Understanding Adolescent Expressions of Sadness: A Qualitative Exploration

2020 ◽  
Vol 34 (4) ◽  
pp. 321-339
Author(s):  
Daniela A. Terrizzi ◽  
Huma A. Khan ◽  
Allison Paulson ◽  
Zach Abuwalla ◽  
Nitza Solis ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Depressive Disorder ◽  
Primary Care Providers ◽  
Epidemiologic Studies ◽  
Empirical Literature ◽  
Subthreshold Depression ◽  
Care Providers ◽  
Structured Interviews ◽  
Risk For Depression

PurposePrimary care providers are positioned to identify adolescents at risk for depression and prevent major depressive disorder. To identify subthreshold depression, we examined the language adolescents use to describe their symptoms.MethodsAdolescents ages 13–18 with elevated levels on the Center for Epidemiologic Studies Depression (CES-D) scale and/or a history of depression who were part of a large randomized clinical trial to prevent depressive disorder were included. We used content analysis to analyze transcripts of semi-structured interviews.ResultsSaturation was reached at 37 interviews. Adolescents self-identified as African American (N = 15), Hispanic (N = 10), and White (N = 21). Three domains were revealed; external sources of stress, adolescent expressions of sadness, and seeking help and care. Within these domains, 12 distinct themes emerged contextualizing these domains. No variations in the expression of the themes identified for subthreshold depression were found between the three ethno-cultural groups.Implications for PracticeOur study identifies, in adolescents' own words, how adolescents with subthreshold depression express feelings and cope with symptoms, and may guide primary care providers to recognize subthreshold depression early. These findings are a step toward filling the gap in the empirical literature needed to improve identification of adolescents at risk for depression in nonspecialist settings.

scholarly journals Implementation of an Opioid and Benzodiazepine Deprescribing Program for Older Adults in an Outpatient Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 906-906
Author(s):  
Lori Armistead ◽  
Jan Busby-Whitehead ◽  
Stefanie Ferreri ◽  
Cristine Henage ◽  
Tamera Hughes ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Older Adult ◽  
Adult Population ◽  
Primary Care Providers ◽  
The United States ◽  
Outpatient Setting ◽  
Care Providers ◽  
Risk Of Falls

Abstract The United States spends $50 billion each year on 2.8 million injuries and 800,000 hospitalizations older adults (age 65 years and older) incur as the result of falls. Chronic use of central nervous system (CNS)-active medications, such as opioid and/or benzodiazepine (BZD) medications, increases the risk of falls and falls-related injuries in this older adult population. This Centers for Disease Control and Prevention (CDC)-funded randomized control trial uses electronic health record (EHR) data from primary care outpatient clinics to identify older adult patients at risk for falls due to chronic opioid or BZD use. The primary program aim is to test the efficacy of a targeted consultant pharmacist service to reduce the dose burden of these medications in the targeted population. Impact of this intervention on the risk of falls in this population will also be assessed. Licensed clinical pharmacists will review at-risk patients’ medical records weekly and make recommendations through the EHR to primary care providers for opioid or BZD dose adjustments, alternate medications, and/or adjunctive therapies to support deprescribing for approximately 1265 patients in the first two cohorts of intervention clinics. One thousand three hundred eighty four patients in the control clinics will receive usual care. Outcome measures will include reduction or discontinuation of opioids and BZDs and falls risk reduction as measured by the Stop Elderly Accidents, Death and Injuries (STEADI) Questionnaire. Primary care provider adoption of pharmacists’ recommendations and satisfaction with the consult service will also be reported.

scholarly journals Stakeholders’ views on identifying patients in primary care at risk of dying: a qualitative descriptive study using focus groups and interviews

2018 ◽  
Vol 68 (674) ◽  
pp. e612-e620 ◽  
Author(s):  
Robin Urquhart ◽  
Jyoti Kotecha ◽  
Cynthia Kendell ◽  
Mary Martin ◽  
Han Han ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Focus Groups ◽  
Early Identification ◽  
Primary Care Providers ◽  
Descriptive Study ◽  
Comparative Approach ◽  
Team Approach ◽  
Care Providers ◽  
Qualitative Descriptive

BackgroundStrategies have been developed for use in primary care to identify patients at risk of declining health and dying, yet little is known about the perceptions of doing so or the broader implications and impacts.AimTo explore the acceptability and implications of using a primary care-based electronic medical record algorithm to help providers identify patients in their practice at risk of declining health and dying.Design and settingQualitative descriptive study in Ontario and Nova Scotia, Canada.MethodSix focus groups were conducted, supplemented by one-on-one interviews, with 29 healthcare providers, managers, and policymakers in primary care, palliative care, and geriatric care. Participants were purposively sampled to achieve maximal variation. Data were analysed using a constant comparative approach.ResultsSix themes were prevalent across the dataset: early identification is aligned with the values, aims, and positioning of primary care; providers have concerns about what to do after identification; how we communicate about the end of life requires change; early identification and subsequent conversations require an integrated team approach; for patients, early identification will have implications beyond medical care; and a public health approach is needed to optimise early identification and its impact.ConclusionStakeholders were much more concerned with how primary care providers would navigate the post-identification period than with early identification itself. Implications of early identification include the need for a team-based approach to identification and to engage broader communities to ensure people live and die well post-identification.

Abstract P077: Missed Opportunities for Behavioral Counseling by Primary Care Providers

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
John D Omura ◽  
Susan A Carlson ◽  
Prabasaj Paul ◽  
Kathleen B Watson ◽  
Fleetwood Loustalot ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
At Risk ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Counseling ◽  
The Metabolic Syndrome ◽  
Patients At Risk ◽  
Risk Patients ◽  
Counseling Practices

Background: In 2014, the US Preventive Services Task Force recommended adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Hypothesis: We hypothesized that primary care providers (PCPs) who discussed physical activity with most of their at risk patients would have a higher prevalence of offering select components than PCPs who discussed physical activity less frequently. Methods: DocStyles 2015, a Web-based panel survey of 1251 PCPs (response rate=76.8%), assessed physical activity counseling practices with patients at risk for CVD (overweight or obese and with hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome). Results: Overall, 55.9% (SE=1.4) of PCPs discussed physical activity with most of their patients at risk for CVD. Among respondents who discussed physical activity with any at risk patients (N=1244), the prevalence of components offered when they counseled ranged from 92.6% encouraging increased physical activity to 15.8% referring to intensive behavioral counseling (Table). PCPs who discussed physical activity with most at risk patients had a higher prevalence of offering all counseling components assessed than PCPs who discussed physical activity less frequently, except for referring to intensive behavioral counseling where no difference was found. Of all PCPs, 8.4% both discussed physical activity with most of their at risk patients and referred them to intensive behavioral counseling. Conclusion: Just over half of PCPs surveyed discussed physical activity with most patients at risk for CVD. These PCPs more frequently offered select components when they counseled with the exception of referral to intensive behavioral counseling. Both the low levels of counseling and referral to intensive behavioral counseling present important opportunities for improving counseling practices.

Abstract P379: Features to Increase Primary Care Provider Referrals to Intensive Behavioral Counseling for Cardiovascular Disease Prevention

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
John D Omura ◽  
Kathleen B Watson ◽  
Fleetwood V Loustalot ◽  
Janet E Fulton ◽  
Susan A Carlson
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
At Risk ◽  
Task Force ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Counseling ◽  
Patients At Risk ◽  
Risk Patients

Background: The US Preventive Services Task Force recommends adults with certain cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling to promote a healthful diet and physical activity for CVD prevention. However, only 1 in 12 primary care providers (PCPs) currently follow this recommendation. This study assessed system and programmatic features PCPs reported would increase their likelihood of referring patients at risk for CVD to intensive behavioral counseling and whether this varied by the percentage of at-risk patients with whom they discuss physical activity. Methods: DocStyles 2018, a web-based panel survey of PCPs, assessed the percentage of at-risk patients with whom PCPs discuss physical activity and the degree to which select features would increase their likelihood of referring to intensive behavioral counseling. Results: Overall, 60.8% of PCPs discussed physical activity with most of their at-risk patients; 21.8% did so with many and 17.4% with few or some. The proportion of PCPs identifying features as increasing their likelihood of referring to intensive behavioral counseling by a great extent ranged from 24.1% for an automated referral in electronic health records, 35.3% for patient progress reports, 41.5% for the program being accredited or evidence-based, to 67.2% for the program having no cost to the patient (Table). These proportions increased for each feature as the percentage of at-risk patients with whom they discuss physical activity increased. Conclusion: PCPs identified programmatic features (i.e. being accredited and of no cost) as having the greatest influence on their likelihood of referring patients at risk for CVD to intensive behavioral counseling, although this varied by the percentage of at-risk patients with whom they discuss physical activity. Findings suggest that the effectiveness of strategies to improve behavioral counseling referrals by PCPs may depend on their current physical activity counseling practices.

scholarly journals What do primary care providers think about implementing breast cancer survivorship care?

2018 ◽  
Vol 25 (3) ◽  
pp. 196 ◽  
Author(s):  
M. Luctkar-Flude ◽  
A. Aiken ◽  
M.A. McColl ◽  
J. Tranmer
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Early Stage ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Survivorship Care ◽  
Care Providers ◽  
Structured Interviews ◽  
Educational Preparation ◽  
Care Guidelines

Purpose As cancer centres move forward with earlier discharge of stable survivors of early-stage breast cancer (bca) to primary care follow-up, it is important to address known knowledge and practice gaps among primary care providers (pcps). In the present qualitative descriptive study, we examined the practice context that influences implementation of existing clinical practice guidelines for providing such care. The purpose was to determine the challenges, strengths, and opportunities related to implementing comprehensive evidence-based bca survivorship care guidelines by pcps in southeastern Ontario.Methods Semi-structured interviews were conducted with 19 pcps: 10 physicians and 9 nurse practitioners.Results Thematic analysis revealed 6 themes within the broad categories of knowledge, attitudes, and resources. Participants highlighted 3 major challenges related to providing bca survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described 3 major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles.Conclusions We identified several important challenges to implementation of comprehensive evidence-based survivorship care for bca survivors, as well as several strengths and opportunities that could be built upon to address those challenges. Findings from our research could inform targeted knowledge translation interventions to provide support and education for pcps and bca survivors.

Primary Care Providers’ Awareness of Physical Activity-Related Intensive Behavioral Counseling Services for Cardiovascular Disease Prevention

2018 ◽  
Vol 33 (2) ◽  
pp. 208-216 ◽  
Author(s):  
John D. Omura ◽  
Kathleen B. Watson ◽  
Fleetwood Loustalot ◽  
Janet E. Fulton ◽  
Susan A. Carlson
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
At Risk ◽  
Primary Care Providers ◽  
The United States ◽  
Counseling Services ◽  
Care Providers ◽  
Behavioral Counseling ◽  
Local Services

Purpose: The US Preventive Services Task Force recommends that adults at risk for cardiovascular disease (CVD) be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. We assessed primary care providers’ (PCPs) awareness of local physical activity-related behavioral counseling services, whether this awareness was associated with referring eligible patients, and the types and locations of services to which they referred. Design: Cross-sectional survey. Setting: Primary care providers practicing in the United States. Subjects: 1256 respondents. Measures: DocStyles 2016 survey assessing PCPs’ awareness of and referral to physical activity-related behavioral counseling services. Analysis: Calculated prevalence and adjusted odds ratios (aORs). Results: Overall, 49.9% of PCPs were aware of local services. Only 12.6% referred many or most of their at-risk patients and referral was associated with awareness of local services (aOR = 2.81, [95% confidence interval: 1.85-4.25]). Among those referring patients, services ranged from a health-care worker within their practice or group (25.4%) to an organized program in a medical facility (41.2%). Primary care providers most often referred to services located outside their practice or group (58.1%). Conclusion: About half of PCPs were aware of local behavioral counseling services, and referral was associated with awareness. Establishing local resources and improving PCPs’ awareness of them, especially using community–clinical linkages, may help promote physical activity among adults at risk for CVD.

scholarly journals 1114. Identifying and Addressing Knowledge Gaps in Influenza Management with Targeted Continuing Medical Education

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S587-S588
Author(s):  
Katie Robinson ◽  
Jennifer Frederick ◽  
Kevin Lester ◽  
Robert A Esgro
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Medical Education ◽  
Influenza Infection ◽  
Primary Care Providers ◽  
Care Providers ◽  
Knowledge Gaps ◽  
Post Test ◽  
Baseline Knowledge ◽  
The Impact

Abstract Background Influenza represents a year-round disease burden. Despite CDC recommendations, providers do not always effectively test for and treat influenza. To address identified knowledge gaps regarding the care of patients with or at-risk for influenza infection, a series of continuing education (CE) initiatives were implemented for distinct specialty audiences, and the impact of the education on provider knowledge was measured. Methods Between July 2018 and June 2020, Vindico Medical Education provided 35 CME programs (19 web, 14 live, and 2 print) targeted primarily to any of 4 specialty audiences – ID specialists, pulmonologists, emergency medicine providers, or primary care providers (PCPs). Baseline knowledge and educational impact were assessed via pre-and post-test, respectively, across 3 primary topics – testing, mechanisms of therapeutic agents, and treatment. Results As of June 1, 2020, 39,677 healthcare providers participated in the education and 19,209 had obtained CE credit. Baseline knowledge was lowest regarding testing (44%) and antiviral mechanisms (43%), particularly among all but the pulmonology specialists. Average post-test scores were highest among pulmonology (85%) and primary care (85%) providers. The average relative increase in knowledge across all topics and specialties was 69%. A total of 17,480 providers who see on average 8.5 patients per month presenting with flu-like symptoms committed to practice improvements, resulting in approximately 150,000 patients per month who are more likely to receive the latest evidence-based care. Moreover, three months following the education, 68% of providers reported implementing practice improvements, including applying the latest clinical guidelines and recommendations. Conclusion As data regarding new options for the treatment of influenza continues to emerge, CE education on these topics will be needed. This study highlights the efficacy of multimodal CE to address knowledge gaps among providers who see patients with or at-risk for influenza infection. Disclosures All Authors: No reported disclosures

scholarly journals Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 537-537
Author(s):  
Emily Franzosa ◽  
Abraham Brody ◽  
Bruce Leff ◽  
Christine Ritchie ◽  
Bruce Kinosian ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Nurse Managers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Provider Perceptions ◽  
Home Based Primary Care ◽  
Sensitive Topics ◽  
Home Based

Abstract The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nurse practitioners, nurse managers, and social workers at 6 NYC practices (N=13) in spring 2020. We used combined open and focused coding to identify themes. Participants employed both hospital-supported and commercial technological platforms to maintain care during COVID-19. Benefits of video telehealth included improved efficiency, capacity and collaboration between providers. Barriers included patients’ physical, cognitive or technological abilities, dependence on caregivers and aides to facilitate video visits, challenges establishing trust with new patients and addressing sensitive topics over video, and concerns over missing important patient information. Considering patient, clinical, and technological conditions can help optimize telehealth implementation among older homebound adults.

scholarly journals Perceptions of primary care providers on TB care for migrants: a mixed methods study in Portugal

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A M Tavares ◽  
A C Garcia ◽  
A Gama ◽  
A B Abecasis ◽  
M Viveiros ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Online Survey ◽  
Social Protection ◽  
Close Contact ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Foreign Born ◽  
Structured Interviews

Abstract Background Tuberculosis (TB) is one of the main causes of death worldwide. In 2017, the proportion of TB cases among foreign-born individuals in Portugal was of 19%, and this proportion has been increasing. TB control among migrant populations largely depends on the role of the healthcare providers and their close contact with the patients. We aimed to explore the perspectives of primary care providers on the provision of TB care for migrant patients in Portugal. Methods An online survey and semi-structured interviews were conducted with healthcare providers from primary care settings in Portugal. Overall, 120 participated in the survey, and 17 were interviewed. Data from the survey and interviews were analysed using descriptive statistics and thematic analysis, respectively. Results Many participants (36.9%) considered that migrants arrive at an advanced stage of TB disease, and the main reason referred was migrants’ unawareness of the disease and its symptoms. Moreover, half (50.0%) of the providers considered that migrants frequently interrupt treatment, mainly due to their mobility, which causes difficulties in follow-up, and their social isolation that hampers social support. Overall, three main barriers for migrants’ access and use of TB care were mentioned: migrants’ low socioeconomic status, great bureaucracy required to register at services, and obstacles to benefit from social protection. Providers also suggested more training to improve their cultural competence and updating training on TB care. Conclusions Our study have shown social and economic factors that must be addressed to improve migrants’ access and use of TB care. In addition, increased health literacy for migrants and more training initiatives for providers can also contribute to improve TB care for migrants. Key messages Perspectives from primary care providers in Portugal highlighted social, economic, and administrative obstacles hampering the provision of TB care for migrants. With this work we expected to contribute with evidence to improve TB care for migrant patients in Portugal.

scholarly journals General practitioner perceptions of telehealth services in Australia: a qualitative study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0182
Author(s):  
Keshia R De Guzman ◽  
Centaine Snoswell ◽  
Chantelle M Giles ◽  
Anthony C Smith ◽  
Helen H Haydon
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Qualitative Study ◽  
Quality Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Telephone Consultation ◽  
Practitioner Perceptions ◽  
New Research

BackgroundPrimary care providers have been rapidly transitioning from in-person to telehealth care during the 2019 coronavirus (COVID-19) pandemic. There is an opportunity for new research in a rapidly evolving area, where evidence for telehealth services in primary care in the Australian setting remains limited.AimTo explore general practitioner (GP) perceptions on providing telehealth (telephone and videoconsultation) services in primary care in Australia.Design & settingA qualitative study using semi-structured interviews to gain an understanding of GP perceptions on telehealth use in Australia.MethodsGPs across Australia were purposively sampled. Semi-structured interviews were conducted, recorded, and transcribed verbatim for analysis. Transcripts were analysed using inductive thematic analysis to identify initial codes, which were then organised into themes.ResultsFourteen GPs were interviewed. Two major themes that described GP perceptions of telehealth were 1) Existence of business and financial pressures in general practice and 2) providing quality of care in Australia. These two themes interacted with four minor themes: 3) consumer-led care, 4) COVID-19 as a driver for telehealth reimbursement and adoption, 5) refining logistical processes and 6) GP experiences shape telehealth use.ConclusionThis study found that multiple considerations influence GP choice of in-person, videoconference, or telephone consultation mode. For telehealth to be used routinely within primary care settings, evidence that supports the delivery of higher quality care to patients through telehealth and sustainable funding models will be required.

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