Entice With Procedures, Inspire With Primary Care: A Preclerkship Pipeline Course

Background and Objectives: The growing demand for primary care clinicians in the United States continues to outstrip their dwindling supply. Many allopathic medical schools, including Stanford University School of Medicine, are not adequately meeting this shortage. We sought to develop a preclerkship elective to increase the visibility and desirability of primary care at our institution. Methods: A novel 9-week preclerkship elective titled “Primary Care Defined: Perspectives and Procedures,” was designed as a series of procedural workshops followed by interactive sessions with local primary care clinicians. A total of 36 medical and physician assistant students were enrolled. We administered a questionnaire pre- and postcourse to evaluate the impact of the elective on learner interest and attitudes toward primary care. Results: Twenty-four enrolled and 10 nonenrolled learners completed the questionnaire both pre- and postcourse. A one-way analysis of covariance controlling for gender, program (medical doctor versus physician assistant), and precourse responses demonstrated that enrollees had a significantly increased interest in primary care compared to nonenrollees after the course (F1,32=9.22, P=.005). Enrollees also more positively rated their attitudes toward compensation, scope of practice, and job fulfillment than nonenrollees. Both groups had high levels of agreement on statements concerning patient-physician interactions and the importance of primary care to the health care system. Conclusion: The design and content of this elective offers a framework for other institutions looking to promote the value of primary care specialties, particularly family medicine. Creating opportunities for experiential learning and early student-faculty engagement may encourage preclerkship learners to consider a career in primary care.

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A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

Family Medicine ◽

10.22454/fammed.2021.500263 ◽

2021 ◽

Vol 53 (10) ◽

pp. 843-856

Author(s):

Constance Gundacker ◽

Tyler W. Barreto ◽

Julie P. Phillips

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Health Outcomes ◽

Primary Care Providers ◽

The United States ◽

Traumatic Experiences ◽

Search Term ◽

Care Providers ◽

Trauma Informed ◽

The Impact

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

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Essay I Primary Care and Public Health

The Practical Playbook ◽

10.1093/med/9780190222147.003.0201 ◽

2015 ◽

pp. 26-27

Author(s):

Julie K. Wood

Keyword(s):

Public Health ◽

Primary Care ◽

Health Professionals ◽

The United States ◽

Federal Agencies ◽

Community Members ◽

Policy Makers ◽

Public Health Professionals ◽

Primary Care Clinicians ◽

The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

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Data and the Future of Public Health

The Practical Playbook ◽

10.1093/med/9780190222147.003.0025 ◽

2015 ◽

pp. 305-310

Author(s):

Jeffrey Engel

Keyword(s):

Public Health ◽

Primary Care ◽

Health Professionals ◽

The United States ◽

Federal Agencies ◽

Community Members ◽

Policy Makers ◽

Public Health Professionals ◽

Primary Care Clinicians ◽

The Right

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Partnering With Medicaid, Medicare, Public Health, and Primary Care to Improve Health Outcomes

The Practical Playbook ◽

10.1093/med/9780190222147.003.0017 ◽

2015 ◽

pp. 195-206

Author(s):

Sharon G. Moffatt ◽

Monica Valdes Lupi ◽

Kathleen Nolan

Keyword(s):

Public Health ◽

Primary Care ◽

Health Professionals ◽

The United States ◽

Federal Agencies ◽

Community Members ◽

Policy Makers ◽

Public Health Professionals ◽

Primary Care Clinicians ◽

The Right

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The Impact of Primary Care: A Focused Review

Scientifica ◽

10.6064/2012/432892 ◽

2012 ◽

Vol 2012 ◽

pp. 1-22 ◽

Cited By ~ 71

Author(s):

Leiyu Shi

Keyword(s):

Primary Care ◽

Health Outcomes ◽

Negative Impact ◽

Healthcare Services ◽

The United States ◽

Emergency Department Visits ◽

Care Practice ◽

Quality Healthcare ◽

The Usa ◽

The Impact

Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.

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Title VII and the Development and Promotion of National Initiatives in Training Primary Care Clinicians in the United States

Academic Medicine ◽

10.1097/acm.0b013e31818906c9 ◽

2008 ◽

Vol 83 (11) ◽

pp. 1021-1029 ◽

Cited By ~ 8

Author(s):

Ardis K. Davis ◽

P Preston Reynolds ◽

Norman B. Kahn ◽

Roger A. Sherwood ◽

John M. Pascoe ◽

...

Keyword(s):

United States ◽

Primary Care ◽

The United States ◽

Title Vii ◽

National Initiatives ◽

Primary Care Clinicians

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The Impact of the “Muslim Ban” Executive Order on Healthcare Utilization in Minneapolis-St. Paul, Minnesota

10.1101/2020.10.23.20218628 ◽

2020 ◽

Author(s):

Elizabeth A. Samuels ◽

Lilla Orr ◽

Elizabeth B. White ◽

Altaf Saadi ◽

Aasim I. Padela ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Emergency Department ◽

Healthcare Utilization ◽

The United States ◽

Emergency Department Visits ◽

Executive Order ◽

Before And After ◽

Muslim Majority ◽

The Impact

AbstractObjectiveDetermine whether the 2017 “Muslim Ban” Executive Order impacted healthcare utilization by people born in Order-targeted nations living in the United States.MethodsWe conducted a retrospective cohort study of people living in Minneapolis-St. Paul, MN in 2016-2017 who were: 1) born in Order-targeted nations, 2) born in Muslim-majority nations not listed in the Order, and 3) born in the United States and non-Latinx. Primary outcomes were: 1) primary care visits, 2) missed primary care appointments, 3) primary care diagnoses for stress-responsive conditions, 4) emergency department visits, and 5) emergency department visits for stress-responsive diagnoses. We evaluated visit trends before and after Order issuance using linear regression and differences between study groups using a difference-in-difference analyses.ResultsIn early 2016, primary care visits and stress-responsive diagnoses increased among individuals from Muslim majority nations. Following the Order, there was an immediate increase in emergency department visits among individuals from Order-targeted nations.ConclusionsIncreases in healthcare utilization among people born in Muslim majority countries before and after the “Muslim Ban” likely reflect elevated cumulative stress including the impact of the Order.

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Implementing a weight-specific quality-of-life tool for young people in primary healthcare

BJGP Open ◽

10.3399/bjgpo.2021.0052 ◽

2021 ◽

pp. BJGPO.2021.0052

Author(s):

Yemi Oluboyede ◽

Sarah Hill ◽

Suzanne McDonald ◽

Emily Henderson

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Young People ◽

General Practitioners ◽

Primary Healthcare ◽

Global Public Health ◽

Framework Analysis ◽

Primary Care Clinicians ◽

The Impact

BackgroundObesity is thought to be one of the most serious global public health challenges of the 21st century. The primary care setting is important in terms of the diagnosis, education and management of obesity in children and young people. This study explored the views of primary care clinicians on the implementation of a quality of life (QoL) tool to help young people and their families identify the impact of weight on QoL.AimTo assess the acceptability and feasibility of implementing the Weight-specific Adolescent Instrument for Economic-evaluation (WAItE) QoL tool for young people aged 11–18 years in primary care.MethodOne-to-one, semi-structured interviews were conducted with a purposive sample of primary healthcare clinicians working in practices located in areas of varying deprivation in Northern England, UK. Interview transcripts were coded and analysed using Framework Analysis in NVivo 10.ResultsParticipants (n=16 General Practitioners; n=4 practice nurses) found the WAItE tool acceptable for them and their patients and believed it was feasible for use in routine clinical practice. It was important to primary care clinicians that the tool would provide an overall QoL score that would be easy for General Practitioners and nurses to interpret, to help them identify patients most in need of specialist help.ConclusionsThis study has developed a platform for further research around QoL in overweight and obese young people. A future feasibility study will focus on implementing the tool in a small number of primary healthcare practices.

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Promoting Motivational Interviewing in Primary Care: More Than Intention

PRiMER ◽

10.22454/primer.2021.287928 ◽

2021 ◽

Vol 5 ◽

Author(s):

Paul J. Hershberger ◽

Lori S. Martensen ◽

Timothy N. Crawford ◽

Dean A. Bricker

Keyword(s):

Primary Care ◽

Motivational Interviewing ◽

Patient Engagement ◽

Care Setting ◽

Survey Question ◽

Patient Interaction ◽

Widespread Implementation ◽

Primary Care Clinicians ◽

The Impact

Introduction: Interacting with patients in a manner that furthers self-responsibility for health is an important skill for primary care clinicians. Motivational interviewing (MI) is such an approach to patient engagement, but it remains to be more widely implemented. In a program training health professionals and health professions students in MI, we examined posttraining attitudes and intentions regarding the utilization of MI. Of particular interest was how posttraining intentions were associated with self-reported action 1 month later. Methods: We obtained immediate posttraining and 30-day follow-up data from 209 participants regarding intent to utilize the MI approach (self-reported implementation at the follow-up interval), impact on confidence with patient interaction, and perceived importance of the training. We analyzied frequencies and percentages for all categorical/ordinal variables to describe the participants and the survey question responses. Results: While 91.5% of participants intended to incorporate MI into their approach with patients (to a moderate or great extent) at posttraining, only 48.7% reported that they had actually implemented the MI approach (to a moderate or great extent) 30 days later. However, another 32.1% indicated that they had occasionally utilized MI. Attitudes toward the importance of MI training and the impact of training on confidence remained strong over the 30 days. Conclusion: Achieving more widespread implementation of the MI approach in the primary care setting is likely to be less dependent on convincing clinicians about its importance for patient engagement, but rather on the translation of intent to actual practice and implementation.

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