Assessment of primary care practitioners’ attitudes and interest in pharmacogenomic testing

2020 ◽  
Vol 21 (15) ◽  
pp. 1085-1094
Author(s):  
D Max Smith ◽  
Tarlan Namvar ◽  
Ryan P Brown ◽  
T Blaise Springfield ◽  
Beth N Peshkin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Care Providers ◽  
Test Results ◽  
Care Providers ◽  
Primary Care Practitioners

Aims: Identify the attitudes and interests of primary care providers (PCPs) in applying clinical pharmacogenomics (PGx) test results. Materials & methods: A questionnaire was designed and then disseminated to PCPs across the MedStar Health System. Results: Ninety of 312 (29%) PCPs responded and were included in analyses. Seventy-six (84%) had heard of PGx and 12 (13%) previously ordered PGx testing. Most, 68 (76%), believed PGx can improve care; however, a minority, 23 (26%), reported confidence in using PGx in prescribing decisions. Sixty-four (70%) wanted a pharmacist consultation. PCPs desired PGx for antidepressants (75%), proton pump inhibitors (72%) and other medications. Conclusion: Most PCPs felt unprepared to interpret PGx results and desired pharmacist consultations. These data can inform future PGx implementations with PCPs.

Systematic review of barriers and enablers to the delivery of palliative care by primary care practitioners

2019 ◽  
Vol 33 (9) ◽  
pp. 1131-1145 ◽  
Author(s):  
Mariko L Carey ◽  
Alison C Zucca ◽  
Megan AG Freund ◽  
Jamie Bryant ◽  
Anne Herrmann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Palliative Care ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Healthcare Services ◽  
Care Providers ◽  
Eligibility Criteria ◽  
Barriers And Enablers ◽  
Primary Care Practitioners

Background: There is increasing demand for primary care practitioners to play a key role in palliative care delivery. Given this, it is important to understand their perceptions of the barriers and enablers to optimal palliative care, and how commonly these are experienced. Aim: To explore the type and prevalence of barriers and enablers to palliative care provision reported by primary care practitioners. Design: A systematic review of quantitative data-based articles was conducted. Data sources: Medline, Embase and PsychINFO databases were searched for articles published between January 2007 and March 2019. Data synthesis: Abstracts were assessed against the eligibility criteria by one reviewer and a random sample of 80 articles were blind coded by a second author. Data were extracted from eligible full-texts by one author and checked by a second. Given the heterogeneity in the included studies’ methods and outcomes, a narrative synthesis was undertaken. Results: Twenty-one studies met the inclusion criteria. The most common barriers related to bureaucratic procedures, communication between healthcare professionals, primary care practitioners’ personal commitments, and their skills or confidence. The most common enablers related to education, nurses and trained respite staff to assist with care delivery, better communication between professionals, and templates to facilitate referral to out-of-hours services. Conclusion: A holistic approach addressing the range of barriers reported in this review is needed to support primary care providers to deliver palliative care. This includes better training and addressing barriers related to the interface between healthcare services.

A Comparison of Perceptions of Reassurance in Patients with Nontraumatic Neck Pain and Whiplash-Associated Disorders in Consultations with Primary Care Practitioners—An Online Survey

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3377-3386
Author(s):  
Alma Viviana Silva Guerrero ◽  
Jenny Setchell ◽  
Annick Maujean ◽  
Michele Sterling
Keyword(s):  
Primary Care ◽  
Neck Pain ◽  
Structural Damage ◽  
Online Survey ◽  
Detailed Comparison ◽  
Primary Care Providers ◽  
Care Providers ◽  
Convenience Sample ◽  
Primary Care Practitioners ◽  
Pain Symptoms

Abstract Objectives Neck pain remains highly prevalent and costly worldwide. Although reassurance has been recommended as a first line of treatment, specific advice on the best ways to provide reassurance has not been provided due to lack of evidence. Pain symptoms and experiences differ between patients with whiplash-associated disorder (WAD) and those with nontraumatic neck pain (NTNP). The aims of this study were to 1) identify and compare the concerns, fears, and worries of patients with WAD and NTNP; and 2) determine if patients believe their concerns are addressed by primary care providers. Methods These questions were investigated through an online survey, with a convenience sample of 30 participants with NTNP and 20 with WAD. Results A thematic analysis of survey responses resulted in the following seven themes related to common concerns, and two regarding how well concerns were addressed. Common concerns expressed by both groups shared four themes: 1) further structural damage, 2) psychological distress, 3) concerns about the future, and 4) hardships that eventuate. Theme 5), pain/disability is long term, was specific to WAD. Themes 6), pain is current or reoccurring, and 7), interference with daily life, were specific to NTNP. Regarding how well patient concerns were addressed, two overarching themes were common to both conditions: 1) concerns were addressed, with both groups sharing the subthemes “successful treatment,” “reassurance,” and “trust”; and 2) concerns were not addressed, where all subthemes were shared with the exception of two unique to NTNP. Conclusions This detailed comparison provides information about neck pain patients’ concerns and fears, while providing health practitioners support for selecting strategies to promote reassurance appropriately for individual patient needs. Our findings from patients’ perspectives enhance the understanding for providing reassurance for neck pain as proposed by our analysis.

scholarly journals Community-dwelling older adults’ awareness of the inappropriate use of proton pump inhibitors

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mohammad Rababa ◽  
Abeer Rababa’h
Keyword(s):  
Older Adults ◽  
Adverse Effects ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Care Providers ◽  
Convenience Sample ◽  
Risks And Benefits

Abstract Background Proton pump inhibitors (PPIs) are effective in treating gastroesophageal reflux, peptic ulcers, and esophagitis. However, the long-term use of PPIs by older adults is associated with adverse health outcomes. There is limited evidence about older adults’ awareness of long-term PPI use and its associated adverse effects. This study aimed to assess older adults’ awareness of the adverse effects of the long-term use of PPIs, and their willingness to stop PPI use given of the risks and benefits of PPI use. Methods this cross-sectional study was conducted on a convenience sample of 120 older adults from three local healthcare centers located in Irbid, Jordan. Older adults’ awareness of PPI use was measured using the Patients’ Perceptions of Proton Pump Inhibitor Risks and Attempts at Discontinuation Survey. Results the majority of the participating older adults were not familiar with any reports linking long-term PPI use with adverse effects, reported no concerns related to the chronic use of PPIs, and reported that they had not discussed the benefits and risks of PPI use with their primary care providers (PCPs). Although the majority of the participants had not previously attempted to stop using PPIs, the majority expressed a willingness to stop PPIs due to their adverse effects, especially if advised to do so by a PCP. The factors associated with the long-term use of PPIs included age, indications for gastrointestinal reflux disease (GERD), improvement of GERD symptoms, and the willingness to reduce or stop PPIs. Being advised by a PCP to stop PPIs (p = 0.049) and having increased concerns about the adverse effects of long-term PPI use (p < 0.0001) were the only two statistically significant predictors of previous attempts to stop PPIs. Conclusions concerns regarding the adverse effects of long-term PPI use were associated with attempts to stop PPIs, especially in cases where this was recommended by a PCP. Discussions between PCPs and patients regarding the risks and benefits of PPIs are necessary in order to ensure that patients do not make inappropriate decisions regarding ongoing PPI therapy. Careful evaluation of the long-term use of PPIs among older adults is required.

scholarly journals Effective communication of molecular genetic test results to primary care providers

2012 ◽  
Vol 15 (6) ◽  
pp. 444-449 ◽  
Author(s):  
Maren T. Scheuner ◽  
◽  
Maria Orlando Edelen ◽  
Lee H. Hilborne ◽  
Ira M. Lubin
Keyword(s):  
Primary Care ◽  
Genetic Test ◽  
Molecular Genetic ◽  
Effective Communication ◽  
Primary Care Providers ◽  
Test Results ◽  
Care Providers ◽  
Genetic Test Results ◽  
Molecular Genetic Test

scholarly journals Not Perfect, but Better: Primary Care Providers’ Experiences with Electronic Referrals in a Safety Net Health System

2009 ◽  
Vol 24 (5) ◽  
pp. 614-619 ◽  
Author(s):  
Yeuen Kim ◽  
Alice Hm Chen ◽  
Ellen Keith ◽  
Hal F. Yee ◽  
Margot B. Kushel
Keyword(s):  
Primary Care ◽  
Health System ◽  
Primary Care Providers ◽  
Safety Net ◽  
Care Providers ◽  
Electronic Referrals

scholarly journals Primary care providers’ beliefs and practices on colorectal cancer screening in Kuwait

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E L Tolma ◽  
S M Aljunid ◽  
M N Amrizal ◽  
J Longenecker ◽  
A Al-Basmy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Health System ◽  
Screening Test ◽  
Primary Care Providers ◽  
Screening Tests ◽  
Care Providers ◽  
Beliefs And Practices ◽  
Crc Screening

Abstract Background Colorectal cancer (CRC) is a major public health issue in the Arab region. In Kuwait, CRC is the second most frequent cancer, with an age-standardized (world) incidence rate of 13.2 cases/100,000 in 2018. Despite the national efforts to promote CRC screening the current participation rate is very low (5 to 17%). Primary Care Providers (PCPs) are considered as the gatekeepers of cancer screening globally. This is one of the first studies in Kuwait that examined the current beliefs/practices of PCPs on CRC screening. Methods This cross-sectional study was conducted at governmental primary care centers in Kuwait from 2015-2017. Of 564 PCPs invited to participate from all centers, 255 completed the self-administered questionnaires. The 14-page survey contained 75 questions on PCPs’ beliefs and practices of CRC screening. Data were analyzed by using descriptive statistics. Results The study sample consisted primarily of females (52.0%) and non-Kuwaiti (79%) physicians, with mean age =43.3 (SD: 11.2) years. Most respondents (92%) believed that colonoscopy is the most effective screening tool. The majority (78%) reported that they recommend CRC screening to their patients, with colonoscopy as the most frequent modality (87%) followed by the Faecal Occult Blood Test (FOBT) (52%). Around 40% of the respondents stated that they did not have time to discuss CRC screening with their patients. The majority (72%) believed that their patients did not complete their CRC screening tests. Health system related barriers included difficulties in obtaining test results from the gastroenterologist (61.4%), ordering follow-up test after a positive screening test (50.6%) and shortage of trained staff to conduct the screening test (44.2%). Conclusions A majority of PCPs in Kuwait recommend CRC screening to their patients, but not all patients follow through their recommendation. More research is needed to find out how to further enhance patient uptake of CRC screening. Key messages Colonoscopy is the most frequent screening CRC modality used in Kuwait. Health system related factors can be important future intervention targets to promote CRC screening.

scholarly journals Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing

2020 ◽  
Vol 70 (697) ◽  
pp. e589-e597 ◽  
Author(s):  
Christopher D Saffore ◽  
Sarette T Tilton ◽  
Stephanie Y Crawford ◽  
Michael A Fischer ◽  
Todd A Lee ◽  
...  
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Qualitative Analysis ◽  
Health System ◽  
Primary Care Providers ◽  
Academic Detailing ◽  
Care Providers ◽  
Opioid Prescribing ◽  
Field Notes ◽  
Safe Opioid Prescribing

Background Understanding barriers to safe opioid prescribing in primary care is critical amid the epidemic of prescription opioid abuse, misuse, and overdose in the US. Educational outreach strategies, such as academic detailing (AD), provide a forum for identification of barriers to, and strategies to facilitate, safe opioid prescribing in primary care.AimTo identify barriers to safe opioid prescribing among primary care providers (PCPs) through AD.Design and settingQualitative analysis of data was collected through an existing AD intervention to improve safe opioid prescribing in primary care. The AD intervention was delivered from June 2018 to August 2018 to licensed PCPs with prescriptive authority within a large independent health system in the metropolitan Chicagoland area.MethodThe AD intervention involved visits by trained detailers to PCPs who contemporaneously documented details from each visit via field notes. Using qualitative analysis, field notes were analysed to identify recurring themes related to opioid prescribing barriers.ResultsDetailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to safe opioid prescribing were organised into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring programme (PMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices.ConclusionBarriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.

scholarly journals Combining faecal immunochemical testing with blood test results to identify patients with symptoms at risk of colorectal cancer: a consecutive cohort of 16,604 patients tested in primary care

2021 ◽  
Author(s):  
Diana R Withrow ◽  
Brian Shine ◽  
Jason Oke ◽  
Andres Tamm ◽  
Tim James ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Blood Test ◽  
Primary Care Providers ◽  
University Hospital ◽  
Test Results ◽  
Care Providers ◽  
Mean Cell Volume ◽  
Predictive Values ◽  
Cancer Symptoms

Objective: Faecal immunochemical tests (FITs) are used to triage primary care patients with low risk colorectal cancer symptoms for referral to colonoscopy. The aim of this study was to determine whether combining FIT with routine blood test results could improve the performance of FIT in the primary care setting. Design: Results of all consecutive FITs requested by primary care providers between March 2017 and December 2020 were retrieved from the Oxford University Hospital Trust. Demographic factors (age, sex), reason for referral, and results of blood tests within 90 days were also retrieved. Patients were followed up for incident colorectal cancer in linked hospital records. The sensitivity, specificity, positive and negative predictive values of FIT alone, FIT paired with blood test results, and several multivariable FIT models, were compared. Results: Among 16,604 eligible patients, 139 colorectal cancers were diagnosed (0.8%). Sensitivity and specificity of FIT alone at a threshold of 10 μg Hb/g were 92.1% and 91.5% respectively. Compared to FIT alone, blood test results did not improve the performance of FIT. Pairing blood test abnormalities with FIT reduced the number of abnormal results needed to detect one cancer but increased the number of cancers missed. Multivariable models retaining FIT, sex, and mean cell volume performed similarly to FIT alone. Conclusion: FIT is a highly sensitive tool for identifying higher risk individuals presenting to primary care with lower risk symptoms. Combining blood test results with FIT does not appear to lead to better discrimination for colorectal cancer than using FIT alone.

Teachers' Experiential Learning about Learning

1998 ◽  
Vol 28 (1) ◽  
pp. 11-20 ◽  
Author(s):  
Martha G. Regan-Smith
Keyword(s):  
Primary Care ◽  
Learning Experience ◽  
Group Discussion ◽  
Primary Care Providers ◽  
Major Theme ◽  
Care Providers ◽  
Personal Learning ◽  
Essential Components ◽  
Medical Educators ◽  
Primary Care Practitioners

Objective: An experiential model of learning suggests that changing a learner's understanding will lead to the learner choosing to change behavior. A workshop was designed for medical educators to examine their understanding of learning in order to change their behavior as teachers. This article describes that workshop which was presented as part of a conference on successful techniques for education of primary care practitioners. Method: Eighteen medical educators participated in the workshop. The educators were instructed to reflect on a recent personal learning experience. Group discussion led to production of a list of components of effective learning. These learning components were then applied in small groups to three hypothetical tasks related to mental health education. Results: Essential characteristics of three generic features of learning were identified: characteristics of the teacher, learner, and learning experience. When these characteristics were then applied to the hypothetical tasks, a major theme that emerged was a focus on the importance of learner motivation. Conclusions: The essential components of learning and their application demonstrate the importance of adult learning theory in which it is more important for the learner than for the teacher to determine what, when, and how to learn. This is in contrast to traditional medical education in which the teacher decides what to learn and if it has been learned. To improve education for practicing primary care providers, a shift from a teaching paradigm to a learning paradigm is indicated.

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