scholarly journals Primary care physician satisfaction with patients diagnosed with depression: International Depression Project results from Colombia

2006 ◽  
Vol 28 (4) ◽  
pp. 283-289 ◽  
Author(s):  
Carlos Gómez-Restrepo ◽  
Adriana Bohórquez Peñaranda ◽  
Mayumi Okuda Benavides ◽  
Jacky Fabian Gil Laverde ◽  
Natalia Sanchez Díaz
Keyword(s):  
Primary Care ◽  
Total Duration ◽  
Clinical Encounter ◽  
Care Physician ◽  
Physician Satisfaction ◽  
Care Practice ◽  
Physical Problems ◽  
Before And After ◽  
Degree Of Satisfaction ◽  
The Impact

OBJECTIVE: To characterize physician satisfaction with doctor-patient encounters, distinguishing between those involving patients diagnosed with depression and those involving patients without depression, as well as to determine the impact of an educational intervention aimed at improving the recognition and management of depression in primary care practice, in Bogotá, Columbia. METHOD: Physician satisfaction when treating outpatients in primary care centers was assesed by means of a questionnaire applied before and after the intervention. RESULTS: The intervention was given to 18 physicians and 5 nurses. A total of 1650 questionnaires related to visits were collected in the first phase, and 1832 were collected in the second one. The percentage of patients diagnosed with depression increased from 5.9% (95% CI: 4.8-7.1%) before the intervention to 10.6% (95% CI: 9.2-12.06%) after. The total duration of the clinical encounter did not change significantly. The percentage of time spent on the physical problems/concerns of the patients decreased in both types of visits. CONCLUSIONS: Health professional satisfaction was the greatest when dealing with the physical problems of the patient. However, in both types of visits, the degree of satisfaction when dealing with the psychological aspects increased after the intervention.

scholarly journals An Effectiveness Trial of STEADI in an Outpatient, Primary Care Practice

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 774-774
Author(s):  
David Rein ◽  
Madeleine Hackney ◽  
Michele Dougherty ◽  
Camille Vaughan ◽  
Laurie Imhof ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Review ◽  
Primary Care Practice ◽  
Controlled Trial ◽  
Care Practice ◽  
Strength Assessment ◽  
Randomized Controlled ◽  
Study Team ◽  
One Year ◽  
The Impact

Abstract The STEADI Options trial uses a randomized, controlled-trial design to assess the effectiveness and cost-effectiveness of the STEADI Initiative . Beginning March, 2020, we will randomize 3,000 adults ≥ 65 years of age at risk for falls seen in an Emory Clinic primary care practice to: (1) full STEADI; (2) a STEADI-derived gait, balance, and strength assessment with physical therapy referrals; (3) a STEADI-derived medication review and management; or (4) usual care. This presentation will discuss decisions made by the study team to facilitate implementation of STEADI including electronically conducting screening prior to the date of encounter, the use of dedicated nursing staff to conduct assessments, implementation of strength, balance, orthostatic hypotension, and vision testing, methods to facilitate medication review, and communication of assessment information to providers. The results from this study will be used to estimate the impact of STEADI on falls, service utilization, and costs over one year.

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
R King ◽  
D Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Primary Care Physician ◽  
Care Physician ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p< 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p< 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p < 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

Family Conference In Primary Care Practice

2021 ◽  
Vol 70 (12) ◽  
pp. 243-245
Author(s):  
Retno Asti Werdhani ◽  
Dhanasari Vidiawati Trisna
Keyword(s):  
Primary Care ◽  
Family Environment ◽  
Primary Care Practice ◽  
Care Physician ◽  
Care Practice ◽  
Successful Management ◽  
Inhibiting Factor ◽  
Family Conference ◽  
The Family ◽  
Physician Family

From the Epidemiology Triangle, we can see that a person’s health status is influenced by 3 factors: host, agent, and the environment. The environment plays the biggest role as the cause of health problems, one of which is the family environment. Family can become a supporting factor or inhibiting factor in the successful management of patient’s cases. Therefore, a primary care physician/family physician needs to conduct family meetings to discuss and agree on solutions with the patient’s family by paying attention to inhibiting and supporting factors and find common solutions for the benefit of the patient.

Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3567-3573 ◽  
Author(s):  
James M Whedon ◽  
Andrew W J Toler ◽  
Louis A Kazal ◽  
Serena Bezdjian ◽  
Justin M Goehl ◽  
...  
Keyword(s):  
Primary Care ◽  
Spinal Pain ◽  
Chiropractic Care ◽  
Care Physician ◽  
Health Claims ◽  
Prescription Opioids ◽  
Office Visits ◽  
Opioid Prescription ◽  
Health Claims Data ◽  
The Impact

Abstract Objective Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. Design and Setting We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017. Subjects We included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care. Methods We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients). Results The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut: hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11–2.17, P = 0.010; in New Hampshire: HR = 2.03, 95% CI = 1.92–2.14, P < 0.0001). Similar differences were observed for the acute groups. Conclusions Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.

scholarly journals P139: The impact of a pancreatitis admission algorithm on emergency department length of stay in a tertiary care academic hospital

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S114-S115
Author(s):  
A. Albina ◽  
F. Kegel ◽  
F. Dankoff ◽  
G. Clark
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Physician Satisfaction ◽  
Academic Hospital ◽  
Before And After ◽  
Potential Applicability ◽  
The Mean ◽  
Algorithm Implementation ◽  
The Impact

Background: Emergency department (ED) overcrowding is associated with a broad spectrum of poor medical outcomes, including medical errors, mortality, higher rates of leaving without being seen, and reduced patient and physician satisfaction. The largest contributor to overcrowding is access block – the inability of admitted patients to access in-patient beds from the ED. One component to addressing access block involves streamlining the decision process to rapidly determine which hospital service will admit the patient. Aim Statement: As of Sep 2011, admission algorithms at our institution were supported and formalised. The pancreatitis algorithm clarified whether general surgery or internal medicine would admit ED patients with pancreatitis. We hypothesize that this prior uncertainty delayed the admission decision and prolonged ED length of stay (LOS) for patients with pancreatitis. Our project evaluates whether implementing a pancreatitis admission algorithm at our institution reduced ED time to disposition (TTD) and LOS. Measures & Design: A retrospective review was conducted in a tertiary care academic hospital in Montreal for all adult ED patients diagnosed with pancreatitis from Apr 2010 to Mar 2014. The data was used to plot separate run charts for ED TTD and LOS. Serial measurements of each outcome were used to monitor change and evaluate for special cause variation. The mean ED LOS and TTD before and after algorithm implementation were also compared using the Student's t test. Evaluation/Results: Over four years, a total of 365 ED patients were diagnosed with pancreatitis and 287 (79%) were admitted. The mean ED LOS for patients with pancreatitis decreased following the implementation of an admission algorithm (1616 vs. 1418 mins, p = 0.05). The mean ED TTD was also reduced (1171 vs. 899 mins, p = 0.0006). A non-random signal of change was suggested by a shift above the median prior to algorithm implementation and one below the median following. Discussion/Impact: This project demonstrates that in a busy tertiary care academic hospital, an admission algorithm helped reduce ED TTD and LOS for patients with pancreatitis. This proves especially valuable when considering the potential applicability of such algorithms to other disease processes, such as gastrointestinal bleeding and congestive heart failure, among others. Future studies demonstrating this external applicability, and the impact of such decision algorithms on physician decision fatigue and within non-academic institutions, proves warranted.

scholarly journals The Cochrane 2018 Review on Brief Interventions in Primary Care for Hazardous and Harmful Alcohol Consumption: A Distillation for Clinicians and Policy Makers

2019 ◽  
Vol 54 (4) ◽  
pp. 417-427 ◽  
Author(s):  
F R Beyer ◽  
F Campbell ◽  
N Bertholet ◽  
J B Daeppen ◽  
J B Saunders ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Alcohol Consumption ◽  
Brief Intervention ◽  
Emergency Care ◽  
Total Duration ◽  
Brief Interventions ◽  
Men And Women ◽  
Harmful Alcohol ◽  
The Impact

Abstract Aims An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. Methods Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. Results We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference −20 g/wk, 95% confidence interval −28 to −12). Subgroup analysis showed a similar effect for men and women. Conclusions Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting.

scholarly journals 3164 Do cancer survivors understand their risk factors for recurrence and the value of coordinated care between an oncologist and a primary care physician? A survey of endometrial and cervical cancer patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 121-121
Author(s):  
Subhjit Sekhon ◽  
Lindsay Kuroki ◽  
Graham Colditz
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cervical Cancer ◽  
Cancer Risk ◽  
Cancer Survivors ◽  
Primary Care Physician ◽  
Care Physician ◽  
Cancer Site ◽  
Care Plans ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: To evaluate gaps in knowledge for women who are cancer survivors regarding the impact of comorbidities and lifestyle behaviors on endometrial and cervical cancer risk, and to assess prevalence of established care with a primary care physician (PCP) among patients and evaluate acceptability of referral to a PCP METHODS/STUDY POPULATION: Single institution cross-sectional study examining all women aged 18 or older with a diagnosis of cervical or endometrial cancer who present for care by a gynecologic oncologist at Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine. Patients will be invited to complete a survey specific to cancer diagnosis that includes questions on participant background and sociodemographic information, knowledge of risk factors for their specific cancer site, and whether or not the patient has a primary care provider and the acceptability of referring RESULTS/ANTICIPATED RESULTS: Majority of women will be unaware of how comorbidities affect cancer risk and treatment outcomes. For women without a PCP, we anticipate that they will be accepting towards the notion of being referred to one for establishing care. DISCUSSION/SIGNIFICANCE OF IMPACT: Pilot information from this study will 1. Allow providers to improve cancer survivorship care plans by increasing collaboration between PCPs and oncologists to provide ongoing care, and 2. Afford information for providers on where gaps in knowledge exist so as to better education patients.

scholarly journals The Impact of Primary Care: A Focused Review

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-22 ◽  
Author(s):  
Leiyu Shi
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Negative Impact ◽  
Healthcare Services ◽  
The United States ◽  
Emergency Department Visits ◽  
Care Practice ◽  
Quality Healthcare ◽  
The Usa ◽  
The Impact

Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.

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