Fever in Pediatric Primary Care: Occurrence, Management, and Outcomes

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_2) ◽  
pp. 260-266
Author(s):  
Jonathan A. Finkelstein ◽  
Cindy L. Christiansen ◽  
Richard Platt
Keyword(s):  
Primary Care ◽  
Laboratory Testing ◽  
Office Visit ◽  
Pediatric Primary Care ◽  
Care Practice ◽  
Meningococcal Sepsis ◽  
Office Visits ◽  
Health Maintenance ◽  
Entire Cohort

Objective. To describe the epidemiology, management, and outcomes of children with fever in pediatric primary care practice. Patients. A cohort of 20 585 children 3 to 36 months of age cared for in 11 pediatric offices of a health maintenance organization between 1991 and 1994. Methods. Using automated medical records we identified all office visits with temperatures ≥38°C for a random sample of 5000 children, and analyzed diagnoses conferred, laboratory tests performed, and antibiotics prescribed. We also determined the frequency of in-person and telephone follow-up after initial visits for fever. Finally, we reviewed hospital claims data for the entire cohort of 20 585 to identify cases of meningitis, meningococcal sepsis, and death from infection. Results. Among 3819 initial visits of an illness episode, 41% of children had no diagnosed bacterial or specific viral source. Of these, 13% with a temperature of 38°C to 39°C and 36% with a temperature of ≥39°C received laboratory testing. Almost half (43%) received some documented follow-up care in the subsequent 7 days. Among the 26 970 child-years of observation in the entire cohort, 15 children (56 per 100 000 child-years) were treated for bacterial meningitis or meningococcal sepsis. Five had an office visit for fever in the week before hospitalization, but only 1 had documented fever ≥39°C and received neither laboratory testing for occult bacteremia nor treatment with an antibiotic. Conclusion. The majority of febrile children in ambulatory settings were diagnosed with a bacterial infection and treated with an antibiotic. Of highly febrile children without a source, 36% received laboratory testing consistent with published expert recommendations, and short-term follow-up was common. Meningitis or death after an office visit for fever without a source was predictably rare. These data suggest that increased testing and/or treatment of febrile children beyond the rates observed here are unlikely to affect population rates of meningitis substantially.

Depression Screening in a Primary Care Practice in Oregon

2013 ◽  
Vol 6 (1) ◽  
pp. 13-18
Author(s):  
Caron L. Strong
Keyword(s):  
Primary Care ◽  
Screening Tool ◽  
Task Force ◽  
Pilot Project ◽  
Routine Screening ◽  
Depression Screening ◽  
Care Practice ◽  
Improvement Project ◽  
Health Maintenance

Depression is a serious and common mental illness in primary care. Regardless of the improvements in depression management, depression in many patients is still unrecognized. Routine screening for depression among adults in primary care is recommended by the U.S Preventive Service Task Force, as long as healthcare organizations are equipped with staff-assisted depression support systems. The purpose of this dissemination pilot project was to evaluate the routine use of the PHQ-9, a depression screening tool, among adult patients presenting for annual health maintenance examinations. Additionally, increasing follow-up visits among patients with positive depression screens was also investigated. The three-week practice quality improvement project was successful in implementing a routine depression screening policy. Among patients scheduled for their annual health maintenance examination, 94% were screened for depression. All patients who self-identified as at risk for depression were screened with the PHQ-9. Among patients with positive screens, the majority were invited for follow-up care during the study. As a result of the pilot, this clinic now exclusively uses the PHQ-9 depression screening tool. Furthermore, they modified their annual health maintenance examination policy to include routine screening for depression.

Development and implementation of a culturally tailored early childhood program in an integrated pediatric primary care practice.

2020 ◽  
Vol 8 (3) ◽  
pp. 288-297
Author(s):  
Tyanna C. Snider ◽  
Whitney J. Raglin Bignall ◽  
Cody A. Hostutler ◽  
Ariana C. Hoet ◽  
Bethany L. Walker ◽  
...  
Keyword(s):  
Primary Care ◽  
Early Childhood ◽  
Primary Care Practice ◽  
Pediatric Primary Care ◽  
Care Practice ◽  
Early Childhood Program ◽  
Culturally Tailored ◽  
Childhood Program

scholarly journals IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Maureen E Barrientos ◽  
Anna Chodos ◽  
Alicia Neumann ◽  
Yvonne Troya ◽  
Pei Chen
Keyword(s):  
Primary Care ◽  
Social Work ◽  
Advance Care Planning ◽  
Health Resources ◽  
The United States ◽  
Care Practice ◽  
Care Planning ◽  
Office Visits ◽  
Advance Care ◽  
Telephone Calls

Abstract Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.

Follow-up of 100 dogs with acute diarrhoea in a primary care practice

2014 ◽  
Vol 199 (1) ◽  
pp. 188-190 ◽  
Author(s):  
C.M. Berset-Istratescu ◽  
O.J. Glardon ◽  
I. Magouras ◽  
C.F. Frey ◽  
S. Gobeli ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Acute Diarrhoea ◽  
Care Practice

scholarly journals Users’ experiences of a pragmatic diabetes prevention intervention implemented in primary care: qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028491 ◽  
Author(s):  
Navneet Aujla ◽  
Thomas Yates ◽  
Helen Dallosso ◽  
Joe Kai
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Diabetes Prevention ◽  
Resource Constraints ◽  
Diabetes Risk ◽  
Care Practice ◽  
Behavioural Intervention ◽  
Specific Information ◽  
Prevention Intervention

ObjectivesTo explore service-user and provider experience of the acceptability and value of the Let’s Prevent Diabetes programme, a pragmatic 6-hour behavioural intervention using structured group education, introduced into primary care practice.DesignQualitative interview-based study with thematic analysis.SettingPrimary care and community.ParticipantsPurposeful sample of 32 participants, including 22 people at high risk of diabetes who either attended, defaulted from or declined the intervention; and 10 stakeholder professionals involved in implementation.ResultsParticipants had low prior awareness of their elevated risk and were often surprised to be offered intervention. Attenders were commonly older, white, retired and motivated to promote their health; who found their session helpful, particularly for social interaction, raising dietary awareness, and convenience of community location. However attenders highlighted lack of depth, repetition within and length of session, difficulty meeting culturally diverse needs and no follow-up as negative features. Those who defaulted from, or who declined the intervention were notably apprehensive, uncertain or unconvinced about whether they were at risk of diabetes; sought more specific information about the intervention, and were deterred by its group nature and day-long duration, with competing work or family commitments. Local providers recognised inadequate communication of diabetes risk to patients. They highlighted significant challenges for implementation, including resource constraints, and facilitation at individual general practice or locality level.ConclusionsThis pragmatic diabetes prevention intervention was acceptable in practice, particularly for older, white, retired and health-motivated people. However, pre-intervention information and communication of diabetes risk should be improved to increase engagement and reduce potential fear or uncertainty, with closer integration of services, and more appropriate care pathways, to facilitate uptake and follow-up. Further development of this, or other interventions, is needed to enable wider, and more socially diverse, engagement of people at risk. Balancing a locality and individual practice approach, and how this is resourced are considerations for long-term sustainability.

Identification of Overweight Status Is Associated With Higher Rates of Screening for Comorbidities of Overweight in Pediatric Primary Care Practice

PEDIATRICS ◽  
2007 ◽  
Vol 119 (1) ◽  
pp. e148-e155 ◽  
Author(s):  
K. J. Dilley ◽  
L. A. Martin ◽  
C. Sullivan ◽  
R. Seshadri ◽  
H. J. Binns ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Pediatric Primary Care ◽  
Care Practice ◽  
Overweight Status

scholarly journals Testing times ahead? An exploration of laboratory use in Primary Care

2015 ◽  
pp. 37-41
Author(s):  
Sharon Louise Cadogan
Keyword(s):  
Primary Care ◽  
Health Service ◽  
Laboratory Testing ◽  
Primary Care Practice ◽  
Care Practice ◽  
Small Hospital ◽  
Health Service Executive ◽  
Medical Activity ◽  
Improve Efficiency ◽  
Laboratory Services

Healthcare budgets worldwide are facing increasing pressure to reduce costs and improve efficiency, while maintaining quality. Laboratory testing has not escaped this pressure. A major component of healthcare budgets, the demand for testing, is increasing at a faster rate than medical activity. And, while laboratory testing is undoubtedly a valuable first step in any diagnosis, the sheer volume of testing may be conducive to waste. Laboratory services cost the Health Service Executive (HSE) approximately €469 million each year. That is over 10 times the budget of a small hospital for a whole year. In terms of volume, there are over 76 million tests performed annually in Irish laboratories. These tests are made up of both urgent and non-urgent tests and originate from various sources including A&E, inpatient, outpatient and primary care, with approximately half from the latter. Laboratory testing is an integral part of day-to-day primary care practice, with approximately ...

scholarly journals Call your doctor: prospective description study of telemedicine during the first COVID-19 outbreak in a Swiss primary care practice

2020 ◽  
Author(s):  
Joëlle Suillot ◽  
Sophie Zuercher ◽  
Lydie Zufferey ◽  
Julien Sagez
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Care Practice ◽  
Emergency Services ◽  
Phone Call ◽  
Categorical Variables ◽  
Care Practice ◽  
Or Groups ◽  
Swiss Primary Care

Abstract Background: Telemedicine is a healthcare assistance method which has been promoted during the COVID-19 pandemic for the management of patients. The aim of this study is to quantify the type of request that primary care physicians are experiencing, as well as the healthcare assistance modalities and ultimately, how many physical consultations are necessary.Methods: We conducted a prospective, descriptive study in a primary care practice in Switzerland on telephone consultations related to COVID-19. The data collected included the reasons for the call, symptoms, healthcare assistance modalities and follow-up. The categorical variables are expressed as percentages of the total cases or groups.Results: We included 200 calls corresponding to 113 patients. The majority of patients (76.1%) were taken care of solely through telemedicine. The physical consultations were due to the need: for a swab test (12.4%), for a somatic assessment at the practice (9.7%) and for an emergency services consultation (1.8%). In 64.6% of cases, patient assistance required only one phone call. Calls lasted 7.85 minutes on average and were more frequent on Mondays (24%) and Fridays (18.5%). Calls led to the prescription of medication in 12.5% of cases, of a bronchodilator in 3% of cases and of an antibiotic in 0.5% of cases.Conclusion: A rigorous telephone follow-up strategy carried out by primary care physicians requires few physical consultations in patients showing symptoms of COVID-19.

Bridging to survivorship in breast cancer: How BMI weighs in.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 32-32
Author(s):  
Janet L. Espirito ◽  
Brian Turnwald ◽  
Robyn K. Harrell ◽  
Debajyoti Bhowmik ◽  
Neelima Denduluri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Office Visit ◽  
Large Network ◽  
Office Visits ◽  
Complete Treatment ◽  
Impact On Survival ◽  
Planning Methods ◽  
Survivorship Care Planning

32 Background: Obesity and depression complicate survivorship in early stage breast cancer (BC) by having a direct impact on survival and morbidity among patients (pts) who complete treatment (tx). The prevalence of obesity after BC tx in the community and concordance with BC tx type is poorly described, but important as we characterize risks of tx and optimize goals for survivorship care planning. Methods: We queried the electronic health record (EHR), iKnowMed, from a large network of community oncology practices for pts diagnosed with stage I-III BC from 2007-2010 with at least 5 office visits and follow up through 11-2012 for our retrospective study. We excluded pts who developed metastatic disease or died. We stratified pts by chemotherapy (CT) utilization (yes/no), hormone receptor (HR) status, age, and documented body mass index (BMI) at first office visit and annually. We evaluated changes in BMI characteristics by tx cohort. Results: We identified 8,506 pts with a documented BMI at first office visit and 1, 2, and 3 years (yrs) thereafter. 4,369 (51% of the total) pts received adjuvant CT and 4,137 (49%) did not. 6,897 pts (81%) were HR positive. Baseline BMI between tx cohorts were similar, though the prevalence of overweight (31%) and overweight or obese (68%) is high. Percent change of BMI at 3 yrs varied significantly between T cohorts (p<0.01) with greater rise among the cohorts who received CT in comparison to those who did not. Pts receiving CT were 46% more likely to have a 5 point or more increase in BMI at 3 yrs compared to pts that did not receive CT (OR 1.46, CI[1.08-1.96]). A stronger association for BMI increase of at least 0.5 points at 3 yrs (OR 1.53, CI [1.4-1.7]) was also observed amongst pts who received CT compared to those that did not. HR positive pts were less likely than HR negative or unknown pts to increase their BMI by at least 0.5 points (OR 0.84, p<0.01), but there was no difference at detecting a difference of 5 points in BMI (OR 0.88, p=0.49). Conclusions: With 3 yrs of follow up, overweight and obese status is remarkably common among BC survivors in the community and appears to be more prevalent after CT tx. Determinants of obesity require further study and point to necessary intervention to improve the health of early stage BC pts.

Sign in / Sign up

Export Citation Format

Share Document