scholarly journals Pediatric primary care and subspecialist providers’ comfort, attitudes and practices screening and referring for social determinants of health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yonit Lax ◽  
Eleanor Bathory ◽  
Sandra Braganza
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Low Income Children ◽  
Academic Medical

Abstract Background Early detection and management of poverty-related disorders is a recommended pediatric practice; however, little is known about variations of practice between pediatric primary care physicians and subspecialists. The objectives of this study were to assess (1) provider perceptions and attitudes toward caring for low-income children in an urban academic medical center, and (2) variations between primary care physicians and subspecialists in social and financial needs screening and referral practices for low-income children. Design/Methods Primary care providers (pediatric and family medicine) and subspecialists providing direct patient care in an urban academic medical center (response rate = 24 %, n = 85/356) completed a 24-item survey (adapted with permission from the AAP Periodic Survey of Fellows No.90) assessing feasibility and comfort screening and addressing social and financial needs, rates of screening for financial hardship, and referrals to local resources. Chi-square tests were performed. Results Among respondents, 88 % (75/85) reported comfort caring for low-income children, while 28 % (24/85) reported comfort inquiring about social and financial needs and 34 % (29/85) referring to community resources. Primary care providers more commonly than subspecialists screened for childcare (80 % vs. 59 %, p = 0.04), parental: employment (84 % vs. 59 %, p = 0.01), education (40 % vs. 17 %, p = 0.02) and mental health (86 % vs. 46 %, p = 0.0001), and less commonly screened for transportation (47 % vs. 73 %, p = 0.01). Primary care providers more commonly referred for public health insurance (74 % vs. 39 %, p = 0.001), public food assistance (30 % vs. 12 %, p = 0.04), and adult mental health services (65 % vs. 44 %, p < 0.05). Conclusions In an urban academic institution serving a population with high poverty rates, pediatric providers feel comfortable providing medical care for low-income children but lack comfort screening and addressing SDH. Though most feel it is their job to refer to resources, less than half felt it was feasible to screen for or address financial needs. Pediatric primary care providers report higher rates of screening and referring than subspecialists. Understanding variations in practice and perceptions among primary care providers and subspecialists may aid in creating interventions to increase screening and referral rates.

scholarly journals Primary care psychiatry eConsults: Descriptive Analysis of an electronic consultation program in a rural, academic medical center (Preprint)

2020 ◽  
Author(s):  
Jade Avery ◽  
Dennis Dwan ◽  
Gillian Sowden ◽  
Matthew Duncan
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Descriptive Analysis ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Question Type ◽  
High Rate ◽  
Care Providers ◽  
Academic Medical

BACKGROUND While primary care providers serve a crucial role in addressing the mental health needs of patients, referrals to specialists may be necessary in the treatment of complex psychiatric conditions. Psychiatry electronic consultations (eConsults) can serve as a valuable tool in providing specialist advice for primary care physicians when specialty care is not readily available. OBJECTIVE The goal of this study was to evaluate the content and implementation rate of eConsults by primary care providers in a rural, academic medical center. METHODS This is retrospective review of 343 electronic consults placed between May 2016 and February 2019 by primary care providers at a single academic medical center. Response time and eConsult content, including patient demographics, distance of patient and PCP from consulting provider, consult question type, patient diagnosis, recommendations, and implementation of recommendation, were analyzed. RESULTS The most common diagnoses associated with our eConsults were depression (40.2%) and anxiety (32.3%). The most commonly asked consult question was regarding medication management, including medication choice, dosage, and side effects (83.5%). A majority of recommendations by the consulting psychiatrist were implemented by the PCP (94%). The average time to respond to an eConsult was 26 hours. CONCLUSIONS This study demonstrates that psychiatry eConsults can be conducted in a timely manner and that PCPs implement the recommendations at a high rate.

scholarly journals 864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S523-S524
Author(s):  
Genevieve Allen ◽  
Jamie Riddell
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Hiv Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Academic Medical ◽  
Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p &lt; 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p &lt; 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

scholarly journals Early Implementation and Evaluation of a Teledermatology Virtual Clinic Within an Academic Medical Center

Iproceedings ◽  
10.2196/35432 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35432
Author(s):  
Ethan D Borre ◽  
Suephy C Chen ◽  
Matilda W Nicholas ◽  
Edward W Cooner ◽  
Donna Phinney ◽  
...  
Keyword(s):  
Primary Care ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Care Clinics ◽  
Number Of Patients ◽  
Virtual Clinic

Background Teledermatology can increase patient access; however, its optimal implementation remains unknown. Objective This study aimed to describe and evaluate the implementation of a pilot virtual clinic teledermatology service at Duke University. Methods Leaders at Duke Dermatology and Duke Primary Care identified a teledermatology virtual clinic to meet patients’ access needs. Implementation was planned over the exploration, preparation, implementation, and sustainment phases. We evaluated the implementation success of teledermatology using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and prioritized outcome collection through a stakeholder survey. We used the electronic health record and patient surveys to capture implementation outcomes. Results Our process consisted of primary care providers (PCPs) who sent clinical and dermatoscopic images of patient lesions or rashes via e-communication to a teledermatology virtual clinic, with a subsequent virtual clinic scheduling of a video visit with the virtual clinic providers (residents or advanced practice providers, supervised by Duke Dermatology attending physicians) within 2-5 days. The teledermatology team reviews the patient images on the day of the video visit and gives their diagnosis and management plan with either no follow-up, teledermatology nurse follow-up, or in-person follow-up evaluation. Implementation at 4 pilot clinics, involving 19 referring PCPs and 5 attending dermatologists, began on September 9, 2021. As of October 31, 2021, a total of 68 e-communications were placed (50 lesions and 18 rashes) and 64 virtual clinic video visits were completed. There were 3 patient refusals and 1 conversion to a telephonic visit. Participating primary care clinics differed in the number of patients referred with completed visits (range 2-32) and the percentage of providers using e-communications (range 13%-53%). Patients were seen soon after e-communication placement; compared to in-person wait times of >3 months, the teledermatology virtual clinic video visits occurred on average 2.75 days after e-communication. In total, 20% of virtual clinic video visits were seen as in-person visit follow-up, which suggests that the majority of patients were deemed treatable at the virtual clinic. All patients who returned the patient survey (N=10, 100%) agreed that their clinical goals were met during the virtual clinic video visits. Conclusions Our virtual clinic model for teledermatology implementation resulted in timely access for patients, while minimizing loss to follow-up, and has promising patient satisfaction outcomes. However, participating primary care clinics differ in their volume of referrals to the virtual clinic. As the teledermatology virtual clinics scale to other clinic sites, a systematic assessment of barriers and facilitators to its implementation may explain these interclinic differences. Acknowledgments We are grateful to the Private Diagnostic Clinic and Duke Institute for Health Innovation for their support. Conflicts of Interest None declared.

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.

scholarly journals Early Implementation and Evaluation of a Teledermatology Virtual Clinic Within an Academic Medical Center (Preprint)

2021 ◽  
Author(s):  
Ethan D Borre ◽  
Suephy C Chen ◽  
Matilda W Nicholas ◽  
Edward W Cooner ◽  
Donna Phinney ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Management Plan ◽  
Care Providers ◽  
Primary Care Clinics ◽  
Number Of Patients ◽  
Virtual Clinic

BACKGROUND Teledermatology can increase patient access; however, its optimal implementation remains unknown. OBJECTIVE This study aimed to describe and evaluate the implementation of a pilot virtual clinic teledermatology service at Duke University. METHODS Leaders at Duke Dermatology and Duke Primary Care identified a teledermatology virtual clinic to meet patients’ access needs. Implementation was planned over the exploration, preparation, implementation, and sustainment phases. We evaluated the implementation success of teledermatology using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and prioritized outcome collection through a stakeholder survey. We used the electronic health record and patient surveys to capture implementation outcomes. RESULTS Our process consisted of primary care providers (PCPs) who sent clinical and dermatoscopic images of patient lesions or rashes via e-communication to a teledermatology virtual clinic, with a subsequent virtual clinic scheduling of a video visit with the virtual clinic providers (residents or advanced practice providers, supervised by Duke Dermatology attending physicians) within 2-5 days. The teledermatology team reviews the patient images on the day of the video visit and gives their diagnosis and management plan with either no follow-up, teledermatology nurse follow-up, or in-person follow-up evaluation. Implementation at 4 pilot clinics, involving 19 referring PCPs and 5 attending dermatologists, began on September 9, 2021. As of October 31, 2021, a total of 68 e-communications were placed (50 lesions and 18 rashes) and 64 virtual clinic video visits were completed. There were 3 patient refusals and 1 conversion to a telephonic visit. Participating primary care clinics differed in the number of patients referred with completed visits (range 2-32) and the percentage of providers using e-communications (range 13%-53%). Patients were seen soon after e-communication placement; compared to in-person wait times of &gt;3 months, the teledermatology virtual clinic video visits occurred on average 2.75 days after e-communication. In total, 20% of virtual clinic video visits were seen as in-person visit follow-up, which suggests that the majority of patients were deemed treatable at the virtual clinic. All patients who returned the patient survey (N=10, 100%) agreed that their clinical goals were met during the virtual clinic video visits. CONCLUSIONS Our virtual clinic model for teledermatology implementation resulted in timely access for patients, while minimizing loss to follow-up, and has promising patient satisfaction outcomes. However, participating primary care clinics differ in their volume of referrals to the virtual clinic. As the teledermatology virtual clinics scale to other clinic sites, a systematic assessment of barriers and facilitators to its implementation may explain these interclinic differences.

scholarly journals Econsultation to Hematologists from Primary Care: An Assessment of Content and Patient Impact

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2279-2279
Author(s):  
Megan Leslie ◽  
Sa Ra Park ◽  
Jennifer Wang ◽  
Kelly Mercer Davidson ◽  
Kimberly Dowdell
Keyword(s):  
Primary Care ◽  
Response Time ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Deficiency Anemia ◽  
Factor V Leiden Mutation ◽  
Face To Face ◽  
Academic Medical ◽  
The Impact

Abstract Introduction: National referral rates and wait times to see specialists continue to increase, contributing to the continued rise of health care cost in the United States. Electronic consultations (eConsults) are text-based inquiry responses between providers and consultants that represent a potential means of ameliorating this trend. eConsults have been shown to improve access to specialist care while increasing patient satisfaction and decreasing unnecessary specialist visits. However, there is little research about the impact and content of eConsults within hematology at U.S. academic medical centers. The available research demonstrates that eConsults to hematology can resolve issues without requiring a face-to-face visit, while hematologists report short response times (Khamisa et al, Blood 2015) and satisfaction with eConsult programs (Cecchini et al, Blood 2016). We aim to study the most common topics queried by primary care providers (PCPs) to hematologists via eConsult, and to evaluate the impact of eConsults on patients. Methods: This retrospective study included eConsults made to benign hematology at a single US based tertiary care academic medical center from December 1, 2015 to June 1, 2018. The patient population included patients established with primary care physicians within the hospital network. For data collection, we modified a template used to analyze eConsultations to gastroenterology developed by the authors (JW, SP) within the same academic medical center. Data review included patient demographics, type of question asked, clinical content, specialist response time, and eConsult outcome. Results: Content of eConsults: Overall, 82 different topics were addressed in a total of 350 eConsults. eConsults to hematology were most often placed by attending physicians (54.8%), followed by nurse practitioners (26.3%) and residents (18.9%). Questions asked were most likely concerning diagnosis or further workup of disease (56%), followed by patient management (38.5%) and lab interpretation (7.5%). Question content fell into one of eight general categories, including anticoagulation (22%), anemia (22%) and abnormal lab result (21%) (Figure 1). Specific topics with a high rate of resolution via eConsult included: macrocytic anemia (93%), microcytic anemia (83%), pulmonary embolism anticoagulation (83%), atrial fibrillation anticoagulation (80%), iron deficiency anemia (75%), and Factor V Leiden mutation anticoagulation (73.3%) (Table 2). Topics requiring a face-to-face hematology visit included: abnormal bleeding (100%), polycythemia (75%) and other venous thrombosis (57%). Patient Impact: The average response time to eConsult was 12 hours, compared to average time between eConsult and in-person hematology visit of 50.21 days. The majority of queries, 63%, were resolved via eConsult alone, avoiding a visit to hematology. The total round trip mileage saved by these eConsults was 18,933.6 miles, with an average of 75.7 miles per person (Table 1, Figure 2). Discussion: Despite lack of in-person evaluation, eConsultants were able to resolve the majority of cases encountered during the study period. In those cases that resulted in a hematology visit, the eConsultant often recommended the appropriate pre-visit workup by the PCP, improving the initial hematology visit. Further, our results demonstrate that eConsults increase patient access to timely specialty input while reducing unnecessary face-to-face visits. These findings elucidate potential topics for further provider education, as well as support the continued development and refinement of eConsult programs in health systems across the country. Disclosures Dowdell: AAMC: Honoraria.

scholarly journals Primary care clinical provider knowledge and experiences in the diagnosis and treatment of tick-borne illness: a qualitative assessment from a Lyme disease endemic community

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie Mattoon ◽  
Caitlin Baumhart ◽  
Ana C. Barsallo Cochez ◽  
Douglas MacQueen ◽  
Jeffrey Snedeker ◽  
...  
Keyword(s):  
Primary Care ◽  
Small Town ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Diagnosis And Treatment ◽  
Care Providers ◽  
Group Data ◽  
Focus Group Data

Abstract Background Primary care and frontline healthcare providers are often the first point of contact for patients experiencing tick-borne disease (TBD) but face challenges when recognizing and diagnosing these diseases. The specific aim of this study was to gain a qualitative understanding of frontline and primary care providers’ knowledge and practices for identifying TBDs in patients. Methods From fall 2018 to spring 2019, three focus groups were conducted with primary care providers practicing in a small-town community endemic to Lyme disease (LD) and with emerging incidence of additional TBDs. A follow up online survey was distributed to urgent and emergency care providers in the small-town community and an academic medical center within the referral network of the local clinical community in spring and summer 2019. Qualitative analysis of focus group data was performed following a grounded theory approach and survey responses were analyzed through the calculation of descriptive statistics. Results Fourteen clinicians from three primary care practices participated in focus groups, and 24 urgent and emergency care clinicians completed the survey questionnaire. Four overarching themes emerged from focus group data which were corroborated by survey data. Themes highlighted a moderate level of awareness on diagnosis and treatment of LD among participants and limited knowledge of diagnosis and treatment for two other regionally relevant TBDs, anaplasmosis and babesiosis. Providers described challenges and frustrations in counseling patients with strong preconceptions of LD diagnosis and treatment in the context of chronic infection. Providers desired additional point-of-care resources to facilitate patient education and correct misinformation on the diagnosis and treatment of TBDs. Conclusions Through this small study, it appears that clinicians in the small-town and academic medical center settings are experiencing uncertainties related to TBD recognition, diagnosis, and patient communication. These findings can inform the development of point-of-care resources to aid in patient-provider communication regarding TBDs and inform the development of continuing medical education programs for frontline and primary care providers.

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