatic stress disorder but not substance misuse. Domestic violence showed strongest associations with most mental health measures, increased for experiences in the past year.ConclusionsAbuse in childhood and adulthood have differential effects on mental health; effects are increased by recency and severity. Women should be routinely questioned about ongoing and recent experiences as well as childhood.

A Cross-Sectional Analysis of Factors that Influence the Detection of Depression in Older Primary Care Patients

2005 ◽  
Vol 39 (4) ◽  
pp. 262-265 ◽  
Author(s):  
Jon J Pfaff ◽  
Jon J Pfaff ◽  
Osvaldo P Almeida
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Older Patients ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Epidemiological Studies ◽  
Self Report ◽  
Screening Tools ◽  
Cross Sectional ◽  
Summary Sheet

Objective: To determine the characteristics of depressed older patients whose mental health status is detected by their general practitioner (GP). Method: Cross-sectional analytical design of 218 patients scoring above the cut-off (≥ 16) of the Center for Epidemiological Studies – Depression Scale (CES-D), from a sample of 916 consecutive patients aged 60 years or over attending one of 54 randomly selected GPs in Western Australia. Prior to their medical consultation, patients completed a self-report questionnaire, which included questions about depressive symptomatology (CES-D). Following the consultation, general practitioners recorded the patient's presenting complaint(s), medication information, and mental health details on a patient summary sheet. Results: Among these 218 patients, 39.9% (87/218) were correctly classified as depressed by their GP. Detection of depressive symptomatology was associated with patients who acknowledged taking sleeping tablets (OR = 2.6, 95% CI = 1.3–5.4), had CES-D scores indicative of major depression (≥ 22) (OR = 2.8, 95% CI = 1.4–5.6) and were thought to be at risk for suicide (OR = 35.1, 95% CI = 4.5–274.2). Conclusions: While GPs are most apt to detect depression among older patients with prominent mental health symptoms, many patients in this age group silently experience significant depressive symptomatology and miss the opportunity for effective treatment. The routine use of screening tools in primary care is recommended to enhance the detection rate of depression in older adults.

scholarly journals Attitudes to depression and its treatment in primary care

2007 ◽  
Vol 37 (9) ◽  
pp. 1239-1248 ◽  
Author(s):  
SCOTT WEICH ◽  
LOUISE MORGAN ◽  
MICHAEL KING ◽  
IRWIN NAZARETH
Keyword(s):  
Primary Care ◽  
Help Seeking ◽  
Medical Condition ◽  
Antidepressant Medication ◽  
Self Report ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Icd 10 ◽  
History Of ◽  
Depressive Episodes

ABSTRACTBackgroundUndertreatment of depression in primary care is common. Efforts to address this tend to overlook the role of patient attitudes. Our aim was to validate and describe responses to a questionnaire about attitudes to depression and its treatment in a sample with experience of moderate and severe depressive episodes.MethodCross-sectional survey of 866 individuals with a confirmed history of an ICD-10 depressive episode in the 12 months preceding interview, recruited from 7271 consecutive general practitioner (GP) attendees in 36 general practices in England and Wales. Attitudes to and beliefs about depression were assessed using a 19-item self-report questionnaire.ResultsFactor analysis resulted in a three-factor solution: factor 1, depression as a disabling, permanent state; factor 2, depression as a medical condition responsive to support; and factor 3, antidepressants are addictive and ineffective. Participants who received and adhered to antidepressant medication and disclosed their depression to family and friends had significantly lower scores on factors 1 and 3 but higher scores on factor 2.ConclusionsPeople with moderate or severe depressive episodes have subtle and divergent views about this condition, its outcome, and appropriate help. Such beliefs should be considered in primary care as they may significantly impact on help seeking and adherence to treatment.

scholarly journals What is the prevalence, and what are the clinical correlates, of insulin resistance in young people presenting for mental health care? A cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025674 ◽  
Author(s):  
Elizabeth M Scott ◽  
Joanne S Carpenter ◽  
Frank Iorfino ◽  
Shane P M Cross ◽  
Daniel F Hermens ◽  
...  
Keyword(s):  
Mental Health ◽  
Insulin Resistance ◽  
Primary Care ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Self Report ◽  
Model Assessment ◽  
Cross Sectional ◽  
Younger Age

ObjectivesTo report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services.DesignCross-sectional.SettingHeadspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney.Participants768 young people (66% female, mean age 19.7±3.5, range 12–30 years).Main outcome measuresIR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI).ResultsFor BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, <1% had an abnormally high fasting blood glucose (>6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score >2.0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p<0.001). Participants in the upper third of HOMA2-IR scores are characterised by younger age, higher BMIs and depression as a primary diagnosis. HOMA2-IR was predicted by younger age (β=0.19, p<0.001) and higher BMI (β=0.49, p<0.001), together explaining 22% of the variance (F(2,361)=52.1, p<0.001).ConclusionsEmerging IR is evident in a significant subgroup of young people presenting to primary care-based mental health services. While the major modifiable risk factor is BMI, a large proportion of the variance is not accounted for by other demographic, clinical or treatment factors. Given the early emergence of IR, secondary prevention interventions may need to commence prior to the development of full-threshold or major mood or psychotic disorders.

scholarly journals Supporting the spread and scale-up of electronic consultation across Canada: cross-sectional analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028888 ◽  
Author(s):  
Clare Liddy ◽  
Aminu Bello ◽  
Jean Cook ◽  
Neil Drimer ◽  
Maxine Dumas Pilon ◽  
...  
Keyword(s):  
Primary Care ◽  
Scale Up ◽  
Implementation Strategies ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cross Sectional ◽  
Online Application ◽  
Electronic Consultation ◽  
Utilisation Data ◽  
The Impact

ObjectiveTo examine the process of implementing an electronic consultation (eConsult) service and evaluate its impact along key metrics outlined by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.DesignCross-sectional study.SettingClinics using eConsult in four provinces across Canada: Alberta, Manitoba, Quebec and Newfoundland and Labrador.ParticipantsAll eConsult cases submitted in four participating provinces were included.InterventionThe eConsult service is a secure online application that allows primary care providers and specialists to communicate regarding a patient’s care. We measured the impact using system utilisation data and mandatory close-out surveys completed at the end of each eConsult.Main outcome measuresImplementation progress and impact were examined using the five categories outlined by the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance.ResultsFour provinces provided data from different periods, ranging from 4 years (Alberta) to 10 months (Manitoba). Total cases completed ranged from 96 (Manitoba) to 6885 (Alberta). Newfoundland had the largest menu of available specialties (n=35), while Alberta and Quebec had the smallest (n=22). The most frequently requested groups varied across provinces, with only endocrinology appearing in the top five for all provinces. The average specialist response time ranged from 3 days (Manitoba) to 16.7 days (Alberta). Between 54% (Newfoundland) and 66% (Manitoba) of cases resulted in new or additional information. Primary care providers avoided completing referrals they had originally considered in 36% (Newfoundland) to 53% of cases (Manitoba), while only between 27 % (Quebec) and 29% (Newfoundland) of cases resulted in a referral. In every province, services demonstrated higher rates of usage in their last quarter of data than their first.ConclusionseConsult was successfully implemented in four new provinces across Canada. Implementation strategies and scope varied, but services demonstrated substantial consistency on several key metrics, most notably on whether new information was learnt and impact on decision to refer.

scholarly journals Continuity of care and delivery of diabetes and hypertensive care among regular users of primary care services in Chile: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e027830
Author(s):  
Javiera Leniz ◽  
Martin C Gulliford
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Cross Sectional Study ◽  
Self Report ◽  
Secondary Outcome ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Services ◽  
Primary Care Services

ObjectivesExplore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control.DesignCross-sectional study.SettingData from the Chilean Health National Survey 2009–2010.ParticipantsRegular users of primary care services aged 15 or older.Primary and secondary outcome measuresProportion of hypertensive and diabetic patients with a blood pressure <140/90 mm Hg and HbA1c<7.0% respectively, self-report of diagnosis, treatment and recent foot and ophthalmological exams. Associations between continuity of care, sociodemographic characteristics, and primary and secondary outcomes were explored using logistic regression.Results3887 primary care service users were included. 14.7% recognised a usual GP, 82.3% of them knew their name. Continuity of care was positively associated with age >65 years (OR 4.81, 95% CI 3.16 to 7.32), being female (OR 1.66, 95% CI 1.34 to 2.05), retired (OR 2.22, 95% CI 1.75 to 2.83), obese (OR 1.66, 95% CI 1.29 to 2.14), high cardiovascular risk (OR 2.98, 95% CI 2.13 to 4.17) and widowed (OR 1.50, 95% CI 1.13 to 1.99), and negatively associated with educational level (8–12 vs <8 years OR 0.79, 95% CI 0.64 to 0.97), smoking (OR 0.65, 95% CI 0.52 to 0.82) and physical activity (OR 0.76, 95% CI 0.61 to 0.95). Continuity of care was associated with diagnosis awareness (OR 2.83, 95% CI 1.21 to 6.63), pharmacological treatment (OR 2.04, 95% CI 1.15 to 3.63) and a recent foot (OR 3.17, 95% CI 1.84 to 5.45) and ophthalmological exam (OR 3.20, 95% CI 1.66 to 6.18) in diabetic but not in hypertensive patients.ConclusionsContinuity of care was associated with higher odds of having a recent foot and ophthalmological exam in patients with diabetes, but not with better diseases control. Findings suggest patients with chronic conditions have better continuity of care access.

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