Influence of patient characteristics on provider surveillance for colorectal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10071-10071
Author(s):  
Joanna M. Brell ◽  
Debora S. Bruno ◽  
Steven A Lewis ◽  
John Daryl Thornton
Keyword(s):  
Colorectal Cancer ◽  
Primary Care Providers ◽  
Safety Net ◽  
Categorical Variables ◽  
First Year ◽  
Care Providers ◽  
Specific Patient ◽  
Care Plans ◽  
Safety Net Hospital ◽  
The Impact

10071 Background: The majority of colorectal cancer (CRC) patients present with resectable disease and benefit from future resection of second primary CRC, local recurrence, and oligometastases. Therefore, in addition to colonoscopy one year after diagnosis, American Society of Clinical Oncology (ASCO) offers consensus recommendations to monitor serum CEA and CT scans for early detection. Limited adherence to guidelines has been reported; we explore the impact of specific patient factors related to CRC on provider prescribing in the first year. Methods: At a single urban safety-net hospital, electronic medical records of patients diagnosed with stages I-III CRC from 2002-2014 were reviewed with IRB approval. Chi-square tests determined extent of associations between categorical variables. Two sample t-tests compared means for continuous outcomes across groups. Cut-off for Type 1 error was alpha = 0.05. Due to minimal change in surveillance guidelines, we applied ASCO 2005 recommendations. Results: Records for 357 patients included 52% females and 40% African-Americans. Median age was 63 years, ever tobacco abuse was 69%. BMI > 30 found in 38%, median weight at diagnosis was 79 kg. Incidence of surveillance and associated variables are in the Table. Conclusions: The providers of this young, urban, almost 40% obese population were < 50% compliant with first year colonoscopy and < 60% compliant with CEA tests. Providers did significantly survey patients with co-morbidities, such as higher weight at diagnosis, in this small study. Most patients complied with orders and primary care providers were least compliant (data not shown). The data supports verification in larger study of safety-net hospitals and future comparison regarding influence of new Survivorship Care Plans on guideline adherence. To improve provider compliance, etiology of nonadherence must be addressed. [Table: see text]

scholarly journals A Primary Care Intervention to Increase HIV Pre-Exposure Prophylaxis (PrEP) Uptake in Patients with Syphilis

2022 ◽  
Vol 21 ◽  
pp. 232595822110733
Author(s):  
Ryan Bonner ◽  
Jessica Stewart ◽  
Ashish Upadhyay ◽  
R. Douglas Bruce ◽  
Jessica L. Taylor
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Safety Net ◽  
Care Practice ◽  
Care Providers ◽  
Entire Study ◽  
Safety Net Hospital ◽  
Syphilis Treatment ◽  
Exposure Prophylaxis ◽  
The Impact

Identifying candidates for HIV pre-exposure prophylaxis (PrEP) is a barrier to improving PrEP uptake in priority populations. Syphilis infection is an indication for PrEP in all individuals and can be easily assessed by primary care providers (PCP) and health systems. This retrospective study evaluated the impact of a multidisciplinary provider outreach intervention on PrEP uptake in patients with a positive syphilis test result in a safety-net hospital-based primary care practice. The PCPs of PrEP-eligible patients with a positive syphilis result were notified via the electronic medical record (EMR) about potential PrEP eligibility and institutional HIV PrEP resources. Rates of PrEP offers and prescriptions were compared in the pre (8/1/2018-12/31/2018, n = 60) and post (1/1/2019-5/31/2019, n = 86) intervention periods. Secondary analyzes evaluated receipt of appropriate syphilis treatment and contemporaneous screening for HIV, gonorrhea, and chlamydia. No significant differences in the overall proportion of patients offered (15% vs 19%) and prescribed (7% vs 5%) PrEP were observed between the pre- and post-periods. Overall, 7% of positive tests represented infectious syphilis. The rate of appropriate syphilis treatment was equivalent (57% vs 56%) and contemporaneous screening for other sexually transmitted infections was suboptimal across the entire study period. Although any positive syphilis test may be an easily abstracted metric from the EMR, this approach was inclusive of many patients without current HIV risk and did not increase PrEP uptake significantly. Future research into population health approaches to increase HIV prevention should focus on patients with infectious syphilis and other current risk factors for incident HIV infection.

Addressing the opioid crisis: An assessment of clinicians’ training experience, practices, and attitudes within a large healthcare organization

2019 ◽  
Vol 15 (3) ◽  
pp. 193-204 ◽  
Author(s):  
Harshal Kirane, MD ◽  
Elina Drits, DO ◽  
Seungjun Ahn, MS ◽  
Sandeep Kapoor, MD ◽  
Jonathan Morgenstern, PhD ◽  
...  
Keyword(s):  
Pain Management ◽  
Healthcare System ◽  
Guideline Implementation ◽  
Primary Care Providers ◽  
Healthcare Organization ◽  
Categorical Variables ◽  
Care Providers ◽  
Additional Support ◽  
Addiction Care ◽  
The Impact

Objective: To assess provider practices and attitudes toward addiction care and pain management within a large healthcare system, as well as to determine the impact of prior training and perceived effectiveness of organizational implementation strategies. Design: A cross-sectional study.Setting: Large healthcare organization comprising 21 hospitals.Participants: Three hundred and thirteen healthcare providers within a large healthcare organization.Main outcome measures: Training, practices, and attitudes toward opioid-related care.Methods: One thousand providers including physicians (MD/DO) and physician extenders (NP/PA) were contacted via email request. The Mann-Whitney test or Fisher’s exact test, as appropriate, was used for comparisons of continuous and categorical variables, respectively.Results: Providers lacked prior pain management (36 percent), addiction (38 percent), or buprenorphine training (92 percent). Few providers were confident in treating opioid use disorders (OUD) (19 percent) and opioid tapering (24 percent) but interested in safe prescribing practices (81 percent). While most providers preferred to refer patients for OUD (89 percent), only a small portion felt appropriate services were readily available (22 percent). Trained providers appear significantly more engaged in checking Prescription Drug Monitoring Program database [median = 1 (Q1 = 1, Q3 = 2) vs 2(1, 3); p 0.001], comfortable obtaining urine drug screens [2(2, 3) vs 3(2, 4); p 0.002], and willing to treat OUD with additional support [3(2, 4) vs 4(3, 4); p 0.022] compared to non-trained providers. Primary care providers were more likely to view OUDs in their scope of practice [4(2, 5) vs 4(3, 5); p 0.016] and willing to treat OUD with additional support [3(2, 3) vs 3(2, 4); p 0.0007] compared to specialists. Buprenorphine providers appear to have more confidence in skills for OUD [2(1, 3) vs 4(3, 4); p 0.0001] and tapering [2(1, 2) vs 4(3, 5); p 0.0001], and diminished preference to refer [2(1, 5) vs 1(1, 2); p 0.0009] compared to non-buprenorphine providers.Conclusions: Providers within a large healthcare system lack training and confidence in management of opioid-related care. Buprenorphine training positively modified key attitudes toward addiction care, yet engagement in medication-assisted treatment remains limited. Providers are concerned about opioid risks, and view guideline implementation and direct input from addiction specialists as effective organizational strategies. Further research is needed to clarify the efficacy of such approaches.

scholarly journals Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices

2020 ◽  
Vol 17 (6) ◽  
pp. 2154 ◽  
Author(s):  
Sung Eun Choi ◽  
Lisa Simon ◽  
Jane R. Barrow ◽  
Nathan Palmer ◽  
Sanjay Basu ◽  
...  
Keyword(s):  
Primary Care ◽  
Dental Care ◽  
Primary Care Providers ◽  
Care Practice ◽  
First Year ◽  
Dental Practice ◽  
Care Providers ◽  
Net Revenue ◽  
Publicly Insured ◽  
The Impact

Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were −$92,053 (95% CI: −93,054, −91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.

Prevalence of metabolic syndrome in older (50 years and older) vs younger (less than 50 years) patients with colorectal cancer diagnosed in a safety net hospital system.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 512-512
Author(s):  
Ashish Sharma ◽  
Johanna Chan ◽  
Tony Trang ◽  
Milena Gould Suarez
Keyword(s):  
Colorectal Cancer ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Older Patients ◽  
Safety Net ◽  
Categorical Variables ◽  
Hospital System ◽  
Younger Patients ◽  
Hospital District ◽  
Safety Net Hospital

512 Background: Colorectal cancer (CRC) incidence has declined overall with screening, though incidence in patients younger than 50 years has increased. Younger patients present with more aggressive and advanced stage CRC. Potential mechanisms are sporadic, genetics, and environmental (alcohol, smoking, metabolic syndrome). Metabolic syndrome (MetS) is an established risk factor for CRC. We examined the prevalence of MetS in younger patients ( < 50 yrs) compared with older patients ( ≥ 50 yrs) with CRC in a safety net hospital population. Methods: IRB-approved retrospective chart review of all patients diagnosed with CRC in the Harris County Hospital District cancer registry from Jan 2008 to Dec 2013. Data was collected for patient characteristics and metabolic syndrome to compare 2 patient groups: < 50 yr (younger) and ≥ 50 yr (older). MetS was defined using 2005 AHA/NHLBI criteria as ≥ 3 of the following components: abdominal obesity (waist circumference > 102 cm in men, > 88 cm in women), serum triglycerides (TG) ( > 150 mg/dL), serum HDL ( < 40 mg/dL in men and < 50 mg/dL in women), BP > 130/85 mmHg, fasting glucose/diabetes ( ≥ 100 mg/dL). Per WHO criteria, BMI > 30 was used as surrogate for waist circumference. Descriptive statistics were performed using t-test for continuous variables and Chi-square / Fisher’s exact test for categorical variables. Results: 625 cases of CRC diagnosed showed median age of 56.5 years and 54.7% female patients. The majority (77.76%) of cases occurred in the older group. Overall, 208/625 patients (33.28%) had MetS. Average BMI overall was 27.33. Prevalence of MetS was 38.27% vs 23% (older vs younger; p = 0.0001). In older compared with younger patients, average BMI 26.13 vs 25.05 (p = 0.02), obesity 25.92% vs 35.87% (p = 0.05), BP > 130/85 mmHg 56.3% vs 31.6% (p = 0.001), low HDL 41.7% vs 31.9% (p = 0.02), TG > 150 34.7 % vs 22.3 % (p = 0.02) and diabetes 36.2% vs 11.5% (p = 0.001). Conclusions: Overall prevalence of MetS in our patient cohort was similar to that of general population (which approximates 34%). Prevalence of MetS was higher in older patients with CRC than in younger patients, though this may reflect the natural history of MetS.

Survivorship care plans for colorectal cancer survivors: What do primary care providers want and need?

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 9131-9131 ◽  
Author(s):  
T. Salz ◽  
K. C. Oeffinger ◽  
P. R. Lewis ◽  
R. Rhyne ◽  
R. L. Williams ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans ◽  
Colorectal Cancer Survivors

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

scholarly journals Impact of insurance status on overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Ravi J. Chokshi ◽  
Jin K. Kim ◽  
Jimmy Patel ◽  
Joseph B. Oliver ◽  
Omar Mahmoud
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Abdominal Wall ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Safety Net ◽  
Insurance Status ◽  
Gynecologic Malignancies ◽  
Safety Net Hospital ◽  
The Impact

AbstractObjectivesThe impact of insurance status on oncological outcome in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is poorly understood.MethodsRetrospective study on 31 patients having undergone 36 CRS-HIPEC at a single institution (safety-net hospital) between 2012 and 2018. Patients were categorized as insured or underinsured. Demographics and perioperative events were compared. Primary outcome was overall survival (OS).ResultsA total of 20 patients were underinsured and 11 were insured. There were less gynecologic malignancies in the underinsured (p=0.02). On univariate analysis, factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01). Treatment with neoadjuvant chemotherapy and abdominal wall resections, but not insurance status, were independently associated with OS (p=0.01, p=0.02 respectively). However, at the end of follow-up, six patients were alive in the insured group vs. zero in the underinsured group.ConclusionsIn this small, exploratory study, there was no statistical difference in OS between insured and underinsured patients after CRS-HIPEC. However, long-term survivors were observed only in the insured group.

The Impact of Primary Care Providers’ Bias on Depression Screening for Lesbian Women

2021 ◽  
pp. 152483992110660
Author(s):  
Shuying Sha ◽  
Mollie Aleshire
Keyword(s):  
Primary Care ◽  
Statistical Tests ◽  
Secondary Analysis ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Lesbian Women ◽  
Care Providers ◽  
Explicit Bias ◽  
Implicit And Explicit ◽  
The Impact

Primary care providers’ (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs’ implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs’ implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs ( n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women ( p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers’ awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

scholarly journals The attitudes of primary care providers towards screening for colorectal cancer

2013 ◽  
Vol 105 (5) ◽  
pp. 272-278 ◽  
Author(s):  
Jesús López-Torres Hidalgo ◽  
M.ª José Simarro-Herráez ◽  
Joseba Rabanales-Sotos ◽  
Ramona Campos-Rosa ◽  
Belén de la-Ossa-Sendra ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers

scholarly journals A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

2021 ◽  
Vol 53 (10) ◽  
pp. 843-856
Author(s):  
Constance Gundacker ◽  
Tyler W. Barreto ◽  
Julie P. Phillips
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Health Outcomes ◽  
Primary Care Providers ◽  
The United States ◽  
Traumatic Experiences ◽  
Search Term ◽  
Care Providers ◽  
Trauma Informed ◽  
The Impact

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

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