Inpatient infusion treatments of headache in patients with chronic migraine and a reported history of head trauma and endocrine co-morbidities

ObjectiveTo evaluate if inpatient infusion treatments for patients with chronic migraine (CM) and history of head trauma and endocrine abnormalities can lead to headache improvement.BackgroundMany patients with CM and history of head trauma have endocrine co-morbidities that can interfere with successful management of headache. In this study, we evaluated if inpatient infusion treatments improved headache outcomes for this patient population.Design/MethodsRetrospective chart review of patients admitted and treated with 4–5 days of intravenous (IV) Dihydroergotamine (DHE), Chlorpromazine, or Valproate for headache. All cases were presented at the Headache Center Case Conference before admission, and plans for addressing co-morbidities were discussed with appropriate specialists and primary care providers. Co-morbidities addressed included diabetes mellitus, pituitary and thyroid dysfunction and endometriosis. During admission, vital signs and appropriate lab work such as serum glucose, thyroid, liver and renal function were monitored. Lifestyle recommendations provided during admission and appropriate follow ups after discharge were arranged with Headache Clinic, primary care, and specialists, when applicable.Results53 patients with CM were included in the analysis. 12 (22.6%) of the 53 patients had both reported history of head trauma and endocrine comorbidity. Of these 12 patients, 8 (66.7%) had improvement in headache up to 6 weeks after admission. Of the 8 that improved, 6 (75%) received DHE and 2 (25%) received Chlorpromazine.ConclusionsInpatient infusion treatments for patients who have CM with history of head trauma and endocrine abnormalities can lead to headache improvement, potentially due to IV infusion therapy along with holistic approaches which include addressing co-morbidities and education on lifestyle modifications. Future studies are needed to evaluate if specific endocrine system dysfunction can predict outcomes from repetitive infusion therapy for persistent headache in patients with CM and a reported history of head trauma.

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1109. Factors Impacting the Decision to Order Stool Diagnostic Testing in Patients With Acute Gastroenteritis Among Primary Care Providers

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.943 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S332-S333

Author(s):

Sean O’Leary ◽

Mandy Allison ◽

Cristina V Cardemil ◽

Laura Hurley ◽

Lori Crane ◽

...

Keyword(s):

Primary Care ◽

Acute Gastroenteritis ◽

Pathogen Detection ◽

Immunocompromised Patient ◽

Diagnostic Testing ◽

Primary Care Providers ◽

Care Providers ◽

Risk Area ◽

High Risk Area ◽

History Of

Abstract Background Diagnostic options for stool pathogens are evolving and expanding rapidly. The majority of acute gastroenteritis (AGE) patients seeking medical care are seen by primary care providers (PCPs), and stool testing may not be performed as AGE is generally self-limited. Little is known about how PCPs decide for which patients to order testing. Our objective was to describe among PCPs factors affecting the decision of whether to order stool diagnostic testing for pathogen detection in patients with AGE symptoms in the outpatient setting. Methods A national survey was conducted from January to March 2018 among primary care pediatricians (Peds), family physicians (FP), and internists (GIM). Results The response rate was 50% (689/1,383; Peds 59% [275/466], FP 49% [226/461], GIM 41% [188/456]). Factors most often reported as greatly increasing the likelihood of testing that did not differ significantly between specialties included patient history of travel to a high-risk area (75% Peds, 71% FP, 72% GIM), immunocompromised patient (Peds 67%, FP 60%, GIM 69%), and clinical suspicion of a pathogen that can be treated with antibiotics or antiparasitics (Peds 63%, FP 56%, GIM 65%). Factors with significant differences between specialties that were most often reported as greatly increasing likelihood of testing included presence of blood in stool (Peds 76%, FP 58%, GIM 48%, P < 0.0001), history of recent antibiotic use (Peds 31%, FP 66%, GIM 72%, P < 0.0001), history of recent hospitalization (Peds 29%, FP 61%, GIM 64%, P < 0.0001), consideration of inpatient admission (Peds 36%, FP 57%, GIM 56%, P < 0.0001), and fever ≥38.5 C (Peds 13%, FP 27%, GIM 40%, P < 0.0001). Factors most often reported as greatly decreasing the likelihood of testing included presence of vomiting without diarrhea (Peds 49%, FP 43%, GIM 50%) and presence of vomiting and diarrhea together (Peds 12%, FP 7%, GIM 9%). Conclusion Physicians rely on a variety of factors when considering diagnostic testing for stool pathogens in AGE, with recent travel, caring for an immunocompromised patient, and antibiotic/antiparasitic treatment decisions often reported as increasing the likelihood of testing. Consideration of the clinical presentation and most common AGE pathogens by age group may be driving some of the differences between specialties. Disclosures All authors: No reported disclosures.

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Characteristics of men and women with diabetes

10.32920/ryerson.14637141 ◽

2021 ◽

Author(s):

Enza Gucciardi ◽

Shirley Chi-Tyan Wang ◽

Lisa Amaral ◽

Donna E. Stewart

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Diabetes Education ◽

Primary Care Providers ◽

Self Management ◽

Care Providers ◽

Family History Of Diabetes ◽

Men And Women ◽

History Of

OBJECTIVE To determine whether men and women with type 2 diabetes have different psychosocial, behavioural, and clinical characteristics at the time of their first visit to a diabetes education centre. DESIGN A questionnaire on psychosocial and behavioural characteristics was administered at participants’ first appointments. Clinical and disease-related data were collected from their medical records. Bivariate analyses (χ2 test, t test, and Mann-Whitney test) were conducted to examine differences between men and women on the various characteristics. SETTING Two diabetes education centres in the greater Toronto area in Ontario. PARTICIPANTS A total of 275 men and women with type 2 diabetes. RESULTS Women were more likely to have a family history of diabetes, previous diabetes education, and higher expectations of the benefits of self-management. Women reported higher levels of social support from their diabetes health care team than men did, and had more depressive symptoms, higher body mass, and higher levels of high-density lipoprotein cholesterol than men did. CONCLUSION The results of this study provide evidence that diabetes prevention, care, and education need to be targeted to men and women differently. Primary care providers should encourage men to attend diabetes self-management education sessions and emphasize the benefits of self-care. Primary care providers should promote regular diabetes screening and primary prevention to women, particularly women with a family history of diabetes or a high body mass index; emphasize the importance of weight management for those with and without diabetes; and screen diabetic women for depressive symptoms.

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Characteristics of men and women with diabetes

10.32920/ryerson.14637141.v1 ◽

2021 ◽

Author(s):

Enza Gucciardi ◽

Shirley Chi-Tyan Wang ◽

Lisa Amaral ◽

Donna E. Stewart

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Diabetes Education ◽

Primary Care Providers ◽

Self Management ◽

Care Providers ◽

Family History Of Diabetes ◽

Men And Women ◽

History Of

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Primary Care Provider Perceptions of Pharmacist Services in an Urban, Safety Net Health System

Journal of Pharmacy Practice ◽

10.1177/0897190019838422 ◽

2019 ◽

Vol 33 (6) ◽

pp. 790-798

Author(s):

Anusha McNamara ◽

Lenny L. S. Chan ◽

Shirley L. Wong

Keyword(s):

Primary Care ◽

Patient Care ◽

Medication Management ◽

Primary Care Providers ◽

Safety Net ◽

Direct Patient Care ◽

Case Conference ◽

Pharmacy Services ◽

Care Providers ◽

Pharmacist Services

While pharmacists have provided services in a multidisciplinary, primary care setting for decades, few publications have yet to evaluate providers’ impressions of- these services. An anonymous 14-item survey distributed to nonresident primary care providers aimed to identify clinical pharmacist services that are most and least helpful to primary care providers, identify barriers to pharmacy services, and develop recommendations to improve pharmacy services in primary care. The most important pharmacist contribution identified by providers is medication management, whereas the least important contributions are case conference, panel management, quality improvement, and transition of care. The primary reasons for referrals to pharmacists included inadequately controlled chronic diseases, poor or questionable adherence, longer visits for more in-depth discussion, and complex regimen requiring frequent monitoring or titration. Providers favored pharmacists working in direct patient care versus indirect patient care activities. Although many providers perceived no barriers to pharmacist service access, pharmacists’ presence and visibility were 2 barriers identified. Most providers preferred comprehensive to disease-specific medication management.

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Management Landscape of Pediatric Hidradenitis Suppurativa

Skin Appendage Disorders ◽

10.1159/000519135 ◽

2021 ◽

pp. 1-4

Author(s):

Justine R. Seivright ◽

Erin Collier ◽

Tristan Grogan ◽

Terri Shih ◽

Marcia Hogeling ◽

...

Keyword(s):

Primary Care ◽

Hidradenitis Suppurativa ◽

Chart Review ◽

Age Of Onset ◽

Severe Disease ◽

Retrospective Chart Review ◽

Primary Care Providers ◽

Care Providers ◽

Delay In Diagnosis ◽

Mean Delay

Introduction: Pediatric hidradenitis suppurativa (HS) is an understudied condition, and the literature describing the provider landscape for this disease is limited. We aim to characterize healthcare utilization in a cohort of pediatric HS patients at an academic institution. Methods: Patients diagnosed with HS before age 18 were identified via retrospective chart review using ICD-9/10 codes for HS. Data on demographics and HS providers were collected. Results: We found that half of the pediatric HS patients first presented to primary care with their HS symptoms. There was a mean delay in diagnosis of 2 years. Dermatologists and pediatricians were the principal HS care providers, and dermatologists most frequently prescribed treatment or procedures (63%). We also found a low rate of utilization of the HS specialty clinic (11%). Females, patients with more severe disease, and patients with earlier age of onset were more likely to be seen by a dermatologist. Conclusions: Dermatologists play a pivotal role in pediatric HS management as principal care providers for patients. Increasing HS awareness among primary care providers, including pediatricians, is critical for early diagnosis and initiation of treatment.

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Evaluation of provider response to positive depression screenings and physician attitudes on integrating psychiatric pharmacist services in primary care settings

Mental Health Clinician ◽

10.9740/mhc.2018.01.028 ◽

2018 ◽

Vol 8 (1) ◽

pp. 28-32 ◽

Cited By ~ 2

Author(s):

Brittany H. Denson ◽

Rory E. Kim

Keyword(s):

Primary Care ◽

Los Angeles ◽

Suicide Ideation ◽

Retrospective Chart Review ◽

Primary Care Providers ◽

Physician Attitudes ◽

Care Providers ◽

Primary Care Clinics ◽

Primary Care Settings ◽

Provider Survey

Abstract Introduction: The aim of this study was to identify potential gaps in the management of depression and assess the perceptions of primary care providers (PCPs) toward integrating psychiatric pharmacists into primary care settings. Method: This was a retrospective chart review of patients ≥18 years of age seen in primary care clinics in Los Angeles County with a documented annual health screening (AHS) between January 1, 2015, through December 31, 2015. Primary outcomes were number and percentage of patients screened for depression with patient health questionnaire (PHQ) assessments, positive depression screenings, and interventions made for positive depression screenings. Secondary outcomes were PCPs' perceptions on management of depression, use of AHS, and roles for psychiatric pharmacists through evaluation of provider survey. Results: Of the patients who received an AHS (n = 6797), 63% received PHQ assessments. Of 145 individuals with a positive PHQ-2, 69% had a positive PHQ-9. Greater than 50% of individuals with a positive PHQ-9 had no preexisting depression diagnosis. Seventy-six percent of individuals with a positive PHQ-9 and 78% with reported suicide ideation had no documented intervention. The majority of providers reported there is a role for psychiatric pharmacists in primary care. Discussion: Gaps in the management of depression were identified. Although depression screenings were performed for the majority of individuals receiving an AHS, no documented interventions were made for most of those individuals who screened positive for depression. Primary care clinics could benefit from psychiatric pharmacist involvement in depression screening and follow-up processes.

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

Crisis ◽

10.1027/0227-5910/a000511 ◽

2018 ◽

Vol 39 (5) ◽

pp. 397-405 ◽

Cited By ~ 3

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.

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