scholarly journals Delirium diagnosis and handover to primary care providers and medical teams

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S31-S32
Author(s):  
Saba Inam ◽  
Joanne Flood ◽  
Aine Butler
Keyword(s):  
Primary Care ◽  
Hospital Setting ◽  
Primary Care Providers ◽  
Acute Hospital ◽  
Care Providers ◽  
Liaison Psychiatry ◽  
Increased Risk ◽  
Medical Teams ◽  
Acute Hospital Setting ◽  
Discharge Summaries

AimsDelirium is a common medical problem with a prevalence of over 50% in over 65s admitted to general hospitals (1,2) . Delirium is linked with poor clinical outcome, including increased risk of falls, prolonged admissions and an overall increased risk of morbidity and mortality (2,3,4). Delirium in older adults is also associated with an increased rate of cognitive decline, future risk of cognitive decline and a risk of depression (5,6,7). There is potential to improve clinical practice by improving assessment and management of delirium. It is imperative that where delirium is detected, it should be clearly documented to aid handover to primary care providers and medical teams (8,9).MethodThe standard for this audit was set according to SIGN 157 (9). Data were collected retrospectively from consults sent to a liaison psychiatry of old age service within an acute hospital setting. The medical discharge summaries from July to December 2019 were reviewed. Two key data points were collated, the diagnoses of delirium by either medical or liaison psychiatry team and the inclusion of this diagnosis in the patient discharge summaries. An updated delirium protocol was devised and introduced in the hospital setting in January 2020 to include tools for effective diagnosis of delirium and instruction to include this diagnosis if made in patient's discharge summaries. Re-audit was initiated following the introduction of the updated delirium protocol for the period of January to March 2020.ResultA total of 116 patients were assessed from July to December 2019. 102 discharge summaries were available for review for the purpose of this audit. Prior to the introduction of the updated delirium protocol, delirium was diagnosed by the liaison team in 57% of all referrals. Delirium was underdiagnosed by medical teams in 73% of those subsequently diagnosed. The diagnosis of delirium was present in 42% of all discharge summaries to primary care providers. Subsequent to the introduction of the updated protocol, delirium was diagnosed in 48% of all liaison referrals during the time period specified. The proportion of under-diagnosis of delirium by medical teams stayed at 73%, the diagnosis of delirium was present in 53% of discharge summaries.ConclusionThe recognition and diagnosis of delirium in the general medical setting continues to be a key issue in the management of older adults. The importance of this diagnosis and it's associated after effects needs to be disseminated amongst all care providers. Greater efforts to enhance these aspects of delirium management in the acute hospital setting are required.

scholarly journals Health Variables Are Informative in Screening for Mild Cognitive Impairment Among Elderly African Americans

2017 ◽  
Vol 38 (10) ◽  
pp. 1421-1444 ◽  
Author(s):  
Siny Tsang ◽  
Scott A. Sperling ◽  
Moon-Ho Park ◽  
Ira M. Helenius ◽  
Ishan C. Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
African Americans ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cognitive Difficulties ◽  
Increased Risk ◽  
State Examination

To aid primary care providers in identifying people at increased risk for cognitive decline, we explored the relative importance of health and demographic variables in detecting potential cognitive impairment using the Mini-Mental State Examination (MMSE). Participants were 94 older African Americans coming to see their primary care physicians for reasons other than cognitive complaints. Education was strongly associated with cognitive functioning. Among those with at least 9 years of education, patients with more vascular risk factors were at greater risk for mild cognitive impairment. For patients with fewer than 9 years of education, those with fewer prescribed medications were at increased risk for dementia. These results suggest that in addition to the MMSE, primary care physicians can make use of patients’ health information to improve identification of patients at increased risk for cognitive impairment. With improved identification, physicians can implement strategies to mitigate the progression and impact of cognitive difficulties.

A multidisciplinary team (MDT) approach to managing alcohol-dependent patients with comorbid depression in an acute hospital setting

2017 ◽  
Vol 41 (S1) ◽  
pp. S393-S393
Author(s):  
L. Owens ◽  
K. Patterson ◽  
G. King ◽  
P. Richardson
Keyword(s):  
Hospital Admissions ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Care Providers ◽  
Increased Risk ◽  
Future Care ◽  
Competing Interest ◽  
Fail Safe ◽  
Alcohol Dependence Treatment ◽  
Alcohol Dependent

IntroductionAlcohol-dependent patients have a significantly increased risk of depression, contributing a cycle of relapse and attendance at acute hospital services seeking help. Care is often focused on the alcohol dependence treatment with little consideration of concomitant psychiatric disorders.AimTo help bridge this gap in care planning and aim toward multidisciplinary long-term support.MethodWe collected data on all patients referred to our alcohol complex patient MDT. We investigated the range of disciplines involved in patient care. We spoke to our patients about why they had chosen to attend hospital. We then developed a referral system to our alcohol MDT where a bespoke pathways of care was developed with all current and future care providers.ResultsOur patients were often being cared for by multiple services, however much of this work was happening in isolation and was at times conflicting. Importantly, the patients were unclear where to go for what, and were utilizing the ED as a fail-safe when they were troubled.Of 15 patients referred to MDT, 7 (50%) had a diagnosis of depression (DSM-IV). These patients had an average of 5.1 hospital attendances and 2.2 hospital admissions in the 3 months prior to MDT. At 3 months post-MDT, we were able to demonstrate a reduction in hospital admissions and attendances (average 2.2 & 1.4, respectively).ConclusionsAn MDT for alcohol-dependent patients with depression facilitates effective and collaborative working for the benefit of patients and services.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals HIV Screening and the Affordable Care Act

2016 ◽  
Vol 11 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Greg Carter ◽  
Christopher Owens ◽  
Hsien-Chang Lin
Keyword(s):  
Primary Care ◽  
Affordable Care Act ◽  
Health Care Disparities ◽  
Primary Care Providers ◽  
Future Research ◽  
Hiv Screening ◽  
Health Providers ◽  
Care Providers ◽  
Increased Risk ◽  
The Affordable Care Act

Men continue to bear disproportionate accounts of HIV diagnoses. The Patient Protection and Affordable Care act aims to address health care disparities by recommending preventative services, including HIV screening, expanding community health centers, and increasing the healthcare workforce. This study examined the decision making of physician and primary care health providers to provide HIV screenings. A quasi-experimental design was used to estimate the effects of the Affordable Care Act on provider-initiated HIV screening. The National Ambulatory Medical Care Survey was used to examine HIV screening characteristic from two time periods: 2009 and 2012. Logistic regression indicated that patient and provider characteristics were associated with likelihood of being prescribed HIV screening. Non-Hispanic Black men were more likely to be prescribed HIV screening compared to non-Hispanic White men (odds ratio [OR] = 12.33, 95% confidence interval [CI; 4.42, 34.46]). Men who see primary care providers were more likely to be prescribed HIV screening compared to men not seeing a primary care provider (OR = 5.94, 95% CI [2.15, 16.39]). Men between the ages of 19 and 22 were more likely to be prescribed HIV screening compared to men between the ages of 15 and 18 (OR = 6.59, 95% CI [2.16, 20.14]). Men between the ages of 23 and 25 were more likely to be prescribed HIV screening compared with men between the ages of 15 and 18 (OR = 10.13, 95% CI [3.34, 30.69]). Health education programs identifying men at increased risk for contracting HIV may account for the increased screening rates in certain populations. Future research should examine age disparities surrounding adolescent and young men HIV screening.

Burnout and its Association with Musculoskeletal Pain among Primary Care Providers

2017 ◽  
Vol 61 (1) ◽  
pp. 1010-1014 ◽  
Author(s):  
Xuanxuan Zhang ◽  
Mark C. Schall ◽  
Richard Sesek ◽  
Sean Gallagher ◽  
Jesse Michel
Keyword(s):  
Primary Care ◽  
Musculoskeletal Pain ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cross Sectional ◽  
Body Regions ◽  
Increased Risk ◽  
The Right

Burnout is a growing concern among primary care providers (PCPs). The condition may lead to diminished quality of patient care as well as reduced quality of life. Although self-reported musculoskeletal pain is common among healthcare providers, the relationship between burnout and musculoskeletal pain among PCPs has been studied very little. We describe a cross-sectional pilot survey conducted among 38 PCPs (MDs, DOs, PAs, and NPs) in the Midwestern United States. Self-reported feelings of burnout and musculoskeletal pain in different body regions were analyzed using regression models. Results suggested that increasing number of hours worked per day, severity of pain in the neck / shoulder area, and severity of pain in the right wrist were associated with an increased risk of burnout. On the contrary, burnout decreased with increasing age. The findings suggest that additional research is needed to understand the risk factors for burnout among PCPs, particularly during the early stages of their career.

scholarly journals A pilot study of the functionality and clinician acceptance of a clinical decision support tool to improve primary care of opioid use disorder

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rebecca C. Rossom ◽  
JoAnn M. Sperl-Hillen ◽  
Patrick J. O’Connor ◽  
A. Lauren Crain ◽  
Laurel Nightingale ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Convenience Sample ◽  
Increased Risk

Abstract Objective Most Americans with opioid use disorder (OUD) do not receive indicated medical care. A clinical decision support (CDS) tool for primary care providers (PCPs) could address this treatment gap. Our primary objective was to build OUD-CDS tool and demonstrate its functionality and accuracy. Secondary objectives were to achieve high use and approval rates and improve PCP confidence in diagnosing and treating OUD. Methods A convenience sample of 55 PCPs participated. Buprenorphine-waivered PCPs (n = 8) were assigned to the intervention. Non-waivered PCPs (n = 47) were randomized to intervention (n = 24) or control (n = 23). Intervention PCPs received access to the OUD-CDS, which alerted them to patients at potentially increased risk for OUD or overdose and guided diagnosis and treatment. Control PCPs provided care as usual. Results The OUD-CDS was functional and accurate following extensive multi-phased testing. PCPs used the OUD-CDS in 5% of encounters with at-risk patients, far less than the goal of 60%. OUD screening confidence increased for all intervention PCPs and OUD diagnosis increased for non-waivered intervention PCPs. Most PCPs (65%) would recommend the OUD-CDS and found it helpful with screening for OUD and discussing and prescribing OUD medications. Discussion PCPs generally liked the OUD-CDS, but use rates were low, suggesting the need to modify CDS design, implementation strategies and integration with existing primary care workflows. Conclusion The OUD-CDS tool was functional and accurate, but PCP use rates were low. Despite low use, the OUD-CDS improved confidence in OUD screening, diagnosis and use of buprenorphine. NIH Trial registration NCT03559179. Date of registration: 06/18/2018. URL: https://clinicaltrials.gov/ct2/show/NCT03559179

scholarly journals Implementation of an Electronic Alert for Improving Adherence to Diabetic Foot Exam Screenings in Type 2 Diabetic Patients in Primary Care Clinics

2020 ◽  
Author(s):  
◽  
Ruby Denson
Keyword(s):  
Primary Care ◽  
Diabetic Foot ◽  
Primary Care Providers ◽  
Completion Rate ◽  
Diabetic Patients ◽  
Intervention Implementation ◽  
Care Providers ◽  
Increased Risk ◽  
Provider Adherence

Practice Problem: Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of complications including foot ulcerations (Harris-Hayes et al., 2020). Preventive care is essential for the early detection of foot ulcers but despite the advantages of preventive screening, a limited number of primary care providers perform annual foot exams (Williams et al., 2018). PICOT: The clinical question that guided this project was, “In adult patients with T2DM receiving care in a primary care setting, will the implementation of an electronic clinical reminder alert (ECR) increase provider adherence to performing an annual diabetic foot exam and risk assessment, compared to adherence rate pre alert implementation, in 30 days?” Evidence: Evidence indicates that ECR alerts to remind providers to perform foot exams improve provider adherence to perform annual foot exams. Intervention: An ECR alert was implemented to remind providers to perform an annual diabetic foot exam to increase provide adherence. Outcome: Twenty-three patients had a completion rate of 46% for their annual diabetic foot exam pre intervention implementation and 45 patients had a completion rate of 56.25% post intervention implementation. There was no statistical significance noted but an increase in provider adherence in performing foot exams, which suggests clinically significant outcomes. Conclusion: Annual foot exams and an ECR alert to remind providers to perform foot exams on people with diabetes can help improve health outcomes in diabetic patients.

Living Alone With Cognitive Impairment

2016 ◽  
Vol 32 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Allison K. Gibson ◽  
Virginia E. Richardson
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Primary Care Providers ◽  
Study Data ◽  
Living Alone ◽  
Cognitive Screening ◽  
Care Providers ◽  
Data Set ◽  
Increased Risk ◽  
Study Participants

Although most individuals experiencing cognitive impairment (CI) reside with a caregiver, an estimated 800,000 live alone. Such individuals may have an increased risk for injury to self or others through self-neglect as a result of the CI symptoms. While persons living alone with CI have been identified as an important area for needed research, few studies have been able to examine this population due to the challenges of identifying and recruiting study participants. By using the National Health & Aging Trends Study data set, the researchers explored the characteristics to describe this population. The results of this study indicated that the majority of persons living with CI were older, widowed females who were not diagnosed with Alzheimer’s or dementia but tested positive on cognitive screening measures. Further, the majority of persons living alone with CI relied on adult children and paid professionals as the primary care providers.

scholarly journals A Primary Care Provider’s Guide to Accessibility After Spinal Cord Injury

2020 ◽  
Vol 26 (2) ◽  
pp. 79-84
Author(s):  
Joseph Lee ◽  
Jithin Varghese ◽  
Rose Brooks ◽  
Benjamin J. Turpen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Care Services ◽  
Increased Risk ◽  
Cord Injury

Individuals with spinal cord injury (SCI) continue to have shorter life expectancies, limited ability to receive basic health care, and unmet care needs when compared to the general population. Primary preventive health care services remain underutilized, contributing to an increased risk of secondary complications. Three broad themes have been identified that limit primary care providers (PCPs) in providing good quality care: physical barriers; attitudes, knowledge, and expertise; and systemic barriers. Making significant physical alterations in every primary care clinic is not realistic, but solutions such as seeking out community partnerships that offer accessibility or transportation and scheduling appointments around an individual’s needs can mitigate some access issues. Resources that improve provider and staff disability literacy and communication skills should be emphasized. PCPs should also seek out easily accessible practice tools (SCI-specific toolkit, manuals, modules, quick reference guides, and other educational materials) to address any knowledge gaps. From a systemic perspective, it is important to recognize community SCI resources and develop collaboration between primary, secondary, and tertiary care services that can benefit SCI patients. Providers can address some of these barriers that lead to inequitable health care practices and in turn provide good quality, patient-centered care for such vulnerable groups. This article serves to assist PCPs in identifying the challenges of providing equitable care to SCI individuals.

Analysis of Teledermatology Consults in a County Hospital Setting (Preprint)

2021 ◽  
Author(s):  
Colton Funkhouser ◽  
Martha E Funkhouser ◽  
Jay E Wolverton ◽  
Stephen E Wolverton ◽  
Toby Maurer
Keyword(s):  
Primary Care ◽  
Chart Review ◽  
Hospital Setting ◽  
Primary Care Providers ◽  
County Hospital ◽  
Care Providers ◽  
Seborrheic Keratosis ◽  
Non Melanoma Skin Cancer ◽  
Skin Conditions ◽  
Melanoma Skin

BACKGROUND Teledermatology consults are increasingly used by primary care providers for diagnosis and triage of skin conditions. However, there are few studies that analyze which conditions are most commonly sent for teledermatology consultation and which of those are most often referred for an in-person visit. OBJECTIVE We aim to examine teledermatology consults sent from primary care providers at a county hospital to identify common diagnoses that prompted use of the teledermatology system and determine which diagnoses required an in-person visit after teledermatology evaluation. METHODS A retrospective analysis was conducted based on 450 teledermatology consults from primary care providers at a county health system. Chart review was performed to identify the diagnoses made by the teledermatologist for each consult and which diagnoses prompted an in-person visit after teledermatology evaluation. RESULTS Our analysis captured 471 diagnoses. Seborrheic keratosis was the most frequent diagnosis (10.2%) prompting teledermatology consultation. Some diagnoses, such as non-melanoma skin cancer, actinic keratosis, and alopecia areata required an in-person visit after each teledermatology consult. Others, such as atopic dermatitis and lentigo, did not require an in-person visit and were able to be managed by teledermatology each time. Overall, 39.9% of diagnoses seen via teledermatology were referred for an in-person visit. CONCLUSIONS Teledermatology is valuable in managing many dermatologic conditions that present to primary care, while serving as an effective triage tool for more complex conditions or concern for malignancy. Conditions that required procedural management or involved the scalp also frequently required an in-person referral after TD evaluation. The lowest proportion of referrals for an in-person visit occurred in banal conditions without concern for malignancy.

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