scholarly journals General practice physician knowledge about headache: evaluation of the municipal continual medical education program

2009 ◽  
Vol 67 (3a) ◽  
pp. 595-599 ◽  
Author(s):  
Pedro André Kowacs ◽  
Carlos Alexandre Twardowschy ◽  
Élcio Juliato Piovesan ◽  
Renata Dal-Prá Ducci ◽  
Raphael Henrique Déa Cirino ◽  
...  
Keyword(s):  
Primary Care Providers ◽  
Secondary Headache ◽  
Care Providers ◽  
Practice Physician ◽  
Physician Knowledge ◽  
City Hall ◽  
Medical Education Program ◽  
Before And After ◽  
Headache Diagnosis ◽  
Headache Care

OBJECTIVE: Headache is a common condition not always managed satisfactorily by primary care providers (PCPs). In an effort to improve headache care, the Curitiba City Hall in consortia with Hospital de Clínicas da Universidade Federal do Paraná - Brazil developed an educational program directed to the PCPs. The goal of the project was to evaluate, to update and to train the PCP on headache knowledge and care. METHOD: The program was designed to have a theoretical phase and a practical phase. Knowledge on headache and medical care of headache were surveyed before and after the theoretical phase thorough a specific questionnaire. RESULTS: Significant improvement in post-CME scores on headache prevalence (p<0.001), migraine diagnosis (p<0.001) and management (p=0.01), secondary headache diagnosis (p=0.005) and management (p=0.005) was reached by the respondents. CONCLUSION: Improvement in post-CME scores confirms that the program had a significant immediate impact on the PCPs knowledge directly affecting the patient's health.

Compliance, capacity, and quality in colonoscopy screening for CRC: A novel solution.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 357-357 ◽  
Author(s):  
S. C. Lloyd
Keyword(s):  
Primary Care ◽  
Training Program ◽  
Primary Care Physicians ◽  
African American Men ◽  
Primary Care Providers ◽  
Care Providers ◽  
Adenoma Detection ◽  
Before And After ◽  
Outstanding Quality

357 Background: CRC is predominately preventable with high quality colonoscopy screenings. Unfortunately, less than half of Americans are “up-to-date.” When referred by primary care providers, less than half complete the process. We proposed to include the primary care provider (PCP) in a novel training program to extend skills from sigmoidoscopy to full colonoscopy in a “mentored and monitored” model. We know that quality in colonoscopy can vary widely (ten fold within a single 12-man group). The protective benefits of colonoscopy reflect the thoroughness of the removal of polyps. Unfortunately, the ACS projections for 2010 predict an increase of 4,400 deaths from CRC over 2009, an 8% rise! Furthermore the death rate for African American men has RISEN 28% since 1960. We are loosing a battle for which we posses the tools to win. To achieve victory we must successfully address all three factors: compliance, capacity and quality. Methods: Thirty primary care physicians in two states (SC, FL) were recruited. We measured compliance rates within the practice before and after enrollment. We further evaluated quality of the colonoscopies as reflected in completion, yield and complications. Results: Compliance more than doubled (38% to 84%). As a compliance enhancement tool, the results were outstanding. The evaluation of quality then became of paramount importance. The gross completion rate was 98.3%, the adenoma detection rate (reflecting polyp yield) was 38%. In over 20,000 cases there were only 5 perforations, substantially below published rates. The quality was consistently at the level of experienced conscientious gastroenterologists. The details of the training program and the use of the “two-man” colonoscopy technique have been reviewed elsewhere (MEDICAL CARE, Aug 2010). Conclusions: If replicated nationally, this model has the potential for saving 25,000 lives annually. The participation of the patient's PCP is a powerful influence for improved compliance. The availability of an “expert” for mentoring and monitoring results in outstanding and consistent quality. The model has the potential to dramatically enhance compliance simultaneously increasing capacity while maintaining outstanding quality. No significant financial relationships to disclose.

An Education Model for Otitis Media Care Field-Tested in Latin America

1993 ◽  
Vol 109 (5) ◽  
pp. 895-898 ◽  
Author(s):  
Roland D. Eavey ◽  
Jose Ignacio Santos ◽  
Moises A. Arriaga ◽  
Richard Gliklich ◽  
Carla Odio ◽  
...  
Keyword(s):  
Primary Care ◽  
Otitis Media ◽  
Primary Care Providers ◽  
World Health ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Media Management ◽  
Before And After ◽  
Health Organization ◽  
Long Term Impact

The World Health Organization has designated the teaching of otitis media management skills a “priority” status. Effective treatment of ear disease requires that the physician be both informationally educated as well as physically trained to use otoscopy. Little is known about how well this education can be provided in a short time and in a foreign country. To more objectively assess teaching effect, results of an education session for rural Mexican pediatric primary-care providers who were given an intensive otitis media lecture and otoscopy skills workshop in 1990 were evaluated. To test immediate cognitive impact, an anonymous written examination was given both before and after the teaching session. Average test scores after the educational sessions improved 24% ( p > 0.001) over baseline scores before the sessions. To evaluate long-term impact on clinical practice, a follow-up telephone survey 2 years later was conducted. The use of an otoscope to diagnose otitis media had increased from 40% to 93% of respondents. We conclude that pediatric primary-care providers In rural Mexico possess a baseline level of knowledge about otitis media that can be significantly enhanced with one educational session. Further, this teaching effort produces an impact on practice pattern that lasts at least 2 years.

Direct observation of depression screening: identifying diagnostic error and improving accuracy through unannounced standardized patients

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 251-256 ◽  
Author(s):  
Alan Schwartz ◽  
Steven Peskin ◽  
Alan Spiro ◽  
Saul J. Weiner
Keyword(s):  
Primary Care ◽  
Clinical Performance ◽  
Standardized Patients ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Control Group ◽  
Care Providers ◽  
Real Patient ◽  
Before And After ◽  
Icd 10

AbstractBackgroundDepression is substantially underdiagnosed in primary care, despite recommendations for screening at every visit. We report a secondary analysis focused on depression of a recently completed study using unannounced standardized patients (USPs) to measure and improve provider behaviors, documentation, and subsequent claims for real patients.MethodsUnannounced standardized patients presented incognito in 217 visits to 59 primary care providers in 22 New Jersey practices. We collected USP checklists, visit audio recordings, and provider notes after visits; provided feedback to practices and providers based on the first two visits per provider; and compared care and documentation behaviors in the visits before and after feedback. We obtained real patient claims from the study practices and a matched comparison group and compared the likelihood of visits including International Classification of Diseases, 10th Revision (ICD-10) codes for depression before and after feedback between the study and comparison groups.ResultsProviders significantly improved in their rate of depression screening following feedback [adjusted odds ratio (AOR), 3.41; 95% confidence interval (CI), 1.52–7.65; p = 0.003]. Sometimes expected behaviors were documented when not performed. The proportion of claims by actual patients with depression-related ICD-10 codes increased significantly more from prefeedback to postfeedback in the study group than in matched control group (interaction AOR, 1.41; 95% CI, 1.32–1.50; p < 0.001).ConclusionsUsing USPs, we found significant performance issues in diagnosis of depression, as well as discrepancies in documentation that may reduce future diagnostic accuracy. Providing feedback based on a small number of USP encounters led to some improvements in clinical performance observed both directly and indirectly via claims.

Abstract 15163: Differences in Preferences Between Physicians and Patients for the Use and Dosing of Direct Oral Anticoagulants for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jennifer A Rymer ◽  
Debbe McCall ◽  
Mellanie T Hills ◽  
Tracy Y Wang
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Primary Care Providers ◽  
Severe Bleeding ◽  
Minor Bleeding ◽  
Care Providers ◽  
Reversal Agent ◽  
Physician Knowledge ◽  
Reduced Dose

Introduction: Direct oral anticoagulants (DOACs) are effective in reducing the risk of stroke for patients with atrial fibrillation (AF) only if prescribed at the labeled dose. Little is known about patient or clinician preferences for DOAC selection and dosing. Methods: We consented 240 physicians treating ≥20 patients with AF and 343 patients with AF. Physician knowledge of DOAC dosing was tested with 4 hypothetical patient case scenarios. Both patients and physicians were asked to grade the importance of 25 factors in anticoagulation decision-making. Results: Among physicians, the median age was 55 years, 13% were female, 23% were primary care providers. Most physicians (63%) stated empirically they would never/rarely use an adjusted lower dose if the patient did not meet dose adjustment criteria. However, in hypothetical case scenarios of a patient indicated for full dose DOAC, 40.8% of clinicians under-dosed apixaban (<5 mg bid daily) and 17.1% for rivaroxaban (<20 mg daily). In scenarios where a patient met dosing criteria for reduced dose DOAC, 64.6% (apixaban 2.5 mg bid daily) and 71.7% (rivaroxaban 15 mg daily) of physicians chose the reduced dose DOAC answer. Only 32.1% of clinicians answered all 4 scenarios correctly. Among patients with AF, the median age was 65 years, 74% were female, 85% had AF >1 year and 89% were currently anticoagulated. Patients and physicians both ranked stroke prevention and avoiding severe bleeding very important when choosing a DOAC. Physicians were more likely than patients to rank cost as very important, patients were more likely than physicians to consider the following very important: may cause minor bleeding, the dose of med can be reduced if need to, reversal agent available, and how long the drug has been on market ( Figure ). Conclusions: DOAC dosing strategies may be driven by gaps in physician knowledge, on top of varying treatment beliefs and preferences between physicians and patients.

scholarly journals Implementing electronic health records (EHRs): health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR

2017 ◽  
Vol 25 (6) ◽  
pp. 618-626 ◽  
Author(s):  
Marie Krousel-Wood ◽  
Allison B McCoy ◽  
Chad Ahia ◽  
Elizabeth W Holt ◽  
Donnalee N Trapani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Preventive Care ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Easy Access ◽  
Care Providers ◽  
Before And After ◽  
Electronic Health

Abstract Objective We assessed changes in the percentage of providers with positive perceptions of electronic health record (EHR) benefit before and after transition from a local basic to a commercial comprehensive EHR. Methods Changes in the percentage of providers with positive perceptions of EHR benefit were captured via a survey of academic health care providers before (baseline) and at 6–12 months (short term) and 12–24 months (long term) after the transition. We analyzed 32 items for the overall group and by practice setting, provider age, and specialty using separate multivariable-adjusted random effects logistic regression models. Results A total of 223 providers completed all 3 surveys (30% response rate): 85.6% had outpatient practices, 56.5% were &gt;45 years old, and 23.8% were primary care providers. The percentage of providers with positive perceptions significantly increased from baseline to long-term follow-up for patient communication, hospital transitions – access to clinical information, preventive care delivery, preventive care prompt, preventive lab prompt, satisfaction with system reliability, and sharing medical information (P &lt; .05 for each). The percentage of providers with positive perceptions significantly decreased over time for overall satisfaction, productivity, better patient care, clinical decision quality, easy access to patient information, monitoring patients, more time for patients, coordination of care, computer access, adequate resources, and satisfaction with ease of use (P &lt; 0.05 for each). Results varied by subgroup. Conclusion After a transition to a commercial comprehensive EHR, items with significant increases and significant decreases in the percentage of providers with positive perceptions of EHR benefit were identified, overall and by subgroup.

Teaching It Forward: Educating Parents About HPV/HPV Vaccine

2019 ◽  
Vol 12 (1) ◽  
pp. 46-58
Author(s):  
Jeanne Potts ◽  
Erik Southard
Keyword(s):  
Primary Care ◽  
Hpv Vaccine ◽  
Hpv Vaccination ◽  
Primary Care Providers ◽  
Educational Video ◽  
Care Providers ◽  
Vaccination Rates ◽  
Before And After ◽  
Primary Care Office ◽  
Intent To Vaccinate

BackgroundHuman papillomavirus (HPV) vaccines are available to prevent HPV-associated cancers. However, parents are reluctant to make the decision to immunize their children. Nationally, HPV vaccination rates remain low.ObjectiveThe objectives were to improve parents' attitudes and knowledge about HPV/HPV vaccine, increase parental intent to vaccinate, and increase HPV vaccination rates in a primary care office.MethodsA one-group, pretest/posttest design was used to assess participants' attitude, knowledge, and intent to vaccinate before and after viewing an HPV educational video. Pre–post project HPV vaccination rates were compared.ResultsParticipants' attitudes toward HPV/HPV vaccine improved while knowledge increased. Intent to vaccine increased by 31% after viewing the HPV educational video. HPV vaccination rates increased 6% (females) and 9% (males).ConclusionsPrimary care providers (PCPs) should look for innovative ways to educate parents about HPV, help parents make informed decisions about the HPV vaccine, and work toward a common goal of preventing HPV-associated cancers.Implications for NursingImplications are three-fold benefiting parents, PCPs, and society. Parents will be more knowledgeable, providers will understand they are an important key in the vaccine process, and society will benefit from a decrease in HPV-associated cancers.

scholarly journals Impact of a Provincial Asthma Guidelines Continuing Medical Education Project: The Ontario Asthma Plan of Action’s Provider Education in Asthma Care Project

2007 ◽  
Vol 14 (2) ◽  
pp. 111-117 ◽  
Author(s):  
M Diane Lougheed ◽  
Dilshad Moosa ◽  
Shelagh Finlayson ◽  
Wilma M Hopman ◽  
Mallory Quinn ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Education Program ◽  
Continuing Medical Education ◽  
Primary Care Providers ◽  
Action Plans ◽  
Care Providers ◽  
Asthma Care ◽  
Medical Education Program ◽  
Case Discussions

BACKGROUND: The Ontario Ministry of Health and Long-Term Care funded the Ontario Lung Association to develop and implement a continuing medical education program to promote implementation of the Canadian asthma guidelines in primary care.OBJECTIVES: To determine baseline knowledge, preferred learning format, satisfaction with the program and reported impact on practice patterns.METHODS: A 3 h workshop was developed that combined didactic presentations and small group case discussions. Outcome measures included a workshop evaluation, baseline assessment of asthma management knowledge and three-month postreflective evaluations.RESULTS: One hundred thirty-seven workshops were delivered to 2783 primary care providers (1313 physicians, 1470 allied health) between September 2002 and March 2005. Of the 2133 participants, 1007 physicians and 1126 allied health professionals submitted workshop evaluations. Most (98%) of the attendees indicated they would recommend the workshop to a colleague. The majority preferred the combination of didactic lecture plus interactive case discussions. A subset of physicians provided consent to use these data for research (n=298 pediatric and 288 adult needs assessments; n=349 postreflective evaluations). Important needs identified included appropriate medication for chronic asthma and development of written action plans. On the postreflective evaluations, 88.7% remained very satisfied, 95.5% reported increased confidence, 91.9% reported an influence on practice and 67.2% reported using a written action plan.CONCLUSIONS: This continuing medical education program addresses identified needs of primary care providers. Participants reported improvements in asthma care, including prescribing practices, use of spirometry and written action plans. Similar programs should be considered as part of multifaceted asthma guidelines dissemination and implementation initiatives in other provinces and nationally.

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