Provider Profiling: Specialty Referral Patterns of Primary Care Providers at Dwight David Eisenhower Army Medical Center

2000 ◽  
Author(s):  
Linda W. Fisher
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Provider Profiling ◽  
Army Medical

scholarly journals 1542. Provider Uptake of Extragenital Screening for Gonorrhea and Chlamydia in Active Duty Air Force Members with Incident HIV Diagnosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S770-S771
Author(s):  
Christian C Lamb ◽  
Joseph Yabes ◽  
Shilpa Hakre ◽  
Jason Okulicz
Keyword(s):  
Primary Care ◽  
Hiv Infection ◽  
Air Force ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Previous History ◽  
Primary Care Providers ◽  
Care Providers ◽  
National Guidelines ◽  
Hiv Diagnosis

Abstract Background The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection. Methods All USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C. Results Patients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone. Table 1 Table 2 Conclusion EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening. Disclosures All Authors: No reported disclosures

Presentation and Referral Patterns in Pediatric Closed Hand Fractures

Hand ◽  
2021 ◽  
pp. 155894472110085
Author(s):  
Landis R. Walsh ◽  
Laura C. Nuzzi ◽  
Amir H. Taghinia ◽  
Brian I. Labow
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Old Patients ◽  
Hand Surgeon ◽  
Hand Fractures ◽  
The Mean

Background Although pediatric hand fractures are common and generally have good outcomes, they remain a considerable source of anxiety for non–hand surgeons, who are less familiar with these injuries. We hypothesized that this anxiety may manifest as inefficiency in referral patterns. Methods The records of pediatric patients with isolated, closed hand fractures without concurrent trauma seen at our institution by a hand surgeon between January 2017 and December 2018 were retrospectively reviewed. Results There were 454 patients included; 62.1% were men, and the mean age was 9.6 years at initial encounter. Most patients (89.6%) were treated nonoperatively and incurred few complications (0.5%). Roughly half of all cases (n = 262) initially presented to an outside provider. Of these, 24.0% (n = 64 of 262) were evaluated by 2+ providers before a hand surgeon. Most commonly, these patients were referred from an outside emergency department (ED) to our ED before hand surgeon evaluation (n = 45 of 64). Forty-seven patients required surgery; however, none were performed urgently. Although a greater proportion of 7- to 11-year-old patients saw 2+ providers prior to a hand surgeon ( P = .007), fewer required surgery ( P < .001). Conclusions Pediatric closed hand fractures are mainly treated nonoperatively and nonemergently with generally excellent outcomes. Our data suggest that many patients continue to be referred through the ED or multiple EDs/providers for treatment. These inefficient referral patterns demonstrate the need for better education for ED and primary care providers, as well as better communication between these providers and local pediatric hand surgeons. Advancements in these areas are likely to improve efficiency of care and decrease costs.

Introducing Shared Mental Health Care in Northwestern Ontario: An Analysis of Changing Referral Patterns of Primary Care Providers

2015 ◽  
Vol 34 (2) ◽  
pp. 63-72 ◽  
Author(s):  
Graham Gaylord ◽  
S. Kathleen Bailey ◽  
John M. Haggarty
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Community Mental Health Services ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns

This study describes a shared mental health care (SMHC) model introduced in Northern Ontario and examines how its introduction affected primary care provider (PCP) mental health referral patterns. A chart review examined referrals (N = 4,600) from 5 PCP sites to 5 outpatient community mental health services from January 2001 to December 2005. PCPs with access to SMHC made significantly more mental health referrals (p < 0.001). Two demographically similar PCPs were then compared, one co-located with SMHC. Referrals for depression to non-SMHC mental health services were 1.69 times more likely to be from the PCP not co-located with SMHC (p < 0.001). Findings suggest SMHC increases access to care and decreases demand on existing mental health services.

Diagnosis of retinal detachments by a tele-ophthalmology screening program

2018 ◽  
Vol 25 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Sarah A McCord ◽  
Mary G Lynch ◽  
April Y Maa
Keyword(s):  
Primary Care ◽  
Screening Program ◽  
Medical Center ◽  
Case Reports ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Eye Care ◽  
Primary Care Clinics ◽  
The Usa

In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.

scholarly journals 864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S523-S524
Author(s):  
Genevieve Allen ◽  
Jamie Riddell
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Hiv Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Academic Medical ◽  
Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p &lt; 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p &lt; 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

Project LIFE: A Partnership to Increase Physical Activity in Elders with Multiple Chronic Illnesses

2006 ◽  
Vol 14 (3) ◽  
pp. 324-343 ◽  
Author(s):  
Miriam C. Morey ◽  
Carola Ekelund ◽  
Megan Pearson ◽  
Gail Crowley ◽  
Matthew Peterson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Usual Care ◽  
High Intensity ◽  
Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Significant Group ◽  
Physical Activity Counseling ◽  
Activity Counseling

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group × Time interaction (p= .041) for physical activity frequency and a similar effect for caloric expenditure (p= .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.

scholarly journals Vanderbilt Health Affiliated Network Statin Outreach Service

2020 ◽  
Author(s):  
Christopher Terry ◽  
Erin B. Neal ◽  
Katelynn Daly ◽  
Donna Skupien ◽  
Michelle L. Griffith
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Medical Center ◽  
Tertiary Care ◽  
Primary Care Providers ◽  
Care Group ◽  
Care Providers ◽  
Physician Practices ◽  
Outreach Service ◽  
Academic Center

The Vanderbilt Health Affiliated Network (VHAN) is a collaborative alliance of physicians, health systems, and employers driving a new level of clinical innovation and teamwork to enhance patient care, contain costs, and improve the health of communities in Tennessee and surrounding states. The network includes more than 5,000 clinicians, 60 hospitals, 12 health systems, and hundreds of physician practices and clinics who work together to strengthen communities and improve quality of life across the Southeast through better health. The statin outreach service was piloted in one VHAN practice, the Vanderbilt Medical Group, a large primary care group at Vanderbilt University Medical Center (VUMC). VUMC is a tertiary care academic center. VUMC primary care providers (PCPs) are located in several practice locations, and one location was chosen to pilot this intervention. The PCPs included internal medicine residents and attending physicians. Before this project, there was no clinical pharmacy presence in this practice.

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