scholarly journals Assessing the impact of Indiana legislation on opioid-based doctor shopping among Medicaid-enrolled pregnant women: a regression analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sukhada S. Joshi ◽  
Nicole Adams ◽  
Yuehwern Yih ◽  
Paul M. Griffin
Keyword(s):  
Pregnant Women ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Public Law ◽  
Longitudinal Change ◽  
Prescription Opioid ◽  
Doctor Shopping ◽  
Prescription Drug Monitoring Programs ◽  
Administrative Code ◽  
The Impact

Abstract Background States have passed various legislative acts in an attempt to reduce opioid prescribing and corresponding doctor shopping, including prescription drug monitoring programs. This study seeks to determine the association between two state-based interventions enacted in Indiana and the level of doctor shopping among Medicaid-enrolled pregnant women. Methods Indiana Medicaid claims data over the period of January 2014 to March 2019 were used in a regression model to determine the longitudinal change in percentage of pregnant women engaged in doctor shopping based on passage of Indiana Administrative Code Title 884 in 2014 and Public Law 194 in 2018. The primary reasons for prescribing were also identified. Results There were 37,451 women that had both pregnancy and prescription opioid claims over the time horizon. Of these, 2130 women met the criteria for doctor shopping. Doctor shopping continued to increase over the time between the passage of the two interventions but decreased after passage of Public Law 194. Conclusion The decrease in doctor shopping among Medicaid-enrolled pregnant women after passage of Public Law 194 points to the importance of addressing this issue across a broad set of healthcare professionals including nurse practitioners and physician assistants. It is also possible that the potential punitive component in the Law for non-compliance played a role.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

scholarly journals THE IMPACT OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS ON NURSING HOME QUALITY

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 841-841
Author(s):  
R. Pradhan ◽  
R. Weech-Maldonado ◽  
S. Gupta ◽  
N. Dayama
Keyword(s):  
Nursing Home ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Nursing Home Quality ◽  
The Impact

Physical therapy in the emergency department: surveying primary care practitioners' perceptions and recommendations

2020 ◽  
Vol 26 (8) ◽  
pp. 1-12
Author(s):  
Stacy J Fisher
Keyword(s):  
Emergency Department ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Physician Assistants ◽  
Geographic Region ◽  
Full Time ◽  
Chi Square ◽  
The Usa ◽  
Primary Care Practitioners ◽  
The Impact

Background/aims Little is known regarding the impact that physiotherapists can have on patients in the emergency department. A study was carried out to explore attitudes of physicians, physician assistants and nurse practitioners in emergency departments about physiotherapists being staffed full-time to assist with patient care. It also aimed to investigate whether physiotherapists should be staffed in emergency departments, what they are capable of doing in an emergency department and identify areas where physiotherapists are most useful in emergency departments in the USA. Methods This sequential mixed method study examined the perceptions and recommendations of emergency medicine practitioners regarding physiotherapists' services in the emergency department. Phase one analysed geographical data. Phase two analysed qualitative components of the survey. Frequencies were analysed and either Fisher's exact or Chi-square tests used to analyse the findings. Participants included physician assistants, nurse practitioners and physicians in emergency departments in the USA. Results A statistically significant association was shown between the geographic region and whether or not physiotherapists were staffed within the emergency departments in states outside the western region. Additionally, 97% of qualified participants reported positive experiences working with physiotherapists regularly. Conclusions Physiotherapists should be used for the specialisation and knowledge they have. More education is needed in emergency departments around the USA to understand what a physiotherapist can offer and how this reduces unnecessary hospital admission. Physiotherapists working in the emergency department can ultimately reduce costs for hospitals.

scholarly journals Exploring the Impact of Group Size on KANSAS JOURNAL of MEDIC INE Medical Students’ Perception of Learning and Professional Development During Clinical Rotations

2019 ◽  
Vol 11 (3) ◽  
pp. 70-75 ◽  
Author(s):  
Samuel Ofei-Dodoo ◽  
Kyle Goerl ◽  
Scott Moser
Keyword(s):  
Medical Students ◽  
Group Size ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Clinical Experiences ◽  
Subjective Experiences ◽  
Learning Groups ◽  
Clinical Rotations ◽  
The Impact ◽  
Method Approach

Introduction. Research assessing the size of learning groups inmedical education and how that affects the learner’s experience islimited. The main goals of the study were to (1) assess the effect ofvarying group size on medical students’ subjective experiences duringclinical years. We hypothesized that students in smaller groups weremore likely to have better experiences during clinical rotation thanthose in larger groups, and (2) determine if medical students havedesirable experiences working with other medical learners (fellows,residents, osteopathic students, physician assistants, and nurse practitioners)during clinical rotations. Methods. The study utilized a mixed method approach where 153medical students in their clinical years were asked to complete a10-item survey. A linear-by-linear association test of trend andMann-Whitney U test were used to evaluate the students’ quantitativedata. A multidisciplinary team used an immersion-crystallizationapproach to analyze the content of the students’ qualitative data. Results. There was a 90% (137/153) response rate. Most students(80%) reported desirable experiences during clinical rotationsbecause of supportive learning environments, engaging preceptors,willingness of residents to teach, as well as the opportunity to participatein patient care. There were significant differences in students’perceived clinical experiences as a function of group size, wheregroups of two students were preferable over groups of four or more. Conclusions. Varying group size appears to affect students’ clinicalexperiences. Kans J Med 2018;11(3):70-75.

scholarly journals Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas

2018 ◽  
Vol 25 (8) ◽  
pp. 484-492 ◽  
Author(s):  
Andrea D Furlan ◽  
Jane Zhao ◽  
Jennifer Voth ◽  
Samah Hassan ◽  
Ruth Dubin ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Nurse Practitioners ◽  
Self Efficacy ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Chronic Pain Management ◽  
Healthcare Outcomes ◽  
The Impact

Introduction Inadequate knowledge and training of healthcare providers are obstacles to effective chronic pain management. ECHO (extension for community healthcare outcomes) uses case-based learning and videoconferencing to connect specialists with providers in underserved areas. ECHO aims to increase capacity in managing complex cases in areas with poor access to specialists. Methods A pre-post study was conducted to evaluate the impact of ECHO on healthcare providers’ self-efficacy, knowledge and satisfaction. Type of profession, presenting a case, and number of sessions attended were examined as potential factors that may influence the outcomes Results From June 2014 to March 2017, 296 primary care healthcare providers attended ECHO, 264 were eligible for the study, 170 (64%) completed the pre-ECHO questionnaire and 119 completed post-ECHO questionnaires. Participants were physicians (34%), nurse practitioners (21%), pharmacists (13%) and allied health professionals (32%). Participants attended a mean of 15 ± 9.19 sessions. There was a significant increase in self-efficacy ( p < 0.0001) and knowledge ( p < 0.0001). Self-efficacy improvement was significantly higher among physicians, physician assistants and nurse practitioners than the non-prescribers group ( p = 0.03). On average, 96% of participants were satisfied with ECHO. Satisfaction was higher among those who presented cases and attended more sessions. Discussion This study shows that ECHO improved providers’ self-efficacy and knowledge. We evaluated outcomes from a multidisciplinary group of providers practicing in Ontario. This diversity supports the generalisability of our findings. Therefore, we suggest that this project may be used as a template for creating other educational programs on other medical topics.

scholarly journals Mitigating primary care provider burnout with interdisciplinary dyads and shared care delivery

2021 ◽  
Author(s):  
Allison Norful ◽  
Yun He ◽  
Adam Rosenfeld ◽  
Cilgy Abraham ◽  
Bernard Chang
Keyword(s):  
Primary Care ◽  
Job Satisfaction ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Intention To Leave ◽  
Physician Assistants ◽  
Current Position ◽  
Provider Outcomes ◽  
The Impact ◽  
Delivery Models

Rationale, aims and objectives: Increased incidence of chronic illnesses coupled with physician shortages have yielded strain on primary care providers (PCP) to meet care demands. Interdisciplinary providers such as nurse practitioners and physician assistants have increasingly been embedded into primary care teams to alleviate some workload demand. Little evidence exists about the impact of interdisciplinary PCP care delivery models on provider outcomes. The objective of this study was to investigate the impact of interdisciplinary PCP care delivery on provider burnout, job satisfaction and intention to leave current position. Methods: We conducted a cross sectional mail survey using Dillman methodology of primary care practices (e.g., internal medicine) across New York State. A random sample of interdisciplinary PCPs (physicians, nurse practitioners, and physician assistants) (n=333) responded. The Provider Co-management Index (α = .85) was used to measure how well interdisciplinary dyads co-management care delivery attributes (effective communication; mutual respect and trust; shared philosophy of care). Provider outcomes were measured with validated AHRQ and HRSA items for burnout, job satisfaction and intention to leave position. Descriptive statistics, logistic regression models, crude and adjusted odds ratios were calculated, controlling for participant and practice characteristics. Results: Almost 30% of participants reported burnout with three times the odds of intending to leave their current position within one year. With each unit increase in effective co-management between interdisciplinary dyads there was 15% less burnout and 10% less odds of intention to leave position. Conclusion: Incorporating interdisciplinary specialties in primary care appears promising to alleviate some adverse provider outcomes. Organizations contemplating delivery models to promote well-being and retention may consider co-management. Cost effectiveness research is needed to determine financial sustainability of interdisciplinary care delivery.

Standardization of the inpatient oncology signout process.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 253-253
Author(s):  
Anish B Parikh ◽  
Elizabeth Aronson ◽  
Amir S. Steinberg ◽  
Cardinale B. Smith
Keyword(s):  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Marrow Transplant ◽  
Health Care Proxy ◽  
Post Intervention ◽  
Code Status ◽  
Included Patient ◽  
The Impact ◽  
Data Informed

253 Background: Provider handoffs are prone to medical errors which in turn impact patient outcomes. Standardized signout tools have helped address this issue, however not in oncology. Methods: A pre-intervention survey (S1) was used to evaluate the current inpatient signout process and identify flaws by querying inpatient hematology/oncology fellows, attendings, nurse practitioners, and physician assistants. This data informed the development of a standardized electronic signout tool which was subsequently piloted on our bone marrow transplant unit. A post-intervention survey (S2) is currently evaluating the impact of this tool. Results: Of S1 respondents (54%, 71/131), 75% felt the signout process needs improvement, largely due to outdated (70%) or incomplete (24%) information and general disorganization (49%). Nearly half felt the signout contains too much (28%) or too little (18%) information. 18% felt that patient care had been compromised or delayed due to poor signout. Items requested for inclusion in the signout tool by more than half of respondents included patient identifiers, health care proxy, code status/goals of care, active issues summary, cancer details and treatment history, and a to-do list. Full S1 results are shown in Table; S2 results are pending. Conclusions: Use of a standardized, electronic signout tool can further enhance the inpatient handoff process in terms of safety and efficiency. [Table: see text]

scholarly journals Implementation to Optimization: A Tailored, Data-Driven Approach to Improve Provider Efficiency and Confidence in Use of the Electronic Medical Record

2018 ◽  
Vol 14 (7) ◽  
pp. e421-e428 ◽  
Author(s):  
Sarah S. Kadish ◽  
Erica L. Mayer ◽  
David M. Jackman ◽  
Mark Pomerantz ◽  
Lauren Brady ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Data Driven ◽  
Training Approach ◽  
Data Driven Approach ◽  
Provider Survey ◽  
Almost All ◽  
The Impact

Purpose: Nine months after the implementation of a new electronic medical record (EMR) system at a single institution, physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs) expressed frustration with its use. We aimed to test if an individually tailored training approach reduced time spent with the EMR and increased confidence. Materials and Methods: Two hours of training were conducted in a one-on-one manner with a trainer. Content was individualized according to the following: provider survey, EMR utilization profile, and shadowing in clinic. Surveys assessed confidence before training and immediately after training. Changes in time spent in various EMR activities before training and after training were compared. Results: Three trainers delivered one-on-one training to 133 MDs, 42 NPs, and 10 PAs who specialized in medical oncology. Participants reported an increase in confidence across all activities, and almost all providers (98%) who responded to our survey agreed that the training enhanced their efficiency. A non–statistically significant trend toward reduction in the overall time in the system was observed. Time in system was reduced primarily in activities such as documentation and ordering of laboratory tests, imaging, medications, and chemotherapy. Conclusion: A personalized and data-driven training approach was highly regarded by providers. EMR usage reports provided extensive data to identify and prioritize training content and were valuable to measure the impact of training on provider time in system. With the growth of EMR implementation and the reported relationship of EMR use to burnout, continuous and personalized training after EMR implementation is effective to reduce the time in system and increase confidence.

scholarly journals P113 How has COVID-19 affected the treatment of osteoporosis? The answers from a global survey

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Nicholas R Fuggle ◽  
Andrea Singer ◽  
Nicholas Harvey ◽  
Jean-Yves Reginster ◽  
Cyrus Cooper ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Physical Therapists ◽  
Physician Assistants ◽  
Asia Pacific ◽  
Mineral Density ◽  
Face To Face ◽  
Medication Delivery ◽  
Relative Neglect ◽  
The Impact ◽  
Intravenous Medication

Abstract Background/Aims  The COVID-19 pandemic has had profound effects on the health of the global population both directly, via the sequelae of the infection, and indirectly, including the relative neglect of chronic disease management. Together the International Osteoporosis Federation and National Osteoporosis Foundation sought to ascertain the impact on osteoporosis management. Methods  Questionnaires were electronically circulated to a sample of members of both learned bodies and included information regarding the location and specialty of respondents, current extent of face to face consultations, alterations in osteoporosis risk assessment, telemedicine experience, alterations to medication ascertainment and delivery, and electronic health record (EHR) utilisation. Responses were collected, quantitative data analysed, and qualitative data assessed for recurring themes. Results  Responses were received from 209 healthcare workers from 53 countries, including 28% from Europe, 24% from North America, 19% from the Asia Pacific region, 17% from the Middle East, and 12% from Latin America. Most respondents were physicians (85%) with physician assistants, physical therapists and nurses/nurse practitioners represented in the sample. The main three specialties represented included rheumatology (40%), endocrinology (22%) and orthopaedics (15%).In terms of the type of patient contact, 33% of respondents conducted telephone consultations and 21% video consultations. Bone mineral density assessment by dual-energy x-ray absorptiometry (DXA) usage was affected with only 29% able to obtain a scan as recommended. The majority of clinicians (60%) had systems in place to identify patients receiving subcutaneous or intravenous medication, and 43% of clinicians reported difficulty in arranging appropriate osteoporosis medications during the COVID-19 crisis. Conclusion  To conclude through surveying a global sample of osteoporosis healthcare professionals, we have observed an increase in telemedicine consultations, delays in DXA scanning, interrupted supply of medications and reductions in intravenous medication delivery. Disclosure  N.R. Fuggle: None. A. Singer: None. N. Harvey: None. J. Reginster: None. C. Cooper: None. S. Greenspan: None.

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