Integrating Oral Health Screening Into Primary Care to Promote Dental Referrals in Maryland

2020 ◽  
Vol 13 (1) ◽  
pp. 42-63
Author(s):  
Susan Scherr ◽  
Shannon Idzik ◽  
David Williams
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Vulnerable Populations ◽  
Primary Care Providers ◽  
Health Screening ◽  
Health Needs ◽  
Project Leader ◽  
Care Providers ◽  
Improvement Project ◽  
Care Clinic

BackgroundVulnerable populations are more likely to present to non-dental healthcare locations with dental issues. Oral health screening in those settings, such as primary care, is an effective way to identify individuals with unmet oral health needs and facilitate dental referrals.ObjectiveTo implement and evaluate the integration of oral health screening at an outpatient transitional primary care clinic in Maryland.MethodsThe quality improvement project occurred over 12 weeks. The project leader obtained support from institutional stakeholders, collaborated with dentistry, provided evidence-based resources, and developed referral strategies. Patients received a pre-screen at registration. Primary care providers used an oral health assessment tool (OHAT) for further screening and/or gave a dental referral.ResultsApproximately 108 patients completed pre-screen: 73% had not seen dentist in the past 12 months; 12% had current oral problem or pain; 53% had no established dentist; <5% had a completed OHAT; 20% referred to existing dentist; 56% received dental resource listing.ConclusionsOral health disparity continues to exist among vulnerable populations.Implications for NursingOral screening by advanced practice nurses is an effective way to identify patients with unmet oral health needs and to promote dental referral.

Abstract P119: Assessment of Cardiovascular Health among Older Women in Primary Care

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Randi E Foraker ◽  
Abigail B Shoben ◽  
Marcelo A Lopetegui ◽  
Albert M Lai ◽  
Philip R Payne ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Health ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Continuous Variables ◽  
Care Providers ◽  
Care Clinic ◽  
Female Patients ◽  
Life’S Simple 7 ◽  
Life's Simple 7

In 2010, the American Heart Association (AHA) launched the groundbreaking Life’s Simple 7™ campaign to improve the cardiovascular health (CVH) of Americans. Five of the 7 [smoking, body mass index (BMI), blood pressure, cholesterol, and glucose] are commonly recorded in electronic medical records (EMRs). Although CVH components are often included in patient-provider discussions, to date there has been no formal attempt to characterize CVH from EMR data. We characterized the CVH of 160 female patients ages 65 and older seen in an Ohio State University primary care clinic from May 1 through July 31, 2013. We defined CVH according to AHA criteria, and assigned each behavior and factor to either an “ideal”, “intermediate”, or “poor” category. We calculated an overall CVH score ranging from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. We calculated means and standard deviations (sd) of continuous variables and report frequencies within CVH categories. Patients were an average of 74.2 (sd=6.7) years old, and 35% were black. Among the 126 (79%) women who had data available on all 5 factors, mean CVH score was 6.0 (sd=1.3). Among all women, the mean fractional score (actual score/maximum possible) was 0.63 (sd=0.14), and it did not differ significantly by race. Greater than 10% of data were missing for BMI (13%) and cholesterol (11%). Figure 1 shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor. We have demonstrated that a majority of Life’s Simple 7™ components are easily queried from EMRs. These data indicate that older female patients seen in the primary care setting have less-than-ideal CVH. There exists great potential to leverage the EMR for patient-provider communication and engagement around CVH. As such, we are implementing an automated assessment of CVH targeted to primary care providers and their older female patients. Following the intervention, CVH values will be compared to these baseline data. Figure 1. Percent of older female patients (n=160) who were seen in a primary care clinic by category of CVH: behaviors and factors*. *Diabetes was defined as either treated by a glucose-lowering medication (intermediate) or not (ideal), since over 90% of data were missing for fasting glucose or hemoglobin A1c.

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.

HIV-positive patients' discussion of oral health with their HIV primary care providers in Miami, Florida

AIDS Care ◽  
2009 ◽  
Vol 21 (12) ◽  
pp. 1578-1584 ◽  
Author(s):  
Margaret Pereyra ◽  
Lisa R. Metsch ◽  
Lauren Gooden
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Primary Care Providers ◽  
Hiv Positive ◽  
Care Providers ◽  
Hiv Primary Care

scholarly journals A Primary Care-based Collaborative Hepatitis C Clinic: Clinical Structure and Virologic Outcomes with Direct Acting Antiviral Therapy

2016 ◽  
Vol 3 (1) ◽  
pp. 70-78
Author(s):  
Samuel B. Ho ◽  
Adrian Dollarhide ◽  
Hilda Thorisdottir ◽  
James Michelsen ◽  
Christine Perry ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Adverse Events ◽  
Nurse Practitioners ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Number Of Patients ◽  
Direct Acting ◽  
Collaborative Primary Care

Background: Currently 4 million persons in the US have active hepatitis C virus (HCV) infection and most have never successfully completed antiviral treatment. Newer therapies herald potential for wider uptake and acceptance of treatment, but the number of hepatology specialists is limited and newer models are needed to increase access to care. The aim of this study is to describe a collaborative primary care-based clinic for HCV treatment. Methods: Retrospective analysis of a collaborative primary care clinic developed for the evaluation and treatment of patients with chronic hepatitis C at one VA medical center. A half-day clinic was organized with 4 primary care MDs, 2 hepatologists, 2 nurse practitioners, and a co-located psychiatrist, pharmacist and nurse case manager. Clinic productivity and outcomes related to the number of patients who initiated and completed treatment with direct acting antivirals (DAA) and pegylated interferon and ribavirin were evaluated. Results: In this 18 month period, the clinic had 1890 confirmed HCV registry patients and 1690 clinic visits. 74 HCV genotype 1 patients initiated DAA therapy. Primary care providers treated 47 patients (32% cirrhotic) and hepatologists treated 27 patients (48% cirrhotic). Final SVR rate was 54.6% (39.2% cirrhotics vs. 65.2% noncirrhotics). SVR rates were higher in patients with primary care providers (61.7%) vs. hepatologists (44.4%). Despite numerous adverse events, early treatment termination for adverse events occurred in 5.3% vs. 21.3% for virologic non-response. Multivariate analysis revealed no significant differences between primary care and hepatology for SVR and treatment discontinuations. Conclusion: This clinic demonstrated effectiveness and safety with DAA therapy. This illustrates potential for a primary care based collaborative clinic, which will be crucial for expanding access to effective HCV care.

scholarly journals Reaching Out to Rural Caregivers and Veterans with Dementia Utilizing Clinical Video-Telehealth

2018 ◽  
Author(s):  
James S. Powers ◽  
Jennifer Buckner
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Mental Health Provider ◽  
Care Providers ◽  
Community Based ◽  
Term Care ◽  
Care Clinic

Context: A clinical video telehealth (CVT) program was implemented improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC&rsquo;s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician &ndash; social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of 1 to 2 CVT encounters originating at their local CBOC lasting 20 to 30 minutes. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient-caregiver pairs, followed for a mean of 15 (1-36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of 8 medications, and resided at a distance of 103 (76-148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusion: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas.

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