scholarly journals Is It “True” Pain? Pain Treatment Discharge Planning for Seriously Injured Patients

2021 ◽  
Vol 31 (1) ◽  
pp. 139-148
Author(s):  
Shoshana V. Aronowitz ◽  
Therese S. Richmond ◽  
Peggy Compton ◽  
Sara F. Jacoby
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Trauma Care ◽  
Pain Treatment ◽  
Physician Assistants ◽  
The United States ◽  
Opioid Overdose ◽  
Care Providers ◽  
Injured Patients

Background: The United States is experi­encing an opioid overdose crisis accounting for as many as 130 deaths per day. As a result, health care providers are increas­ingly aware that prescribed opioids can be misused and diverted. Prescription of pain medication, including opioids, can be in­fluenced by how health care providers per­ceive the trustworthiness of their patients. These perceptions hinge on a multiplicity of characteristics that can include a patient’s race, ethnicity, gender, age, and present­ing health condition or injury. The purpose of this study was to identify how trauma care providers evaluate and plan hospital discharge pain treatment for patients who survive serious injuries.Methods: Using a semi-structured guide from November 2018 to January 2019, we interviewed 12 providers (physicians, nurse practitioners, physician assistants) who pre­scribe discharge pain treatment for injured patients at a trauma center in Philadelphia, PA. We used thematic analysis to interpret these data.Results: Participants identified the impor­tance of determining “true” pain, which was the overarching theme that emerged in analysis. Subthemes included perceptions of the influence of reliable methods for pain assessment, the trustworthiness of their patient population, and the consequences of not getting it right.Conclusions: Trauma care providers de­scribed a range of factors, beyond patient-elicited pain reports, in order to interpret their patients’ analgesic needs. These included consideration of both the risks of under treatment and unnecessary suffering, and overtreatment and contribution to opi­oid overdoses.Ethn Dis. 2021;31(1):139- 148; doi:10.18865/ed.31.1.139

scholarly journals Endoscopy by Nonphysicians

2007 ◽  
Vol 21 (1) ◽  
pp. 17-18 ◽  
Author(s):  
Elaine R Gossman
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
The United States ◽  
Current Status ◽  
Care Providers ◽  
Kaiser Permanente ◽  
Efficient System ◽  
Effective Manner

In 1945, Henry J Kaiser organized a group of physicians to provide health care for shipyard workers and their families. His foundation, Kaiser Permanente (USA), has developed into a prepaid health plan facility serving 8.4 million members in nine states and in Washington, DC, within the United States. It aspires to provide high quality, affordable, integrated health care within an organized, efficient system. A focus on preventive care in a cost-effective manner is a high priority. The Kaiser Permanente northwest region (covering northwest Oregon and southwest Washington) serves nearly one-half of a million members. Our region has utilized nurse practitioners (NPs) and physician assistants (PAs) (allied health care providers) in a variety of capacities for many years. The present paper reviews the background and current status of their role in endoscopy.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

Communication Outcomes in Audiologic Reporting

2011 ◽  
Vol 22 (04) ◽  
pp. 231-241 ◽  
Author(s):  
Virginia Ramachandran ◽  
James D. Lewis ◽  
Mahsa Mosstaghimi-Tehrani ◽  
Brad A. Stach ◽  
Kathleen L. Yaremchuk
Keyword(s):  
Health Care ◽  
Doctoral Students ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Doctoral Student ◽  
Physician Assistants ◽  
Educational Background ◽  
Care Providers ◽  
Provider Type ◽  
Improvement Program

Background: Audiologists often work collaboratively with other health professionals—particularly otolaryngology providers. Some form of written reporting of audiologic outcomes is typically the vehicle by which communication among providers occurs. Quality patient care is dependent on both accurate interpretation of outcomes and effectiveness of communication between providers. Audiologic reporting protocols tend to vary among clinics and providers, with most methods being based on preference rather than standardized definitions. Purpose: As part of an ongoing quality-improvement program, audiologic communication was reviewed by comparing written audiometric reports to descriptions of the audiometric results dictated by otolaryngology providers to evaluate the agreement of communication between provider groups. Research Design: Retrospective chart review. Study Sample: The study sample consisted of 6000 randomly selected charts from a total of 15,625 for the years 2004 and 2008 in the electronic medical record system of a large academic health-care system. Data Collection and Analysis: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist and two audiology doctoral students. Communication occurred among 37 audiology providers and 39 otolaryngology providers. Data collected included rating of congruence or incongruence between reports, normal versus abnormal audiologic outcomes, and the nature of communication disparities. Data also included provider type (audiologist, audiology doctoral student, or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident, physician assistant, or nurse practitioner). Results: Incongruent results were higher among the sample of audiologic evaluations with abnormal outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent, differences in reporting audiometric results stemmed largely from variance in reporting of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and communication of the ear tested (8.6%). Of those cases in which the interpretations of audiology providers differed from those of otolaryngology providers, incongruent results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%), type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and other domains (4.2%). Rates of incongruent results were similar regardless of experience level of the audiology provider (audiologist or audiology doctoral student/CFY) but differed depending on the educational background and experience of the otolaryngology provider. The highest incongruent interpretations were found among residents (32.5%), followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners (21%). Conclusions: This study highlights the need for audiologists to critically evaluate the effectiveness of their communication with other health-care providers and demonstrates the need for evidence-based approaches for interpreting audiologic information and reporting audiologic information to others.

‘Have you ever traded sex for money or drugs?’ Health care providers’ perspectives on sex trafficking risk assessments in clinics

2021 ◽  
pp. 135581962199747
Author(s):  
Lara Gerassi ◽  
Anna Pederson
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Sex Trafficking ◽  
Health Care Organization ◽  
The United States ◽  
Care Staff ◽  
Risk Assessments ◽  
Care Organization ◽  
Care Providers

Objective The United States’ Institute of Medicine recommends that health care providers be aware of sex trafficking (ST) indicators and conduct risk assessments to identify people at risk. However, the challenges among those who conduct such assessments remain largely understudied. The aim of this study was to understand the perceived barriers to ST risk assessment among health care providers in a large health care organization. Methods This study used a collective case study approach in five sites of a large health care organization that serves high-risk populations in a Midwestern state. Twenty-three in-depth, semi-structured interviews were conducted with health care staff (e.g. medical assistants, nurse practitioners). Two research team members conducted independent deductive coding (e.g. knowledge of ST), and inductive coding to analyse emerging themes (e.g. responses to ST risk or commercial sex disclosures, provider role ambiguity). Results Although staff routinely screened by asking ‘Have you ever traded sex for money or drugs?’, participants primarily described avoiding further discussions of ST with adult patients because they (1) aimed to be non-judgmental, (2) viewed following up as someone else’s job, and/or (3) lacked confidence to address ST concerns themselves, particularly when differentiating sex work from ST. Differences all emerged based on clinical context (e.g. urban location). Conclusions There may be missed opportunities to assess patients for ST risk and use harm-reduction strategies or safety plan to address patients’ needs. Implications for practice, policy, and future research are discussed.

Practice gaps and challenges integrating new immuno-oncology agents in the treatment of cancer patients in the United States: A mixed-method study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11028-11028
Author(s):  
Neal E. Ready ◽  
Aparna Raj Parikh ◽  
Patrice Lazure ◽  
Morgan Peniuta ◽  
Marianne Davies ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Cancer Patients ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Predictive Biomarkers ◽  
The United States ◽  
Care Providers ◽  
Immune Biomarkers

11028 Background: Previous research has indicated challenges integrating new immuno-oncology agents (IOAs) and predictive immune biomarkers into practice. Barriers, clinical gaps and underlying causalities explaining these challenges, however, are poorly understood. Methods: A mixed-methods educational needs assessment was conducted with physicians from 6 specialties (oncology, interventional radiology, pathology, pulmonology, emergency medicine and rheumatology), clinical pharmacists, physician assistants and advanced nurse practitioners involved in the care of cancer patients in the United States. Semi-structured interviews and discussion groups were thematically analyzed to identify challenges, barriers and underlying causalities. Qualitative findings subsequently informed the development of online surveys, which served to quantify findings. The following findings pertain to oncologists. Results: A total of 660 health care providers participated in the study, in which 17 interviews and 88 surveys were completed with oncologists. Seventy-two percent reported sub-optimal knowledge of the interactions between IOAs and the tumor’s micro-environment, while 62% reported sub-optimal skills determining which IOA to select based on this information. Oncologists reported sub-optimal knowledge of best practices for using IOAs to treat cancer in presence of an autoimmune disease (74%-80% depending on condition), and sub-optimal skills weighing the risks and benefits of prescribing IOAs for these profiles (66%-77%). In addition, 50% of oncologists reported feeling overwhelmed by the volume of new IOAs being made available. Many oncologists expressed doubts regarding the clinical benefit (59%) and innovative nature (43%) of emerging IOAs. Finally, 46% reported limited skills identifying viable treatment options based on pharmacodiagnostic test reports. Barriers to having predictive biomarkers inform treatment decisions included sub-optimal communication between specialists regarding specimen requirements and desired biomarker information. Conclusions: This study demonstrates the need to further support healthcare professionals as they face challenges integrating new IOAs and predictive immune biomarkers into practice. Given the wide array of IOAs becoming available each year, addressing the knowledge, skills, confidence and attitude gaps identified in this study could help improve health care delivery and potentially optimize outcomes for cancer patients.

Unusual Drugs of Abuse in Chronic Pain Patients

2017 ◽  
Author(s):  
Alan D. Kaye ◽  
Elyse Cornett ◽  
Charles Fox ◽  
Shilpadevi Patil ◽  
Harish Siddaiah ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Drug Abuse ◽  
Health Care Providers ◽  
Drugs Of Abuse ◽  
Pain Treatment ◽  
The United States ◽  
Care Providers ◽  
Chronic Pain Patients ◽  
Pain Patients

Chronic pain occurs in one third of the American population. Management of chronic pain is a growing area in health care; however, there is a dilemma for health care providers to treat the chronic pain of individuals who have known current or suspected drug abuse or addiction. Even if the individual is not addicted to opiates or prescription pain medications, it is possible to become addicted to a new substance. The National Institutes of Health considers drug addiction a neurophysiologic disease, and as of 2014, 24.6 million people in the United States abuse drugs. As more patients are seeking treatment for chronic pain, health care providers are seeing an increase in patients who have a history of drug abuse or addiction, and it is imperative that health care providers are aware of how best to care for these patients. This review discusses chronic pain and the drugs that are typically used to treat chronic pain, as well as drugs that have been reported to be abused in chronic pain patients. There are limited or no data available on the more recent designer drugs, such as bath salts, K2 (spice), and even common drugs of abuse, such as methylenedioxymethamphetamine (MDMA). More research should be conducted on what drugs are abused in chronic pain patients, especially nonopioid drugs such as stimulants. This information would help educate health care providers and create better pain treatment regimens for patients who abuse drugs. Key words: chronic pain, drug abuse, marijuana, methamphetamine, opioids

Unusual Drugs of Abuse in Chronic Pain Patients

2017 ◽  
Author(s):  
Alan D. Kaye ◽  
Elyse Cornett ◽  
Charles Fox ◽  
Shilpadevi Patil ◽  
Harish Siddaiah ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Drug Abuse ◽  
Health Care Providers ◽  
Drugs Of Abuse ◽  
Pain Treatment ◽  
The United States ◽  
Care Providers ◽  
Chronic Pain Patients ◽  
Pain Patients

Chronic pain occurs in one third of the American population. Management of chronic pain is a growing area in health care; however, there is a dilemma for health care providers to treat the chronic pain of individuals who have known current or suspected drug abuse or addiction. Even if the individual is not addicted to opiates or prescription pain medications, it is possible to become addicted to a new substance. The National Institutes of Health considers drug addiction a neurophysiologic disease, and as of 2014, 24.6 million people in the United States abuse drugs. As more patients are seeking treatment for chronic pain, health care providers are seeing an increase in patients who have a history of drug abuse or addiction, and it is imperative that health care providers are aware of how best to care for these patients. This review discusses chronic pain and the drugs that are typically used to treat chronic pain, as well as drugs that have been reported to be abused in chronic pain patients. There are limited or no data available on the more recent designer drugs, such as bath salts, K2 (spice), and even common drugs of abuse, such as methylenedioxymethamphetamine (MDMA). More research should be conducted on what drugs are abused in chronic pain patients, especially nonopioid drugs such as stimulants. This information would help educate health care providers and create better pain treatment regimens for patients who abuse drugs. Key words: chronic pain, drug abuse, marijuana, methamphetamine, opioids

The Special Perils of Being Old and Sick in Prison

2020 ◽  
Vol 32 (5) ◽  
pp. 276-284
Author(s):  
William J. Jefferson
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
The United States ◽  
United States Constitution ◽  
Care Providers ◽  
Medical Practitioners ◽  
Medical Needs ◽  
Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States

2020 ◽  
Vol 59 (04/05) ◽  
pp. 162-178
Author(s):  
Pouyan Esmaeilzadeh
Keyword(s):  
United States ◽  
Health Care ◽  
Health Information ◽  
Health Care Providers ◽  
Information Exchange ◽  
The United States ◽  
Exchange Mechanism ◽  
Care Providers ◽  
Security Risks ◽  
Direct Exchange

Abstract Background Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. Objectives Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. Methods In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. Results Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. Conclusion This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.

scholarly journals Is Video Laryngoscopy the Optimal Tool for Successful Intubation in a Neonatal Simulation Setting? A Single-Center Experience

2020 ◽  
Vol 10 (01) ◽  
pp. e5-e10 ◽  
Author(s):  
Iram Musharaf ◽  
Sibasis Daspal ◽  
John Shatzer
Keyword(s):  
Health Care ◽  
Success Rate ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Clinical Training ◽  
Video Laryngoscopy ◽  
Care Providers ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Endotracheal intubation is a skill required for resuscitation. Due to various reasons, intubation opportunities are decreasing for health care providers. Objective To compare the success rate of video laryngoscopy (VL) and direct laryngoscopy (DL) for interprofessional neonatal intubation skills in a simulated setting. Methods This was a prospective nonrandomized simulation crossover trial. Twenty-six participants were divided into three groups based on their frequency of intubation. Group 1 included pediatric residents; group 2 respiratory therapists and transport nurses; and group 3 neonatal nurse practitioners and physicians working in neonatology. We compared intubation success rate, intubation time, and laryngoscope preference. Results Success rates were 100% for both DL and VL in groups 1 and 2, and 88.9% for DL and 100% for VL in group 3. Median intubation times for DL and VL were 22 seconds (interquartile range [IQR] 14.3–22.8 seconds) and 12.5 seconds (IQR 10.3–38.8 seconds) in group 1 (p = 0.779); 17 seconds (IQR 8–21 seconds) and 12 seconds (IQR 9–16.5 seconds) in group 2 (p = 0.476); and 11 seconds (IQR 7.5–15.5 seconds) and 15 seconds (IQR 11.5–36 seconds) in group 3 (p = 0.024). Conclusion We conclude that novice providers tend to perform better with VL, while more experienced providers perform better with DL. In this era of decreased clinical training opportunities, VL may serve as a useful tool to teach residents and other novice health care providers.

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