Structured Encounter Form: The Impact on Provider Performance and Recording of Well-Child Care

PEDIATRICS ◽  
1990 ◽  
Vol 85 (1) ◽  
pp. 104-113 ◽  
Author(s):  
Anne Kaszuba Duggan ◽  
Barbara Starfield ◽  
Catherine DeAngelis
Keyword(s):  
Child Care ◽  
Primary Care Clinic ◽  
Study Data ◽  
Control Group ◽  
Process Of Care ◽  
Care Clinic ◽  
Provider Performance ◽  
Well Child Care ◽  
Hospital Pediatric ◽  
The Impact

The impact of record format on provider performance and recording of the process of care and their concordance were examined in this study. The process of care was defined by existing sets of explicit criteria developed for quality assessment. The study was conducted in an urban teaching hospital pediatric primary care clinic. Housestaff were encouraged, but not required, to use the clinic's structured, age-specific forms for recording well-child care. Performance and recording were compared during required well-child visits using the structured form and those using the basic clinic form. Study data from 1031 visits to 68 housestaff during a 14-month period were collected using medical record abstracting of all visits and direct observation of 243 of them. Twenty-three of the providers were assigned randomly to an unobserved control group to assess the effect of observation on recording. Use of the structured form was associated with significantly higher levels of both recorded and observed performance. When performance could be merely checked off to document performance, overdocumentation was found. Record-based estimates of performance were more accurate during visits when the structured form was used. Record format can improve provider performance and recording of the process of care.

scholarly journals 2188. Provider Education and Rapid Antigen Detection Test Use in Private and Academic Pediatric Clinics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S744-S745
Author(s):  
Steven Dahl ◽  
Emily A Hurley ◽  
Brian R Lee ◽  
Jason Newland ◽  
Andrea Bradley-Ewing ◽  
...  
Keyword(s):  
Sample Size ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Antigen Detection ◽  
Control Group ◽  
Healthy Children ◽  
Provider Education ◽  
Care Clinic ◽  
The Impact ◽  
Gas Exposure

Abstract Background Rapid antigen detection testing (RADT) is needed to differentiate Group A Streptococcal (GAS) pharyngitis from viral pharyngitis. Guidelines do not recommend RADT in patients with viral symptoms or in children <3 years old without GAS exposure. Reduction in unnecessary RADT use may impact inappropriate antibiotic use by decreasing prescriptions in children likely colonized with GAS. We examined the impact of guideline concordant education of appropriate RADT and antibiotic use in pharyngitis on providers’ (physician and APRN) use of RADT in an academic and private pediatric primary care clinic. Methods Retrospective chart review of 1,085 healthy children, age 1–5 years old, seen in clinics between September 2015 and March 2019 (355 pre- and 730 post-education; 211 academic and 874 private). Education occurred in 3/2017. Cases selected had either complaint of sore throat, RADT, or diagnosis of GAS pharyngitis or pharyngitis. Data collected included the presence of viral symptoms (e.g., cough, rhinorrhea), RADT/GAS culture results, diagnosis, and prescribed antibiotics. RADT was deemed unnecessary for all children < 3 years old without GAS exposure, in patients with ≥ 2 viral symptoms, or in patients ≥ 3 years old without pharyngitis. Results Overall, RADT use decreased from pre to post intervention (72.1% vs. 23.4% of patients, P ≤ 0.0001). Unnecessary RADT use decreased overall (50.4% vs. 16.2%, P ≤ 0.0001), in all clinics (private: 56.2% vs. 16.0%, P ≤ 0.0001; academic: 38.1% vs. 17.4%, P = 0.0012), and with all providers (physician: 41.6% vs. 18.3%, P ≤ 0.0001; APRN: 58.8% vs. 14.1%, P ≤ 0.0001). Unnecessary RADT use decreased for children <3 years old (28.1% vs. 7.4%, P ≤ 0.0001) and ≥2 viral symptoms (65.7% vs. 16.5%, P ≤ 0.0001). Conclusion Unnecessary RADT use decreased in the post-education period overall (34%), in children <3 years old (21%), and in patients with ≥ 2 viral symptoms (49%). Reductions were also seen in both academic (21%) and private (40%) clinics as well as with both physicians (23%) and ARPNs (45%). Limitations include lack of a control group and sample size variance by the clinic. We observed positive trends in RADT reduction following provider education in private and academic settings; however, further research including control and optimal sample size is needed to confirm any direct impact. Disclosures All authors: No reported disclosures.

scholarly journals Elderly Patients in Primary Care are Still at Risks of Receiving Potentially Inappropriate Medications

2021 ◽  
Vol 12 ◽  
pp. 215013272110350
Author(s):  
Pasitpon Vatcharavongvan ◽  
Viwat Puttawanchai
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Study Data ◽  
Patient Specific ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Care Clinic ◽  
Inappropriate Medications

Background Most older adults with comorbidities in primary care clinics use multiple medications and are at risk of potentially inappropriate medications (PIMs) prescription. Objective This study examined the prevalence of polypharmacy and PIMs using Thai criteria for PIMs. Methods This study was a retrospective cross-sectional study. Data were collected from electronic medical records in a primary care clinic in 2018. Samples were patients aged ≥65 years old with at least 1 prescription. Variables included age, gender, comorbidities, and medications. The list of risk drugs for Thai elderly version 2 was the criteria for PIMs. The prevalence of polypharmacy and PIMs were calculated, and multiple logistic regression was conducted to examine associations between variables and PIMs. Results Of 2806 patients, 27.5% and 43.7% used ≥5 medications and PIMs, respectively. Of 10 290 prescriptions, 47% had at least 1 PIM. The top 3 PIMs were anticholinergics, proton-pump inhibitors, and nonsteroidal anti-inflammatory drugs (NSAIDs). Polypharmacy and dyspepsia were associated with PIM prescriptions (adjusted odds ratio 2.48 [95% confident interval or 95% CI 2.07-2.96] and 3.88 [95% CI 2.65-5.68], respectively). Conclusion Prescriptions with PIMs were high in the primary care clinic. Describing unnecessary medications is crucial to prevent negative health outcomes from PIMs. Computer-based clinical decision support, pharmacy-led interventions, and patient-specific drug recommendations are promising interventions to reduce PIMs in a primary care setting.

scholarly journals Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Sophia Jung ◽  
Mary Elizabeth Sexton ◽  
Sallie Owens ◽  
Nathan Spell ◽  
Scott Fridkin
Keyword(s):  
Antibiotic Prescription ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
Multivariable Logistic Regression Analysis ◽  
Comorbid Condition ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Care Clinic ◽  
The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

Sexual Activity and Sex Hormone Levels in Aging Men

1993 ◽  
Vol 5 (2) ◽  
pp. 181-186 ◽  
Author(s):  
Moshe Sadowsky ◽  
Helen Antonovsky ◽  
Reuven Sobel ◽  
Benyamin Maoz
Keyword(s):  
Sexual Activity ◽  
Primary Care Clinic ◽  
Structured Interview ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Sexual Hormones ◽  
Cross Sectional ◽  
Care Clinic ◽  
Aging Men ◽  
The Impact

A cross-sectional study of 60 men aged 65–80 was carried out to test the impact of the aging process on sexual hormones (testoterone, FSH, LH, prolactin), sexual activity, and the relations between them. Blood samples for hormone assays were taken between 8–9 A.M. in the primary care clinic at which the participants were registered. Data on sexual activity (coitus), sexual desire (libido), marital status, and age were obtained from the respondents by means of a structured interview. No relationship was found between testosterone (T) or prolactin (PL) and sexual activity. Nevertheless, a statistically significant relationship between FSH and LH versus age, and an inverse relationship between sexual activity and age were found. Hypogonadism (T level less than 3ng/ml) with normal levels of FSH and LH was observed in 11 respondents.

scholarly journals Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial

10.2196/16266 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16266 ◽  
Author(s):  
Yeoree Yang ◽  
Eun Young Lee ◽  
Hun-Sung Kim ◽  
Seung-Hwan Lee ◽  
Kun-Ho Yoon ◽  
...  
Keyword(s):  
Primary Care ◽  
Mobile Phone ◽  
Diabetes Management ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Glucose Monitoring ◽  
Feedback System ◽  
Control Group ◽  
Care Clinic ◽  
Cluster Randomized

Background Recent evidence of the effectiveness of mobile phone–based diabetes management systems is generally based on studies conducted in tertiary hospitals or professional diabetes clinics. Objective This study aimed to evaluate the clinical efficacy and applicability of a mobile phone–based glucose-monitoring and feedback system for the management of type 2 diabetes mellitus (T2DM) in multiple primary care clinic settings. Methods In this multicenter, cluster-randomized controlled, open trial, 13 primary care clinics in Seoul and other large cities in South Korea were voluntarily recruited. Overall, 150 (9 clinics) and 97 (4 clinics) participants with T2DM were assigned to the intervention and control groups, respectively (2:1 allocation). Every month, participants in both groups attended face-to-face physicians’ consultation for the management of diabetes in the clinic. For the intervention group, participants were required to upload their daily self-monitoring of blood glucose (SMBG) results using the mobile phone app in addition to outpatient care for 3 months. The results were automatically transmitted to the main server. Physicians had to check their patients’ SMBG results through an administrator’s website and send a short feedback message at least once a week. At baseline and 3 months, both groups had anthropometry and blood tests, including hemoglobin A1c (HbA1c), and responded to questionnaires about treatment satisfaction and compliance. Results At 3 months, participants in the intervention group showed significantly more improvement in HbA1c (adjusted mean difference to control −0.30%, 95% CI −0.50 to −0.11; P=.003) and fasting plasma glucose (−17.29 mg/dL, 95% CI −29.33 to −5.26; P=.005) than those in the control group. In addition, there was significantly more reduction in blood pressure, and the score regarding treatment satisfaction and motivation for medication adherence increased more in the intervention group than in the control group. In the subgroup analyses, the effect on glycemic control was more significant among younger patients and higher baseline HbA1c levels. Conclusions The mobile phone–based glucose-monitoring and feedback system was effective in glycemic control when applied in primary care clinic settings. This system could be utilized effectively with diverse institutions and patients. Trial Registration Clinical Research Information Service (CRIS) https://tinyurl.com/tgqawbz

scholarly journals Exploring Interpersonal Relationships in a Nurse-Managed Clinic and Their Impact on Clinical Outcomes

SAGE Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 215824401985843
Author(s):  
Charlotte T. Lee ◽  
Susanne Phillips ◽  
Susan Tiso ◽  
Camille Fitzpatrick
Keyword(s):  
Health Care ◽  
Interpersonal Relationships ◽  
Health Care Providers ◽  
Access To Health Care ◽  
Primary Care Clinic ◽  
Patient Characteristics ◽  
Care Providers ◽  
Care Clinic ◽  
Outcomes Of Care ◽  
The Impact

This study explores the impact of interpersonal relationships on processes and outcomes of care at a nurse-managed, primary care clinic in Southern California serving a vulnerable population. Ten semistructured interviews were conducted with all health care providers in the clinic to explore patient characteristics, types of relationships experienced, and how they may have affected processes and outcomes of care. Themes in interviews were identified through thematic analysis. We found that (a) patients with limited access to health care and resources establish different types of relationships to support their needs, and (b) interpersonal relationships, including those among providers, affect quality of care.

A Parent Coach-Led Model of Well-Child Care for Young Children in Low-Income Communities: A Cluster Randomized Trial Protocol (Preprint)

2021 ◽  
Author(s):  
Rachel Hurst ◽  
Kendra Liljenquist ◽  
Sarah J Lowry ◽  
Peter Szilagyi ◽  
Kevin A. Fiscella ◽  
...  
Keyword(s):  
Child Care ◽  
Low Income ◽  
Pragmatic Trial ◽  
Urgent Care ◽  
Main Element ◽  
Anticipatory Guidance ◽  
Well Child Care ◽  
Time Motion ◽  
Cluster Randomized ◽  
The Impact

BACKGROUND The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator ("Parent Coach") to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. OBJECTIVE To evaluate the impact of PARENT using a cluster randomized controlled trial (RCT). METHODS This study will test the effectiveness of PARENT at 10 clinical sites of two federally-qualified health centers (FQHCs) in Tacoma, WA and Los Angeles, CA. We are conducting a cluster RCT that includes 940 families with a child ≤ 12 months old at the time of the baseline survey. Parents will be followed up at 6 months and 12 months post-enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening/referral, and developmental and behavioral surveillance, screening, and guidance at each WCC visit, and is supported by parent-focused pre-visit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical exam and any concerns that require a clinician’s attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health–related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally-recommended WCC services, family-centeredness of care, and parent experiences of care) and healthcare utilization (WCC, urgent care, emergency department [ED], and hospitalizations), conduct a cost/cost-offset analysis, and conduct a separate Time Motion Study to assess clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent and parenting-focused outcomes. Our primary outcomes are receipt of anticipatory guidance and ED utilization. RESULTS Participant recruitment began in March 2019 and will continue through June 2021. After recruitment concludes, 6 and 12 month follow up surveys will be completed. Thus far, over 500 participants have been enrolled. CONCLUSIONS This large pragmatic trial of PARENT in partnership with FQHCs will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. CLINICALTRIAL ClinicalTrials.gov NCT03797898

Evaluation of Group Well-Child Care for Improving Burn Prevention Practices in the Home

PEDIATRICS ◽  
1984 ◽  
Vol 74 (5) ◽  
pp. 879-882
Author(s):  
Katherine A. Thomas ◽  
Ruth S. Hassanein ◽  
Edward R. Christophersen
Keyword(s):  
Child Care ◽  
Hot Water ◽  
Control Group ◽  
Specific Information ◽  
Home Safety ◽  
Well Child Care ◽  
Burn Prevention ◽  
Significant Difference ◽  
Smoke Detectors ◽  
Experimental Group

The inclusion of counseling on home safety procedures has been recommended by the American Academy of Pediatrics as a routine part of well-child care. However, few, if any, data exist to give direction to the pediatrician interested in advising parents about home safety. In the present study, 58 couples were randomly assigned, prospectively, to an experimental group and a control group. Both were enrolled in a single group well-child care class that lasted 90 minutes. The control group was provided with information and discussion on nutrition, dental care, safety in the car and home, child development, child rearing, illness management, and immunizations. The experimental group received information and discussion on the same topics, and they also received specific information on burn prevention: hot water heater settings and smoke detectors. On a subsequent home visit, 65% of the couples in the experimental group had their hot water temperature measured at 54.4°C (130°F) or less, whereas all of the couples in the control group had hot water temperatures of more than 54.4°C (130°F) (a significant difference). Although only one couple in the experimental group did not have an operational smoke detector, enough of the couples in the control group had operational smoke detectors that results were not significant. These results suggest that the pediatrician may now be in a position to include effective safety counseling procedures for burn prevention in the home as a part of well-child care.

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