Assessment of Burnout Among Canadian Pharmacists Working in Team-based Primary Care Settings

Background: Burnout syndrome is well-documented among healthcare professionals across various practice settings. There has been recent expansion of Canadian pharmacists into team-based primary care and burnout in this setting has not been assessed. Our objective was to assess workplace burnout and to identify factors that play a role in perpetuating or diminishing it. Method: An online survey to assess burnout was developed using the Maslach Burnout Inventory (MBI) tool and questions regarding pharmacist background and practice. Invitations to complete the survey were sent to Canadian pharmacists working in team-based primary care settings on November 26, 2019 via a national primary healthcare listserv. Results: A total of 31/433 completed responses were collected. The main analysis focused on the personal accomplishment (PA) domain as it had an adequate response rate. The PA domain had a median score of 5.0 (95% CI 4.69-5.22). We compared medians of the PA domain across different groups of each categorical variable. We found that the number of years working in primary care settings was positively associated with a higher PA domain score (p= 0.029). Discussion: PA was higher in pharmacists who have been practicing in a primary care setting for longer; however, burnout rates could not be properly assessed due to the limited response rate. Conclusion: This is the first study to assess burnout among Canadian team-based primary care pharmacists. Personal accomplishment was higher in those who have been practicing in a primary care setting for longer. Future studies should consider alternate methods to evaluate burnout in this population. Article Type: Original Research

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Screening Younger Individuals in a Primary Care Setting Flags Putative Dementia Cases and Correlates Gastrointestinal Diseases with Poor Cognitive Performance

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000452485 ◽

2016 ◽

Vol 43 (1-2) ◽

pp. 15-28 ◽

Cited By ~ 5

Author(s):

Ilka M. Rosa ◽

Ana Gabriela Henriques ◽

Liliana Carvalho ◽

Joana Oliveira ◽

Odete A.B. da Cruz e Silva

Keyword(s):

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Gastrointestinal Disease ◽

Gastrointestinal Diseases ◽

Diagnostic Tools ◽

Clinical Dementia Rating ◽

Dementia Prevalence ◽

Dementia Screening ◽

Primary Care Settings

Background/Aims: Diagnosing dementia is challenging in many primary care settings, given the limited human resources and the lack of current diagnostic tools. With this in mind, a primary care-based cohort was established in the Aveiro district of Portugal. Methods: A total of 568 participants were evaluated using cognitive tests and APOE genotyping. Results: The findings revealed a dementia prevalence of 12%. A strong correlation between increasing Clinical Dementia Rating (CDR) scores and education was clearly evident. Other highly relevant risk factors were activities of daily living (ADL), instrumental ADL, aging, depression, gender, the APOE ε4 allele, and comorbidities (depression as well as gastrointestinal, osteoarticular, and neurodegenerative diseases). A hitherto unreported, significant correlation between gastrointestinal disease and high CDR score was clearly observable. Conclusions: This study shows the merit of carrying out a dementia screening on younger subjects. Significantly, 71 subjects in the age group of 50-65 years were flagged for follow-up studies; furthermore, these cases with a potentially early onset of dementia were identified in a primary care setting.

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Impact of a Pharmacist-Provided Spirometry Service on Access to Results in a Primary Care Setting

Journal of Primary Care & Community Health ◽

10.1177/2150132718759213 ◽

2018 ◽

Vol 9 ◽

pp. 215013271875921 ◽

Cited By ~ 1

Author(s):

Lisa A. Mueller ◽

Alexa Sevin Valentino ◽

Aaron D. Clark ◽

Junan Li

Keyword(s):

Primary Care ◽

Care Setting ◽

Primary Care Setting ◽

Time Frame ◽

Primary Objective ◽

Completion Rate ◽

Primary Care Settings ◽

Significant Difference ◽

Referral Completion ◽

Time Frames

Objectives: The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry referrals completed with results reviewed by the ordering provider. Secondary objectives evaluated differences between internal and external referrals, medication recommendations made by the pharmacist, and revenue brought in by the service. Methods: Chart reviews were completed to determine the referral completion rates between patients who received a spirometry referral before (December 2014–September 2015) and after (January 2016–October 2016) the implementation of the pharmacy-provided spirometry service. Chart reviews were also used to determine the number and completion rate among referrals for internal and external services in the postimplementation time frame. Chart reviews also assessed medication recommendations made by the pharmacist. Results: The results demonstrate an increase in referral completion rate from 38.1% to 47.0% ( P = .08) between the pre- and postimplementation time frames. In the postimplementation time frame, there was a statistically significant difference in the percentage of referrals completed between in-house referrals and external referrals (70.0% and 40.9%, respectively, P = .0004). Comparing clinics with and without the spirometry service, there was a statistically significant difference in the total number of spirometry referrals (1.13% and 0.59%, respectively, P < .0001) and the percent of referrals completed (0.55% and 0.27%, respectively, P = .0002). Conclusion: The results suggest that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to the primary care provider. Additionally, the results show that there is an increased completion rate in patients who receive an internal spirometry referral, which may be due to reduced barriers in obtaining this testing. Overall, these results demonstrate that providing spirometry in the primary care setting helps to increase spirometry results obtained and could be beneficial in other primary care settings.

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Scottish Psychiatrists in Primary Health-Care Settings

The British Journal of Psychiatry ◽

10.1192/bjp.153.5.663 ◽

1988 ◽

Vol 153 (5) ◽

pp. 663-666 ◽

Cited By ~ 31

Author(s):

Ian M. Pullen ◽

Alex J. Yellowlees

Keyword(s):

Primary Care ◽

Rural Areas ◽

Care Setting ◽

Primary Care Setting ◽

Health Care Settings ◽

Primary Care Settings ◽

Practice Experience ◽

Primary Health ◽

Similar Survey ◽

Primary Health Care Settings

There has been a growing number of reports of psychiatrists moving out into primary-care settings. We report a survey of consultant psychiatrists to assess the extent of this practice in Scotland. Some time spent in the primary-care setting was reported by 56%, the figures being highest in rural areas. An equal number of non-consultant medical staff were involved. Most schemes were initiated by psychiatrists, over half of whom had had some postgraduate general-practice experience. A similar survey in England and Wales showed that only 19% of consultant psychiatrists spent time in primary-care settings, a smaller proportion of non-consultant staff being involved. The value of working in primary-care settings has yet to be assessed.

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Treatment of Neck Pain with Opioids in the Primary Care Setting: Trends and Geographic Variation

Pain Medicine ◽

10.1093/pm/pnaa372 ◽

2020 ◽

Author(s):

Meghana Jami, ◽

Majd Marrache ◽

Varun Puvanesarajah ◽

Micheal Raad ◽

Niyathi Prasad ◽

...

Keyword(s):

Primary Care ◽

Neck Pain ◽

Geographic Variation ◽

Outpatient Clinic ◽

Care Setting ◽

Primary Care Setting ◽

High Dose ◽

Primary Care Visit ◽

Primary Care Settings ◽

First Time

Abstract Objective Neck pain is a leading cause of years lived with disability and is often managed with opioid medications in primary care settings, though this is contraindicated by national guidelines. The aim of this study was to determine the prevalence of opioid prescription for neck pain at a primary care visit and to analyze the geographic variation and trends in opioid prescriptions between 2011 and 2017. Methods Using a prescription drug claims database, we identified 591,961 adult patients who presented for neck pain in primary care settings between 2011 and 2017. Patients who had outpatient specialty visits within 1 year before presentation, a concomitant diagnosis of a non-musculoskeletal cause of neck pain, or preexisting chronic opioid use were excluded. Results The mean age of the patients was 45 ± 12 years, and 64% were female. Fifteen percent of patients were prescribed opioids within 30 days of their encounter. Eleven percent of patients were prescribed moderate- to high-dose opioids (>20 morphine milligram equivalents). From 2011–2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions given to first time presenters to an outpatient clinic for neck pain was highest in Mississippi (20%) and lowest in New Mexico (6%) (P < 0.001). In 2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions was highest in the Midwest (10.4%) and lowest in the Northeast (4.9%). The proportion of patients with filled opioid prescriptions declined between 2011 (19%) and 2017 (13%) (P < 0.001), and the proportion of patients with moderate- to high-dose prescriptions declined from 2011 (13%) to 2017 (8%) (P < 0.001). first-time presenters of neck pain to an outpatient clinic Conclusions Opioid medication use for neck pain in the primary care setting is significant. Although opioid prescriptions are declining, there remains a need for further standardization in prescription practices.

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Clinicoepidemiological profile and practices to manage dizziness in primary care setting: results from an Indian registry

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20210164 ◽

2021 ◽

Vol 7 (2) ◽

pp. 320

Author(s):

Divya Prabhat ◽

Ganga Kiran

Keyword(s):

Primary Care ◽

Management Practices ◽

Care Setting ◽

Primary Care Setting ◽

Treatment Approach ◽

Study Data ◽

Common Symptom ◽

Primary Care Settings ◽

Concomitant Medications

Background: Dizziness is a common symptom encountered in primary care settings by general physicians and specialists. This study evaluated the clinicoepidemiological profile and management practices in patients with dizziness in an Indian primary care setting.Methods: This prospective, multicentric, observational study was conducted between November 2018 and June 2019. Patients aged≥18 years presenting with clinical features of dizziness were eligible. The study data included demographics and socioeconomic details, complete medical history, medication and concomitant medication use, and the cause and pattern of dizziness. Patients had a baseline visit and two follow-up visits at weeks 1 and 4. Results: Overall, 1000 patients with a mean age of 45.1 years were included (women: 51.5%; men: 48.5%). Of these, 762 reported dizziness as a primary complaint; whereas, 238 reported it as a complaint associated with nausea, vomiting and light-headedness on visit 1, which reduced on subsequent visits. Around 34% of the patients were unemployed and 59% belonged to the upper-middle class. The most common co-morbidities were hypertension and diabetes mellitus (n=132, each). More than 50% of the patients presented with vestibular cause (n=577), followed by neurologic (n=179), metabolic (n=84) and psychiatric (n=61) etiologies. Betahistine (n=581) and prochlorperazine (n=312) were the commonly prescribed medicines for primary and associated complaints. The most commonly used concomitant medications were telmisartan (n=53), glimepiride plus metformin (n=40), metformin (n=32) and ondansetron (n=29). Conclusions: Dizziness has a multifactorial origin necessitating a multifactorial treatment approach. Betahistine and prochlorperazine were the most commonly prescribed drugs in the primary care setting (CTRI/2018/11/016408).

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Effective Patient-Provider Communication For Newly Diagnosed Patients In A Primary Care Setting: A Quantitative Study

Journal of Student Research ◽

10.47611/jsr.vi.512 ◽

2018 ◽

Author(s):

Ralston R Lockett ◽

Myra Michelle DeBose, PhD, MSN, MSEd, RN

Keyword(s):

Primary Care ◽

Depressive Symptoms ◽

Health Outcomes ◽

Care Setting ◽

Graduate Program ◽

Primary Care Setting ◽

Depression Scale ◽

Provider Communication ◽

Newly Diagnosed ◽

Primary Care Settings

Ralston Lockett, BSN, RN - FNP StudentMyra Michelle DeBose, PhD, MSN, MSEd, RN - Faculty AdvisorPrairie View A & M University - College of Nursing - Graduate Program - Houston, TXBackground: There are newly diagnosed patients in primary care settings with depressive symptomsdue to lack of communication from providers. The aim of this proposed study is to assess newlydiagnosed patients who may express depressive symptomology. Establishing a sound relationshipbetween patients and providers is essential for a trusting relationship. Patient-centeredcommunication increases better health outcomes in primary care settings. There is reason to believethat missed opportunities between patient-providers can decrease patient compliance and increasedepression.Research Hypothesis: Newly diagnosed patients that receive effective provider communication willhave a decrease in depressive symptoms as compared to newly diagnosed patients who do not receiveeffective communication.Methodology: This study uses a longitudinal, quasi-experimental research design, conveniencesampling. Up to 80 newly diagnosed patients who did not receive effective communication will beevaluated for approximately six months. The primary setting will be 2 urban area clinics in Houston,Texas. The Center for Epidemiologic Studies Depression Scale (CES-D), will be used within 30 days afterthe initial healthcare provider visit to assess depressive symptoms.Results: Depressive symptoms will be measured using the (CES-D) assessment tool of 20 – items. Thetool assesses how frequently an individual experienced depressive symptoms within a week. Inaddition, a 45 min post visit survey regarding provider communication will be sent after 30 days.Sample analysis will include diagnosis and literacy level. Participants will be asked to identify preferredmethods of communicating with their provider.Significance: There is a correlation between depressive symptoms and lack of effective communicationwith patients in a primary care setting. Poor identification of patient’s mental health status andengagement in plan of care can lead to poor patient health outcomes, increase health care costs, anddisparities to under-privilege communities.

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Lost in Transition: Pharmacist Roles in Identifying and Evaluating Medication-Related Problems During Hospital Discharge Follow-up Visits in a Primary Care Setting

Journal of Primary Care & Community Health ◽

10.1177/2150132720917297 ◽

2020 ◽

Vol 11 ◽

pp. 215013272091729

Author(s):

Alexis Dellogono ◽

Aimee Dawson ◽

Marisa Piers-Gamble ◽

Jerril Varghese ◽

Lori Lewicki

Keyword(s):

Primary Care ◽

Hospital Discharge ◽

Care Setting ◽

Adverse Drug Events ◽

Primary Care Setting ◽

Health Care Team ◽

Care Team ◽

Transitions Of Care ◽

Primary Care Settings

Objectives: The objective of this study was to identify and evaluate medication-related problems (MRPs) found during hospital discharge transitions of care visits in a primary care setting. Design, Settings, and Participants: This retrospective cohort took place within a federally qualified health center (FQHC) where pharmacists are part of the interprofessional transitions of care team to help patients transition back to primary care after being discharged from the hospital. Pharmacists utilized standardized forms to document MRPs, potential and adverse drug events, and interventions made during the visit. This study quantifies the role that pharmacists can have by conducting medication reconciliation during postdischarge primary care visits. Patients included in this study were 18 years and older with at least 5 medications. Outcome Measures: The outcomes of this study include the number and type(s) of MRPs, number and severity of potential adverse drug events (pADEs) and adverse drug events (ADEs) that were identified, as well as the number and type of recommendations or interventions made by the pharmacist. The MRP types and pADE/ADE severity were classified and stratified using predetermined definitions. Results: During the 4-month study period from October 1, 2018 to February 4, 2019, 134 visits were completed. Outcomes included a total of 454 MRPs, with an average of 3 identified per visit. The most common MRPs were medication list in electronic health record inaccurate (79.1% of visits), poor adherence (32.1% of visits), and refills needed (30.6% of visits). A total of 72 pADEs and 27 ADEs were identified, with 524 recommendations made. Conclusion: Pharmacists serve a unique role during transitions of care by identifying MRPs. Pharmacists are an integral part of a patient’s health care team by making recommendations or interventions related to these MRPs. FQHCs and other primary care settings should consider integrating pharmacists into a collaborative transitions of care team.

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