scholarly journals Use of Computerized Insulin Dose Adjustment Algorithms to Facilitate Adjusting Insulin Doses by Primary Care Providers

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Mayer Davidson ◽  
S. Davidson
Keyword(s):  
Primary Care ◽  
Dose Adjustment ◽  
Insulin Dose ◽  
Glucose Monitoring ◽  
Primary Care Providers ◽  
Insulin Regimen ◽  
Care Providers ◽  
Baseline Hba1c ◽  
Hba1c Levels ◽  
Clinic Visits

Insulin use is challenging for both primary care providers (PCPs) and patients. For PCPs, a major challenge is time constraints, and for many, inexperience. For patients, it is providing enough fingerstick glucose readings for insulin dose adjustments to be made. The first author has developed algorithms for adjusting insulin doses based on the following principles. Depending on when injected, each component of the insulin regimen has a maximal effect on a specific period of the 24-hour cycle, e.g., overnight, morning, afternoon, evening. The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting or not. There needs to be enough glucose readings in a period that reflects a patient’s current lifestyle for a decision to be made about that component of the insulin regimen that maximally affects that period. A registered nurse using these algorithms at clinic visits lowered HbA1c levels in 111 poorly controlled insulin-requiring patients from 11.0% to 7.2% within 9-12 months. When computerized, these FDA-cleared algorithms produce a report within 15 seconds after glucose meters are downloaded with recommendations for insulin dose adjustments that the PCP can modify or accept. In a pilot project utilizing these computerized algorithms in poorly controlled insulin-requiring patients who performed remote glucose monitoring, baseline HbA1c levels decreased from 10.0% to 8.1% in 3 months and to 7.6% in 6 months without any clinic visits for adjustment of insulin doses. In a proof-of-concept project utilizing these computerized algorithms in poorly controlled insulin-requiring patients using continuous glucose monitoring (CGM), baseline HbA1c levels decreased from 11.5% to 8.3% over a mean of 3 months. Computerized insulin dose adjustment algorithms and CGM meet both the PCP and patient challenges. These innovations should be strongly considered to effectively decrease HbA1c levels, especially in poorly controlled patients.

A Conversation on an Effective, Straightforward, Quantitative Approach to the Outpatient Use of Insulin

2022 ◽  
Author(s):  
Mayer B. Davidson
Keyword(s):  
Primary Care ◽  
Human Insulin ◽  
Primary Care Providers ◽  
Quantitative Approach ◽  
Insulin Regimen ◽  
Maximal Effect ◽  
Care Providers ◽  
Injection Regimen ◽  
Straightforward Approach

For primary care providers, using insulin can present challenges that can be met by a straightforward approach using the following principles. Depending on when it is injected, each component of the insulin regimen has a maximal effect on a specific period of the 24-hour cycle (e.g., overnight, morning, afternoon, or evening). The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting. Regarding which insulin types and insulin regimens to use, human insulin (NPH and regular) is as effective as analog insulins, and a two-injection intensified insulin regimen is as effective as a four-injection regimen.

Medications Used Routinely in Primary Care to be Dose-Adjusted or Avoided in People With Chronic Kidney Disease: Results of a Modified Delphi Study

2020 ◽  
Vol 54 (7) ◽  
pp. 625-632 ◽  
Author(s):  
Leena Taji ◽  
Marisa Battistella ◽  
Allan K. Grill ◽  
Jessie Cunningham ◽  
Brenda L. Hemmelgarn ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Delphi Study ◽  
Dose Adjustment ◽  
Sglt2 Inhibitor ◽  
Primary Care Providers ◽  
Delphi Panel ◽  
Care Providers ◽  
Modified Delphi

Background: Chronic kidney disease (CKD) affects up to 18% of those over the age of 65 years. Potentially inappropriate medication prescribing in people with CKD is common. Objectives: Develop a pragmatic list of medications used in primary care that required dose adjustment or avoidance in people with CKD, using a modified Delphi panel approach, followed by a consensus workshop. Methods: We conducted a comprehensive literature search to identify potential medications. A group of 17 experts participated in a 3-round modified Delphi panel to identify medications for inclusion. A subsequent consensus workshop of 8 experts reviewed this list to prioritize medications for the development of point-of-care knowledge translation materials for primary care. Results: After a comprehensive literature review, 59 medications were included for consideration by the Delphi panel, with a further 10 medications added after the initial round. On completion of the 3 Delphi rounds, 66 unique medications remained, 63 requiring dose adjustment and 16 medications requiring avoidance in one or more estimated glomerular filtration rate categories. The consensus workshop prioritized this list further to 24 medications that must be dose-adjusted or avoided, including baclofen, metformin, and digoxin, as well as the newer SGLT2 inhibitor agents. Conclusion and Relevance: We have developed a concise list of 24 medications commonly used in primary care that should be dose-adjusted or avoided in people with CKD to reduce harm. This list incorporates new and frequently prescribed medications and will inform an updated, easy to access source for primary care providers.

scholarly journals Providers’ perceptions of barriers and facilitators to disclosure of alcohol use by women veterans

2016 ◽  
Vol 18 (01) ◽  
pp. 64-72 ◽  
Author(s):  
Traci H. Abraham ◽  
Eleanor T. Lewis ◽  
Karen L. Drummond ◽  
Christine Timko ◽  
Michael A. Cucciare
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Women Veterans ◽  
Primary Care Providers ◽  
Barriers And Facilitators ◽  
Matrix Analysis ◽  
Care Providers ◽  
Harmful Drinking ◽  
Problematic Drinking ◽  
Clinic Visits

Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care in order to better identify problematic drinking and enhance provider–patient communication about harmful drinking. Background Women presenting to primary care may be less likely than men to disclose potentially harmful alcohol use. No studies have qualitatively examined the perspectives of primary care providers about factors that affect accurate disclosure of alcohol use by women veterans during routine clinic visits. Methods Providers (n=14) were recruited from primary care at two veterans Administration Women’s Health Clinics in California, United States. An open-ended interview guide was developed from domains of the consolidated framework for implementation science. Interviews elicited primary care providers’ perspectives on barriers and facilitators to women veterans’ (who may or may not be using alcohol in harmful ways) disclosure of alcohol use during routine clinic visits. Interview data were analyzed deductively using a combination of template analysis and matrix analysis. Findings Participants reported six barriers and five facilitators that they perceived affect women veteran’s decision to accurately disclose alcohol use during screenings and openness to discussing harmful drinking with a primary care provider. The most commonly described barriers to disclosure were stigma, shame, and discomfort, and co-occuring mental health concerns, while building strong therapeutic relationships and using probes to ‘dig deeper’ were most often described as facilitators. Findings from this study may enhance provider–patient discussions about alcohol use and help primary care providers to better identify problematic drinking among women veterans, ultimately improving patient outcomes.

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

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
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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