scholarly journals MON-LB105 Resident Obesity Management: Comfort Correlates With Action

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Mita Shah Hoppenfeld ◽  
Nadeem E Abou-Arraj ◽  
Michelle E Hauser
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lifestyle Changes ◽  
Obesity Management ◽  
Lifestyle Counseling ◽  
Treatment Practice ◽  
Primary Care Clinics ◽  
Lifestyle Counselling

Abstract The projected prevalence of obesity in the US is 50% by 2030.1 Little data exists on resident physician obesity management in their primary care clinics.2 We aimed to explore internal medicine (IM) resident comfort, knowledge, and treatment practice of obesity in primary care. IM residents at one academic medical center (N=125), at 5 primary care sites were anonymously surveyed about knowledge, comfort, and practice behaviors around obesity management. In this exploratory analysis, respondents self-reported comfort with lifestyle counselling and weight management medication (WMM) prescription on 4-point Likert scales; scores were combined into an overall Comfort Score (CS). Correlation analysis (Pearson’s correlation) compared CS with the following Clinical Actions: referral to lifestyle specialists, lifestyle counseling, WMM prescription, and bariatric surgery referral. The response rate was 70/125 (56%). Most residents (91%) reported discomfort with prescribing WMMs and most (84%) had never prescribed one. While most residents (81%) were “comfortable” or “somewhat comfortable” with lifestyle counseling, only 33% reported consistently providing it. Of the 31% of residents that correctly identified indications for bariatric surgery, only 9% reported referring patients they considered appropriate for surgery. Notably, a higher CS was significantly correlated with more frequent bariatric surgery referrals (r = 0.29; p = 0.015), lifestyle counselling (r = 0.33; p = 0.004), WMM prescription (r = 0.32; p=0.006), and lifestyle specialist referral (r = 0.25; p = 0.035). Reported barriers to lifestyle counseling were lack of time (93%), poor familiarity with resources (50%), and lack of training in motivational interviewing (36%). Barriers to WMM prescription were unfamiliarity with the medications (84%) and side effect concerns (61%). Finally, 90% desired more training in pharmacotherapy, and 77% wanted more information on referral processes for surgical and medical interventions. Most residents surveyed do not feel adequately prepared to provide evidence-based management of obesity via lifestyle changes counseling, WMM prescription, or specialty care referral. Comfort and knowledge of system processes/resources and WMMs are critical to resident management of obesity. These are potential targets for educational intervention in residency curricula that may improve care for patients with obesity. Citations: 1. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. 2019;381(25):2440-2450. doi:10.1056/NEJMsa19093012. Huang J, Yu H, Marin E, Brock S, Carden D, Davis T. Physicians’ Weight Loss Counseling in Two Public Hospital Primary Care Clinics. Acad Med. 2004. doi:10.1097/00001888-200402000-00012

Predictors of Primary Care Referral to Bariatric Surgery or Weight Loss Medicine at a Major Academic Medical Center

2020 ◽  
Vol 231 (4) ◽  
pp. S27-S28
Author(s):  
Jacob Nudel ◽  
Susanna W.L. de Geus ◽  
Jayakanth Srinivasan ◽  
Jonathan Woodson ◽  
Donald Thomas Hess
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Weight Loss ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

scholarly journals Evaluation of an Education Strategy versus Usual Care to Implement the STEADI Algorithm in Primary Care Clinics in an Academic Medical Center

2020 ◽  
Vol Volume 15 ◽  
pp. 1059-1066
Author(s):  
Kelly Urban ◽  
Patricia B Wright ◽  
Amy L Hester ◽  
Geoffrey Curran ◽  
Martha Rojo ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinics ◽  
Academic Medical ◽  
Education Strategy ◽  
Strategy Versus

scholarly journals Racial Differences in Alzheimer’s Disease Specialist Encounters are Associated with Usage of Molecular Imaging and Dementia Medications: An Enterprise-Wide Analysis Using i2b2

2020 ◽  
pp. 1-15
Author(s):  
Charles F. Murchison ◽  
Richard E. Kennedy ◽  
Jonathan E. McConathy ◽  
Erik D. Roberson
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
African Americans ◽  
Racial Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinics ◽  
Academic Medical ◽  
Increased Risk

Background: African Americans are at increased risk for Alzheimer’s disease (AD) but barriers to optimal clinical care are unclear. Objective: To comprehensively evaluate potential racial differences in the diagnosis and treatment of AD in an academic medical center. Methods: We used the clinical informatics tool, i2b2, to analyze all patient encounters for AD or mild cognitive impairment (MCI) in the University of Alabama at Birmingham Health System over a three-year period, examining neuroimaging rates and dementia-related medication use by race and clinic site using ratio tests on contingency tables of stratified patient counts. Results: Enterprise-wide, African Americans were not underrepresented among outpatients seen for AD/MCI. However, there were differences in the clinic setting where visits occurred, with African Americans overrepresented in Geriatrics and primary care clinics and underrepresented in Memory Disorders specialty clinics. There were no racial differences in the rates at which any clinic ordered PET neuroimaging tests or dementia-related medications. However, unsurprisingly, specialty clinics ordered both PET neuroimaging and dementia-related medications at a higher rate than primary care clinics, and overall across the medical enterprise, African Americans were statistically less likely to have PET neuroimaging or dementia-related medications ordered. Conclusion: African Americans with AD/MCI were not underrepresented at this academic medical center but were somewhat less likely to have PET neuroimaging or to be on dementia-related medications, potentially in part from underrepresentation in the specialty clinics where these orders are more likely. The reasons for this underrepresentation in specialty clinics are likely multifactorial and important to better understand.

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 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 >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.

Primary Care Population Management for COVID-19 Patients

2020 ◽  
Author(s):  
MD Deborah Blazey-Martin ◽  
FNP Elizabeth Barnhart ◽  
Joseph Gillis ◽  
Gabriela Andujar Vazquez
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Physician Assistants ◽  
Population Management ◽  
Severe Illness ◽  
Management Approach ◽  
Primary Care Population ◽  
At Home

Abstract BACKGROUND: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill.AIM: We developed an innovative population management approach for managing COVID-19 patients remotely.SETTING: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice.PARTICIPANTS: Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses.PROGRAM DESCRIPTION: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely.PROGRAM EVALUATION: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged.DISCUSSION: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion.

scholarly journals Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center

2020 ◽  
Vol 173 (7) ◽  
pp. 527-535
Author(s):  
Malathi Srinivasan ◽  
Steven Asch ◽  
Stacie Vilendrer ◽  
Samuel Crandall Thomas ◽  
Rika Bajra ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Qualitative Assessment ◽  
System Transformation ◽  
Academic Medical

scholarly journals Depression Screening and Measurement-Based Care in Primary Care

2020 ◽  
Vol 11 ◽  
pp. 215013272093126
Author(s):  
Kimberly A. Siniscalchi ◽  
Marion E. Broome ◽  
Jason Fish ◽  
Joseph Ventimiglia ◽  
Julie Thompson ◽  
...  
Keyword(s):  
Primary Care ◽  
Task Force ◽  
Medical Center ◽  
Academic Medical Center ◽  
Unmet Need ◽  
The United States ◽  
Depression Screening ◽  
Improvement Project ◽  
Measurement Based Care

The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.

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