scholarly journals HIV Preexposure Prophylaxis Training in Family Medicine Residencies: A National Survey

2022 ◽  
Vol 54 (1) ◽  
pp. 24-29
Author(s):  
Byron K. Jasper ◽  
James N. Becker ◽  
Allison Myers ◽  
Peter F. Cronholm
Keyword(s):  
High Risk ◽  
Rural Communities ◽  
Family Medicine ◽  
Hiv Transmission ◽  
Program Directors ◽  
Preexposure Prophylaxis ◽  
Primary Care Workforce ◽  
Rural Residency ◽  
Risk Patients ◽  
Research Alliance

Background and Objectives: Preexposure prophylaxis (PrEP) reduces HIV transmission among high-risk individuals. Yet, the HIV epidemic continues to expand among marginalized populations and America’s Southeastern states. Various barriers remain to PrEP uptake, namely provider knowledge and education. We sought to investigate residency training, competency, and prescribing of PrEP among population size. Additionally, we asked program directors to identify barriers to PrEP. Methods: We surveyed family medicine program directors as part of the Council of Academic Family Medicine Educational Research Alliance survey from January 2018 through February 2018. Results: Our survey questions had a 52.9% (276/522) response rate. No programs in rural communities less than 30,000 population (0/27) reported significant PrEP training for their residents; those in nonrural communities of at least 30,000 reported this training more frequently (41/246, 16.7%). Compared to Fischer expected values, the finding was statistically significant (P=.019); using a 75,000 population demarcation lowered significance (P=.192). We found programs that identify significant PrEP training also cite more PrEP prescribing within their practice (OR 7.27, P<.001). Programs with significant training also report their residents graduate with greater PrEP competency (OR 18.33, P<.001). The largest barriers identified were faculty expertise, not having enough high-risk patients, inadequate screening, and resident knowledge/training. Conclusions: We identified natural associations between increased training in PrEP and perceived PrEP competencies. We identified a lack of significant PrEP training and associated PrEP competencies in rural residency programs. Barriers identified in this study can help inform curricular needs to improve primary care workforce capacity to lower HIV risk.

Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

2021 ◽  
Vol 17 (2) ◽  
pp. 109-113
Author(s):  
Julienne K. Kirk, PharmD, CDE, BCPS ◽  
Matthew Q. Tran, PharmD ◽  
Samantha Pelc, PharmD ◽  
Katherine G. Moore, PharmD, BCPS, BCACP
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Family Medicine ◽  
Quality Improvement Intervention ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Support Person ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

scholarly journals Impact of Pharmacist-Physician Collaboration on Osteoporosis Treatment Rates

2018 ◽  
Vol 52 (9) ◽  
pp. 876-883 ◽  
Author(s):  
Brandi L. Bowers ◽  
Amy M. Drew ◽  
Christian Verry
Keyword(s):  
Vitamin D ◽  
High Risk ◽  
Family Medicine ◽  
Cohort Analysis ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Economic Consequences ◽  
Collaborative Management ◽  
Medicine Physician ◽  
Risk Patients

Background: The vast majority of women at high risk for osteoporotic fractures are not treated, despite known significant clinical and economic consequences of this prevalent condition. To date, this is the first study of this size and duration to examine the role of pharmacists in management of osteoporosis in a family medicine clinic. Objective: To compare the initiation or continuation of prescription antifracture therapy in high-risk patients with collaborative pharmacist-physician to physician-only management; secondarily, to evaluate recommendation rates for antifracture therapy and calcium and vitamin D. Methods: This retrospective cohort analysis included women older than 65 years with a dual-energy X-ray absorptiometry (DXA) scan ordered by a family medicine physician. High risk was defined as T-scores ≤−2.5 at the lumbar spine, femoral neck, or 33% radius, or a FRAX 10-year fracture risk score ≥20% for major osteoporosis-related or ≥3% for hip fractures. Results: There were 466 (311 high-risk) pharmacist-physician and 549 (237 high-risk) physician-managed DXAs included. For high-risk DXAs, collaborative management resulted in increased rates of receiving antifracture therapy prescriptions over physician-only management (66% vs 34%, P < 0.001), advisement for antifracture therapy (87% vs 32%, P < 0.001), and calcium and vitamin D (97% vs 45%, P < 0.001). Collaborative management also improved calcium and vitamin D advisement among all DXAs (96% vs 46%, P < 0.01). There was no difference in adverse events documented in the pharmacist-physician compared with physician-only management (7.2% vs 3.7%, P = 0.32). Conclusion and Relevance: Pharmacist-physician collaboration is associated with higher treatment rates of osteoporosis. This study supports the pharmacist-physician partnership as one method of improving osteoporosis management.

scholarly journals Training Family Medicine Residents to Perform Home Visits: A CERA Survey

2017 ◽  
Vol 9 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Tomoko Sairenji ◽  
Stephen A. Wilson ◽  
Frank D'Amico ◽  
Lars E. Peterson
Keyword(s):  
Family Medicine ◽  
Primary Care Physicians ◽  
Home Visit ◽  
Home Visits ◽  
Program Directors ◽  
Family Medicine Residency ◽  
Resident Time ◽  
Faculty Time ◽  
Research Alliance ◽  
Residency Program Directors

ABSTRACT Background  Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. Objective  To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. Methods  This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. Results  There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. Conclusions  There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.

scholarly journals Point-of-Care Ultrasound in Family Medicine Residencies 5-Year Update: A CERA Study

2020 ◽  
Vol 52 (7) ◽  
pp. 505-511
Author(s):  
Jeffrey W. W. Hall ◽  
Harland Holman ◽  
Tyler W. Barreto ◽  
Paul Bornemann ◽  
Andrew Vaughan ◽  
...  
Keyword(s):  
Family Medicine ◽  
Core Curriculum ◽  
Point Of Care ◽  
Program Directors ◽  
Point Of Care Ultrasound ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Survey Results ◽  
Research Alliance ◽  
Residency Program Directors

Background and Objectives: In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources, barriers, and scope of POCUS training in family medicine residencies 5 years after its inception. Methods: Questions regarding current training and use of POCUS were included in the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors, and results compared to similar questions on the 2014 CERA survey. Results: POCUS is becoming a core component of family medicine training programs, with 53% of program directors reporting establishing or an established core curriculum. Only 11% of program directors have no current plans to add POCUS training to their program, compared to 41% in 2014. Despite this increase in training, the reported clinical use of POCUS remains uncommon. Only 27% of programs use six of the eight surveyed POCUS modalities more than once per year. The top three barriers to including POCUS in residency training in 2019 have not changed since 2014, and are (1) a lack of trained faculty, (2) limited access to equipment, and (3) discomfort with interpreting images without radiologist review. Conclusions: Training in POCUS has increased in family medicine residencies over the last 5 years, although practical use of this technology in the clinical setting may be lagging behind. Further research should explore how POCUS can improve outcomes and reduce costs in the primary care setting to better inform training for this technology.

Reaching High-Risk Patients for HIV Preexposure Prophylaxis

JAMA ◽  
2016 ◽  
Vol 316 (2) ◽  
pp. 211 ◽  
Author(s):  
James Riddell ◽  
Jonathan A. Cohn
Keyword(s):  
High Risk ◽  
High Risk Patients ◽  
Preexposure Prophylaxis ◽  
Risk Patients

Vaccination Rates in Patients With Medical Indications for the Pneumococcal Polysaccharide Vaccine in a Family Medicine Clinic

2017 ◽  
Vol 32 (2) ◽  
pp. 154-157 ◽  
Author(s):  
Anthony Trovato ◽  
Karen Gunning ◽  
Karly Pippitt
Keyword(s):  
High Risk ◽  
Family Medicine ◽  
Pneumococcal Vaccination ◽  
Low Risk ◽  
Vaccination Rates ◽  
Medical Indication ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Patient Refusal

Background: Pneumococcal vaccination rates among high-risk patients (eg, diabetes, asthma, smoking) seen in 2 family medicine clinics are unknown. Objectives: To assess differences in pneumococcal polysaccharide vaccination rates and reasons for nonvaccination among patients with diabetes and asthma and patients who smoke. Methods: A chart review at 2 family medicine residency training clinics showed 425 patients with a medical indication for PPSV23 were seen between April 1, 2015, and April 30, 2015. One reviewer searched the electronic health records to assess reasons for nonvaccination. Results: Rates of nonvaccination were 29.8% in patients with diabetes, 58.7% in patients with asthma, and 62.5% in patients who smoke cigarettes. Patients were classified into 3 groups based on the reasons for nonvaccination: documented patient refusal, not being addressed by a provider, and being documented as low risk despite the presence of a medical indication. Conclusion: The 3 reasons for nonvaccination were vaccination not being addressed, misclassification of high-risk patients as low-risk patients for infection, and documented patient refusal. Providers overlooked vaccination more often in patients with asthma and cigarette use than in patients with diabetes. Patients seeing pharmacists were most likely to be vaccinated, whereas patients seeing physician assistants were least likely to be vaccinated. Pharmacists see patients to provide medication management and preventive care, whereas other providers treat more urgent conditions. Because indications are often overlooked and not addressed, pharmacists can play a larger role in identifying and vaccinating high-risk patients.

scholarly journals Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors

2021 ◽  
Vol 53 (9) ◽  
pp. 773-778
Author(s):  
Winfred Frazier ◽  
Stephen A. Wilson ◽  
Frank D'Amico ◽  
George R. Bergus
Keyword(s):  
Family Medicine ◽  
Program Directors ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Faculty Knowledge ◽  
Remediation Strategies ◽  
Research Alliance ◽  
And Training ◽  
Remediation Process ◽  
Faculty Responsibility

Background and Objectives: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. Methods: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. Results: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies. Conclusions: Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.

scholarly journals Training Residents in Maternal Depression Care to Improve Child Health: A CERA Study

2019 ◽  
Vol 51 (9) ◽  
pp. 756-759
Author(s):  
Nicola A. Conners Edge ◽  
Shashank Kraleti ◽  
Lorraine McKelvey ◽  
Diane M. Jarrett ◽  
Jackie D. Sublett ◽  
...  
Keyword(s):  
Family Medicine ◽  
Maternal Depression ◽  
Current Knowledge ◽  
Well Being ◽  
Program Directors ◽  
Resident Training ◽  
Health And Development ◽  
Research Alliance ◽  
Residency Program Directors ◽  
The Impact

Background and Objectives: Untreated maternal depression negatively impacts both the mother and her children’s health and development. We sought to assess family medicine program directors’ (PDs) knowledge and attitudes regarding maternal depression management as well as resident training and clinical experience with this disorder. Methods: Data were gathered through the Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) national survey of family medicine PDs in US and Canadian programs, from January through February, 2018. Results: Surveys were completed by 298 PDs (57.1% response rate) who were majority male (58.9%) and white (83.8%). Nearly all (90.2%) PDs agreed that family physicians should lead efforts to minimize the impact of maternal depression on child well-being. According to PD report, in the family medicine clinics where residents train, most (77.3%) have a clinic process that ensures that routine screening for depression occurs, and 54.4% do some screening of mothers during pediatric visits. Only 18.2% report routinely taking steps to minimize the impact of the mothers’ depression on child well-being. Finally, 41.3% of PDs reported being familiar with the literature on the impact of maternal depression on children; self-reported familiarity was significantly associated with more comprehensive resident training on this topic. Conclusions: Family medicine residency program directors are supportive of training in maternal depression, though their current knowledge is variable and there are opportunities to enhance care of mothers and children impacted by this common and serious disorder.

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