scholarly journals Are We Treating The Patient or the Disease?

2014 ◽  
Vol 5 (4) ◽  
Author(s):  
Eleanor Vogt ◽  
Patricia Shane ◽  
Henry Kahn
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Medication Management ◽  
Healthcare Delivery ◽  
Psychosocial Health ◽  
Routine Care ◽  
Care Patient ◽  
Psychosocial Stressors ◽  
Institute Of Medicine ◽  
Primary Care Clinicians

The evidence abounds. A compelling body of research estimates that psychosocial stressors play a role in a significant number of patient complaints seen in primary care. In addition to the challenges faced by primary care clinicians who must consider their patients' psychosocial stressors, these factors can also affect pharmacists' care. Patient stress, through a number of mechanisms, can limit the efficacy of medicine as well as our efforts to achieve optimal medication management, and adds a poorly examined complexity to patient care practices. A landmark Institute of Medicine report calls for "whole patient "care, addressing psychosocial health needs, not as an embellishment, but as part of routine care. Whole patient care requires a fundamental shift, with patient needs at the center of healthcare delivery, and psychosocial-linked distress considered as integral to that model. These considerations place this topic squarely within the pharmacists' scope of practice and urgently call for an expanded approach to patient care and an opportunity for pharmacists to address that need. To parallel this discussion, the contributing role of practitioner stress is briefly reviewed.   Type: Idea Paper

scholarly journals Clinical Recommendations for Reducing the Risk of Cognitive Decline

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 187-188
Author(s):  
G Adriana Perez ◽  
Kelly O'Brien ◽  
Marwan Sabbagh ◽  
Michelle Bruno
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Primary Prevention ◽  
Cognitive Decline ◽  
Risk Reduction ◽  
Routine Care ◽  
Leadership Group ◽  
Patients At Risk ◽  
Primary Care Clinicians ◽  
Improve Health

Abstract As much as 40% of dementia cases can be attributed to modifiable risk factors (Livingston et al., 2020). Much of that risk-reduction can be accomplished by changing behavior in midlife. In light of the emerging evidence that dementia may be preventable, UsAgainstAlzheimer’s convened a workgroup of national experts to develop new recommendations that primary care clinicians and general neurologists can use to initiate primary prevention conversations with their patients about cognitive decline. Few resources address steps that clinicians can take in their routine care to help patients reduce risk. Some relevant resources provide excellent guidance but tend to be more focused on early detection or slowing disease progression rather than primary prevention. The Risk Reduction Workgroup (RRWG) was convened to help address the need for clinicians to know how to discuss cognitive decline with their patients. The workgroup aligned on 11 recommendations for primary care clinicians and general neurologists. In addition the RRWG provide considerations for implementing the recommendations in clinical practice. The recommendations are mindful of social determinants of health, account for cultural differences, and are designed for general accessibility. This effort is part of a broader initiative by UsAgainstAlzheimer’s to address risk-reduction for cognitive decline and early interventions. Under the guidance of a multidisciplinary Provider Leadership Group consisting of representatives from some of the nation's largest health provider serving organizations, three independent workgroups are developing guidance and tools to assist providers in their clinical practice and improve health outcomes for patients at-risk for Alzheimer's and related dementias.

scholarly journals Family Caregiver Assessment in Primary Care: A Nationwide Survey

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 73-73
Author(s):  
Catherine Riffin ◽  
Jennifer Wolff ◽  
Julianna Maisano ◽  
Sylvia Lee ◽  
Karl Pillemer
Keyword(s):  
Primary Care ◽  
Social Workers ◽  
Healthcare Delivery ◽  
Nationwide Survey ◽  
Care Practice ◽  
Caregiver Support ◽  
Care Plans ◽  
Primary Care Clinicians ◽  
Common Barriers ◽  
And Training

Abstract Family caregivers play an important role in the healthcare of older adults, but their circumstances, needs, and risks are often unknown to medical professionals. Standardizing how caregivers’ needs are assessed in healthcare delivery can help clinicians design care plans that take caregivers’ capabilities into account and provide targeted recommendations for caregiver support. Despite the potential of caregiver assessment, little is known about its use in primary care practice. The present study surveyed a national random sample of 1,000 U.S. primary care clinicians (physicians, nurses, social workers) to characterize current practices, barriers, and facilitators of caregiver assessment. A total of 231 completed responses were received. A minority of respondents (11%) reported that their practice or clinic had a standardized procedure for caregiver assessment; one in ten (10%) reported that they had personally conducted a caregiver assessment using a standardized instrument in the past year. The most common barriers to caregiver assessment were lack of time (65%), inability to have private discussions with caregivers (36%), lack of access to referral options (30%), inadequate reimbursement (30%), and reluctance of caregivers to discuss their needs (30%). The most frequently endorsed facilitators to aid future implementation included better availability of referral options (77%), easier referral mechanisms (67%), co-location of mental health specialists, care managers, or social workers (65%), and training in how to address caregiver issues (61%). Findings are discussed within the context of emerging healthcare policies and practice initiatives designed to promote caregiver assessment in health care settings.

scholarly journals Acceptability, feasibility, and quality of telehealth for adolescent healthcare delivery during the COVID-19 pandemic: A cross-sectional study of patient and family experiences (Preprint)

2021 ◽  
Author(s):  
Sarah Wood ◽  
Julia Pickel ◽  
Alexis W Phillips ◽  
Kari Baber ◽  
John Chuo ◽  
...  
Keyword(s):  
Medication Management ◽  
Healthcare Delivery ◽  
Vital Signs ◽  
Cross Sectional Study ◽  
Quality Data ◽  
Adolescent Medicine ◽  
Institute Of Medicine ◽  
Patient Centeredness ◽  
Chi Square ◽  
Cross Sectional

BACKGROUND Telehealth acceptability, feasibility, and quality data are lacking among adolescents and young adults (AYA) and their parents and caregivers (caregivers). OBJECTIVE To assess non-inferiority of telehealth vs in-person visits, comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. METHODS Cross-sectional web-based survey sent to caregivers and AYA following video visits within an adolescent medicine subspecialty clinic, May-July, 2020. Proportions of AYA and caregivers who rated telehealth as non-inferior were compared using chi-square tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis, using the Institute of Medicine (IOM) dimensions of healthcare quality, was used to code open-ended question responses. RESULTS Survey response rates were 20.5% (n=55) for AYA and 21.8% (n=123) for caregivers. The majority of respondents were White, cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA, compared to caregivers, found telehealth inferior with respect to confidentiality (22% vs 3%, p<0.01). One quarter of patients and 32% of caregivers reported technical difficulties. Dominant themes in qualitative data included advantages of telehealth for efficiency and equity of healthcare delivery. However, respondents’ concerns included reduced safety and effectiveness of care, particularly for patients with eating disorder, due to lack of hands-on exams, collection of vital signs, and laboratory testing. CONCLUSIONS Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.

Primary Care Provider Perceptions of Pharmacist Services in an Urban, Safety Net Health System

2019 ◽  
Vol 33 (6) ◽  
pp. 790-798
Author(s):  
Anusha McNamara ◽  
Lenny L. S. Chan ◽  
Shirley L. Wong
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Medication Management ◽  
Primary Care Providers ◽  
Safety Net ◽  
Direct Patient Care ◽  
Case Conference ◽  
Pharmacy Services ◽  
Care Providers ◽  
Pharmacist Services

While pharmacists have provided services in a multidisciplinary, primary care setting for decades, few publications have yet to evaluate providers’ impressions of- these services. An anonymous 14-item survey distributed to nonresident primary care providers aimed to identify clinical pharmacist services that are most and least helpful to primary care providers, identify barriers to pharmacy services, and develop recommendations to improve pharmacy services in primary care. The most important pharmacist contribution identified by providers is medication management, whereas the least important contributions are case conference, panel management, quality improvement, and transition of care. The primary reasons for referrals to pharmacists included inadequately controlled chronic diseases, poor or questionable adherence, longer visits for more in-depth discussion, and complex regimen requiring frequent monitoring or titration. Providers favored pharmacists working in direct patient care versus indirect patient care activities. Although many providers perceived no barriers to pharmacist service access, pharmacists’ presence and visibility were 2 barriers identified. Most providers preferred comprehensive to disease-specific medication management.

Trends from the Field: Impact of Telecommuting on Clinician Absenteeism in Primary Care

2021 ◽  
Author(s):  
Aleece Caron ◽  
Kim Bauchens ◽  
Francesca Russo ◽  
Kathryn Teng
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Safety Net ◽  
Care Nurse ◽  
Additional Tool ◽  
Average Decrease ◽  
Hospital Systems ◽  
Primary Care Clinicians

Abstract Provider burnout is a challenge faced by most large healthcare systems. Like many hospital systems, our system has struggled with burnout and turnover in our primary care clinician workforce. In March 2020 due to COVID, our large safety-net system had to rapidly transform from primarily in-person care to primarily telehealth visits. We sought to understand how this change in our model of healthcare delivery to enable telecommuting would affect absenteeism among primary care clinicians. We transitioned all 192 primary care nurse practitioners and physicians in the fields of Internal medicine, Family medicine, Medicine-Pediatrics, and Geriatrics across our health system to predominately a remote telehealth schedule. During March-May 2019, the percentage of telehealth visits was less than 1%. The shift to telehealth Mid-March 2020, shows an increase in telehealth by 35.9%. Telehealth visit volumes shifted to 87.4% for the month of April 2020 while leveling to 58.4% in May 2020 as patients needed services that required in person visits. Our analysis shows that the average decrease in call off rate from March- May 2019 compared to 2020 was 40.8%. Telehealth includes telecommunication through a variety of platforms. For primary care clinicians, telehealth provides an additional tool to manage panels of patients with potentially greater ease and efficiency. We know that clinicians want to provide high quality care for their patients, and they want some flexibility and autonomy to do so. Telecommuting may offer those benefits to providers.

Implementing Serious Illness Communication Processes in Primary Care: A Qualitative Study

2020 ◽  
pp. 104990912095109
Author(s):  
Joanna Paladino ◽  
Elise Brannen ◽  
Emily Benotti ◽  
Natalie Henrich ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Program Implementation ◽  
Primary Care Physicians ◽  
Care Program ◽  
Routine Care ◽  
Structured Interviews ◽  
Patient Centered ◽  
Serious Illness ◽  
Primary Care Clinicians

Purpose: Primary care clinicians face barriers to engaging patients in conversations about prognosis, values, and goals (“serious illness conversations”). We introduced a structured, multi-component intervention, the Serious Illness Care Program (SICP), to facilitate conversations in the primary care setting. We present findings of a qualitative study to explore practical aspects of program implementation. Methods: We conducted semi-structured interviews of participating primary care physicians, nurse care coordinators, and social workers and coded transcripts to assess the activities used to integrate SICP into the workflow. Results: We conducted interviews with 14 of 46 clinicians from 6 primary care clinics, stopping with thematic saturation. Qualitative analysis revealed major themes around activities in the timing of the conversation (before, during, and after) and overarching insights about the program. Clinicians used a variety of strategies to adapt program components while preserving key program goals, including processes to generate accountability to ensure that conversations happen in busy clinical workflows. The interviews revealed changes to clinicians’ mindset and norms, such as the recognition of the need to start conversations earlier in the illness course and the use of more expansive models of prognostic communication that address function and quality of life. Data also revealed indicators of sustainable behavior change and the spread of communication practices to patients outside the intended program scope. Conclusion: SICP served as a framework for primary care clinicians to integrate serious illness communication into routine care. The shifts in processes employed by inter-professional clinicians revealed comprehensive models for prognostic communication and creative workflows to ensure that patients with complex illnesses had proactive, longitudinal, and patient-centered serious illness conversations and care planning.

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