scholarly journals Evaluation of a Primary Care Weight Loss Program

2017 ◽  
Vol 10 (1) ◽  
pp. 79-84
Author(s):  
Callie Schlicht ◽  
Christine Shaw ◽  
Kristin Haglund ◽  
Susan Breakwell
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Nurse Practitioners ◽  
Chart Review ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Weight Loss Program ◽  
Strong Positive Correlation ◽  
Care Clinic

Nurse practitioners at a primary care clinic established a weight loss program to address high obesity rates among their African American patients. Interviews and a retrospective chart review were used to evaluate the weight loss program. Number of appointments was the only significant predictor of weight loss, and there was a strong positive correlation between total number of appointments and weight loss. The overall view of the program was positive. This description and evaluation of the program may be useful to nurse practitioners seeking to develop an individualized effective weight loss intervention for African Americans within a primary care setting.

scholarly journals Advance Care Planning in a Geriatric Primary Care Clinic: A Retrospective Chart Review

2018 ◽  
Vol 36 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Ariana Barkley ◽  
Mike Liquori ◽  
Amy Cunningham ◽  
John Liantonio ◽  
Brooke Worster ◽  
...  
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Chart Review ◽  
Demographic Variable ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Power Of Attorney ◽  
Care Clinic ◽  
Advance Care

Purpose: Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. Methods: A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts. The sample consisted of patients aged 65 and older who were seen in the clinic from January 1, 2015, to December 31, 2016. Charts were reviewed for ACP documentation and data regarding age, gender, race, religion, comorbidities (end-stage renal disease, congestive heart failure, cancer, and dementia), recent hospitalizations, and visit type. Results: Ninety-eight charts were reviewed (n = 98). Nine patients (9.18%) had an advance directive (AD) or power of attorney (POA) available within their EMR. Twenty-five patients (25.5%) had provider notes documenting that they have an AD, POA, or preferred health-care decision maker; however, no documents were available. The remaining 64 (65.3%) patients had no evidence of ACP documentation within their EMR. Age was the only demographic variable associated with completion of an AD ( P = .038). Discussion: The rate of ACP documentation (34.6%) was lower than the average among US adults aged 65 and over (45.6%); further, most patients with ACP documentation did not have an AD or POA on file. The authors plan to reevaluate ACP statistics in the same office following a future intervention.

scholarly journals Providing food to patients in primary care to induce weight loss: a systematic literature review

2021 ◽  
pp. bmjnph-2020-000195
Author(s):  
Lauren Ball ◽  
Mari Sommerville ◽  
Jennifer Crowley ◽  
Zoe Calleja ◽  
Katelyn Barnes
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Assessment Tool ◽  
Public Health Practice ◽  
Primary Care Clinic ◽  
Or Education ◽  
Eligibility Criteria ◽  
High Quality Research ◽  
Care Clinic ◽  
Primary Care Settings

PurposePrimary care is the ideal setting to promote weight management, warranting innovative ways to support patients. This systematic review aimed to determine whether providing food to patients in primary care can help to reduce body weight.MethodsFour databases were searched for studies that aimed to elicit weight loss by directly providing foodstuffs and/or supplements to patients in primary care settings. Interventions with adults of any gender or race were included. Interventions that involved other components such as exercise classes or education sessions were excluded. The methodological quality of each study was appraised using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.ResultsFour heterogeneous studies met the eligibility criteria, representing 476 adults. Two studies used meal-replacement products but differed in length and intensity, another study provided green tea and vitamin E supplementation, and the final study provided vouchers for use at a farmers’ market hosted at a primary care clinic. Interventions ranged in length from 4 to 13 weeks. Three of the four studies observed weight loss in some form and all studies observed at least one other improvement in a health outcome such as waist circumference, blood pressure or fasting insulin levels.ConclusionsA small yet notable body of literature supports the concept of providing food to patients in primary care settings to support weight loss. Further, high-quality research is needed on the efficacy and cost-effectiveness of this approach to ultimately inform policy initiatives for primary care.

Prevalence of advance care planning in a resident run clinic in an underserved community.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24067-e24067
Author(s):  
Swetha Ann Alexander ◽  
Vinay Mathew Thomas ◽  
David Wu ◽  
Radhika Kulkarni ◽  
William Rabitaille
Keyword(s):  
Primary Care ◽  
African American ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Care Clinic ◽  
Underserved Community ◽  
Advance Care ◽  
End Stage

e24067 Background: Advance Care Planning (ACP) ensures that patients receive care that is in line with their values and preferences. ACP is best done in the outpatient setting. Despite recognizing the importance of ACP, the rates of ACP completion continue to be low. We conducted a retrospective study to determine the rates of ACP in a resident run primary care clinic in Hartford, Connecticut, which serves the underserved community. We looked at patient characteristics to find correlation with ACP completion. We also aimed to determine the reasons which could decrease the completion of ACP. Methods: This was a retrospective chart review. Patients who met any of the inclusion criteria [i) Age>65 ii) End stage renal disease on dialysis iii) Metastatic/Recurrent cancer iv) End stage heart failure v) COPD Gold stage D] and were seen in the primary care clinic from September 1, 2019 to December 31, 2019 were selected. Their charts were reviewed to see if ACP was documented during primary care visits over the past two years. The demographics of the patients were noted. Subsequently, a survey was distributed to residents to determine the possible causes of low rates of ACP discussion. Results: The characteristics of the 373 patients included in the study are shown in Table 1. Only 14 (3.8%) of the 373 had documentation of ACP during their primary care visits. The characteristics of the 14 patients in whom ACP was done are as follows: Sex- Female 9/14 (64%); Ethnicity- Hispanic 10/14 (71%), African American 4/14 (29%); Religious Affiliation- Christian 13/14 (93%), None 1/14 (7%); Married/Partner 2/14 (14%). Patient demographics including sex (p 0.6), religious beliefs (p 0.8), and marital status (p 0.6) did not show any correlation with the likelihood of ACP completion. Of the 31 residents who answered the survey, the most commonly listed barriers to ACP completion were the following: lack of time to conduct these discussions (94%), forgetting to conduct ACP discussions (48%), and lack of training (19%). All the residents believed that ACP discussion was beneficial to patients and medical providers. Conclusions: The rates of ACP planning in our clinic are much lower than the national average. African American and Hispanics, who make up the majority of our clinic population, traditionally have had low rates of ACP completion. This is an important issue that needs to be addressed. Advance care planning training should be also be strengthened during residency. [Table: see text]

Abstract P134: Selected Social Determinants Of Health And Hypertension For Patients Of An Urban Community Primary Care Clinic

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Melvin R Echols ◽  
Paula Pollard-Thomas ◽  
Henry Nuss ◽  
Heartley Egwuogu ◽  
Kristen Hobbs ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
African American ◽  
Food Insecurity ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Clinic ◽  
Financial Strain ◽  
Care Clinic ◽  
Stage 1

Background: Hypertension (HTN) is the most potent cardiovascular disease worldwide and a major public health concern in the U.S. Although Social Determinants of Health (SDoH) are associated with HTN, it is unclear whether these indicators are routinely captured in the primary care setting. We sought to examine the prevalence of any HTN and its association with captured SDoH for new patients (pts) presenting to an urban community primary care clinic for 2019 and 2020. Methods and Results: We identified a cohort-based, cross-sectional sample of 2,577 new pts ≥ 18 years of age in a community clinic in Atlanta, GA, between Jan 2019 and Dec 2020. Electronic health records were reviewed to determine the rate of selected SDoH indicators (financial strain, transportation, medical transportation, and food insecurity) captured at any time and the presenting blood pressure for all new patients. Blood pressure was classified as follows: normal, systolic BP/diastolic BP (SBP/DBP) ≤120/80 mmHg, elevated SBP 120-129mmHg and DBP<80mm, stage 1 SBP 130-139mmHg or DBP 80-90mmHg, and stage 2 SBP ≥ 140mmHg+ or DBP 90mmHg+. Likelihood-ratio Chi-square tests were analyzed to detect an association between SDOH and stages of HTN. Of the 2,577 pts seen, 93% were African American, 72% were female, 59% were single, 77% had BMI ≥ 25, and 85% were insured. Only 41% (n=1062) pts had information of at least one SDoH measure in the entire cohort. Of the SDoH domains evaluated, financial strain and food insecurity were more likely in new pts with stage 1 HTN or higher (χ2= 16.0, df=8, p=0.04; χ2= 27.7, df=12, p=0.006). Conclusion: Routine assessments of SDoH for African American pts presenting for new pt visits are suboptimal in the primary care setting. However, financial strain and food insecurity are significantly associated with stage 1 and 2 HTN in this population. Standardization of intake processes is essential to increase the collection of SDoH indicators and may ultimately guide secondary prevention strategies for HTN interventions.

scholarly journals Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

2020 ◽  
Vol 11 ◽  
pp. 215013272090837
Author(s):  
Elizabeth Gregg ◽  
Carrie Linn ◽  
Emma Nace ◽  
Lillian Gelberg ◽  
Brianna Cowan ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Root Cause ◽  
Preexposure Prophylaxis ◽  
Provider Knowledge ◽  
Improve Access

Objective: Oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV-1 acquisition, yet it is underutilized among at-risk populations. In this pilot quality improvement (QI) initiative, we sought to identify barriers to PrEP implementation and create interventions to improve access to PrEP in a primary care clinic for homeless veterans. Methods: The setting was a large homeless primary care clinic at the Veterans Affairs in an urban area with high HIV prevalence. A root cause analysis was performed to identify barriers to PrEP expansion in the primary care clinic. Targeted interventions to improve provider knowledge and patient access to PrEP were implemented by the QI team. Results: Root cause analysis revealed 3 primary barriers to PrEP expansion in the primary care clinic: institutional limitations for prescribing PrEP, inconsistent screening and recognition of eligible patients by clinic staff, and lack of clinic workflow processes to support PrEP prescription. A multidisciplinary focus group found low levels of PrEP awareness and knowledge, with only 22% of providers reporting comfort discussing PrEP with patients. This improved to 40% of providers following targeted clinic educational interventions. The QI team also developed a pathway for primary care providers to obtain institutional PrEP prescribing privileges and used work groups to develop clinic workflows and protocols for PrEP. At the end of the intervention, at least 50% of primary care providers in the clinic had initiated PrEP in a new patient. Conclusions: We describe a multidisciplinary QI model to implement PrEP within a primary care setting serving Veterans and persons experiencing homelessness. Our program successfully addressed provider knowledge deficits and improved primary care capacity to prescribe PrEP. The primary care clinic can be a viable and important clinical setting to improve access to PrEP for HIV prevention, especially for vulnerable populations.

The effect of a primary care-based Medical Weight Loss Program on weight loss and anthropomorphic metrics

2020 ◽  
Author(s):  
Vivienne A Rose ◽  
Elena N Klyushnenkova ◽  
Min Zhang ◽  
Verlyn O Warrington
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Care Setting ◽  
Primary Care Practice ◽  
Primary Care Setting ◽  
Weight Loss Program ◽  
Care Practice ◽  
Control Group ◽  
Baseline Weight ◽  
Medical Weight Loss

Abstract Background Diet and lifestyle intervention programs have been shown to be effective in decreasing obesity/overweight and many associated comorbidities in specialty research settings. There is very little information however as to the efficacy of such programs conducted in usual/typical primary care practices. We analysed effectiveness of the Medical Weight Loss Program (MWLP) designed to specifically address overweight/obesity in the setting of an urban academic primary care practice. Objective To determine whether participation in the MWLP within a general primary care setting can result in weight loss. Methods A retrospective medical chart review of patients treated in MWLP and a control group of patients with obesity receiving regular care in the general primary care setting. From the practice database (1 April 2015–31 March 2016), 209 patients (≥18 years old) who participated in the MWLP were identified; 265 controls were selected from the remaining population based on the presence of the obesity-related diagnoses. Results MWLP patients lost on average 2.35 ± 5.88 kg in 6 months compared to their baseline weight (P &lt; 0.0001). In contrast, the control group demonstrated a trend of gaining on average 0.37 ± 6.03 kg. Having three or more visits with the MWLP provider within 6 months after program initiation was the most important factor associated with successful loss of at least 5% of the baseline weight. Weight loss also correlated with a decrease in abdominal girth. Conclusion MWLP integrated into the general primary care practice may potentially be an effective model for managing obesity and related morbidities.

scholarly journals Evaluation of the Integrated Primary Care Clinic Into Behavioral Care Setting

2018 ◽  
Vol 10 (11) ◽  
pp. 169
Author(s):  
Jarman Alqahtani ◽  
Daniel West
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Behavioral Health Care ◽  
Patient Survey ◽  
Care Clinic ◽  
New Model ◽  
Care Services ◽  
Primary Care Services ◽  
Short Period

OBJECTIVE: The study has aimed to explore the process, outcomes of primary care, and barriers that make the primary care access difficult for the patients. DESIGN &amp; SETTING: The study has utilized quantitative and qualitative approach and collected data from the clinic and patients. Patient survey was conducted to ask the patients about the possible reasons, which prevent them from accessing primary care services in the past. RESULTS: The mean age of patients was 46 years, among which majority (65%) were males. The results showed that education was the significant factor in determining the health status of a specific population. The clinic was successfully integrated into the behavioral health care setting. Many patients had been enrolled in the clinic for the first time with the help of a care manager that facilitated the identification of those patients. Most commonly, transportation was the main barrier for those populations for not seeking the primary care services. Emergency department use significantly declined after the implementation of the new model that reduced the cost of health services dramatically in a short period of time i.e. 6 months. CONCLUSION: There are susceptical gaps within the fragmented care due to high rates of physical health conditions. Majority of the patients in the study sample were satisfied with the new model; therefore, the new model was termed as effective and efficient.

scholarly journals Attributing Patients to Pediatric Residents Using Electronic Health Record Features Augmented with Audit Logs

2020 ◽  
Vol 11 (03) ◽  
pp. 442-451
Author(s):  
Mark V. Mai ◽  
Evan W. Orenstein ◽  
John D. Manning ◽  
Anthony A. Luberti ◽  
Adam C. Dziorny
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Real Life ◽  
Specific Model ◽  
Care Clinic ◽  
Pediatric Residents ◽  
Patient Interactions ◽  
C Statistic ◽  
Data Elements

Abstract Objective Patient attribution, or the process of attributing patient-level metrics to specific providers, attempts to capture real-life provider–patient interactions (PPI). Attribution holds wide-ranging importance, particularly for outcomes in graduate medical education, but remains a challenge. We developed and validated an algorithm using EHR data to identify pediatric resident PPIs (rPPIs). Methods We prospectively surveyed residents in three care settings to collect self-reported rPPIs. Participants were surveyed at the end of primary care clinic, emergency department (ED), and inpatient shifts, shown a patient census list, asked to mark the patients with whom they interacted, and encouraged to provide a short rationale behind the marked interaction. We extracted routine EHR data elements, including audit logs, note contribution, order placement, care team assignment, and chart closure, and applied a logistic regression classifier to the data to predict rPPIs in each care setting. We also performed a comment analysis of the resident-reported rationales in the inpatient care setting to explore perceived patient interactions in a complicated workflow. Results We surveyed 81 residents over 111 shifts and identified 579 patient interactions. Among EHR extracted data, time-in-chart was the best predictor in all three care settings (primary care clinic: odds ratio [OR] = 19.36, 95% confidence interval [CI]: 4.19–278.56; ED: OR = 19.06, 95% CI: 9.53–41.65' inpatient: OR = 2.95, 95% CI: 2.23–3.97). Primary care clinic and ED specific models had c-statistic values > 0.98, while the inpatient-specific model had greater variability (c-statistic = 0.89). Of 366 inpatient rPPIs, residents provided rationales for 90.1%, which were focused on direct involvement in a patient's admission or transfer, or care as the front-line ordering clinician (55.6%). Conclusion Classification models based on routinely collected EHR data predict resident-defined rPPIs across care settings. While specific to pediatric residents in this study, the approach may be generalizable to other provider populations and scenarios in which accurate patient attribution is desirable.

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