scholarly journals Evidence-based primary care approach to treating people with COVID-19 infection to prevent life-threatening complications: A review of the evidence for practical application in a clinical setting

2021 ◽  
Vol 5 (1) ◽  
pp. 009-014
Author(s):  
Sharon Thomas A
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Treatment Guidelines ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Cytokine Storm ◽  
Care Providers ◽  
Vitamin D Levels ◽  
Cytokine Levels ◽  
Standard Practices

The NIH has published treatment guidelines for treating COVID-19 patients in the hospital. However, as of this writing, there are no established protocols for treating COVID-19 positive patients in primary care. Accordingly, this investigator has taken on the task of reviewing the medical literature to be able to propose evidence-based protocols for treating COVID-19 positive patients in primary care. The CDC is advising people to do nothing when they find out they are positive for COVID-19 unless they have symptoms. The evidence from the literature irrefutably shows COVID-19 infection evokes a massive and deadly hyperinflammatory response called the “Cytokine storm” and that Cytokine levels in the blood have a predictive value in identifying an impending Cytokine storm. With such data primary care providers can effectively lower Cytokine levels and prevent critical illness and death. Accordingly, this paper presents identification of the problem of not having standard practices in primary care for people who are positive for COVID-19 and not knowing who is at risk. Moreover, the evidence shows that knowing vitamin D levels and correcting deficiencies can go a long way in reducing Cytokine levels. Additionally, the literature review presents evidence that undeniably shows the stark possibility that many of the COVID-19 related deaths can be prevented by identifying who is at risk for the Cytokine storm and other complications and providing early treatment even before symptoms appear.

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

scholarly journals IMPROVING PRIMARY CARE PROVIDER EDUCATION AND SATISFACTION VIA THE CATCH-ON LEARNING COMMUNITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S36-S36
Author(s):  
Erin Emery-Tiburcio ◽  
Magdalena Bednarcyzk ◽  
Febe Wallace ◽  
Michelle Newman
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Learning Communities ◽  
Cost Model ◽  
Healthcare Access ◽  
Primary Care Providers ◽  
Educational Interventions ◽  
Evidence Based ◽  
Care Providers ◽  
Provider Education

Abstract Nationally, there is a shortage of geriatric trained healthcare providers caring for older adults. As the population of older adults grows, health care systems and primary care providers struggle to provide high quality, cost effective care for older adults. Time for training is also limited in busy community health centers. The CATCH-ON Learning Communities (LCs) are telehealth educational interventions based on the ECHO model, modified to be less time intensive, thus decreasing cost to participating clinics. In the LC, geriatric specialists provide evidence-based, best practice training utilizing case discussions to illustrate pertinent learning points via monthly one hour video conferences. Practical, specific behavioral recommendations are offered for immediate implementation in each session. LCs are provided to interprofessional primary care teams. The first LC with a federally-qualified health center (FQHC) yielded consistently high satisfaction from participants, along with a 17% decrease in high risk medication prescriptions and 22% increase in falls screenings. Training the primary care workforce in evidence based geriatric interventions can improve the care of all older adults within each health system, improving healthcare access to help mitigate healthcare inequalities, slow adoption of best practices and rising costs of caring for complex older adults. The CATCH-ON Learning Community is an effective, low cost model of training the primary care work force without geographical or financial constraints that frequently limit access to specialized care.

scholarly journals Implementation of an Opioid and Benzodiazepine Deprescribing Program for Older Adults in an Outpatient Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 906-906
Author(s):  
Lori Armistead ◽  
Jan Busby-Whitehead ◽  
Stefanie Ferreri ◽  
Cristine Henage ◽  
Tamera Hughes ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Older Adult ◽  
Adult Population ◽  
Primary Care Providers ◽  
The United States ◽  
Outpatient Setting ◽  
Care Providers ◽  
Risk Of Falls

Abstract The United States spends $50 billion each year on 2.8 million injuries and 800,000 hospitalizations older adults (age 65 years and older) incur as the result of falls. Chronic use of central nervous system (CNS)-active medications, such as opioid and/or benzodiazepine (BZD) medications, increases the risk of falls and falls-related injuries in this older adult population. This Centers for Disease Control and Prevention (CDC)-funded randomized control trial uses electronic health record (EHR) data from primary care outpatient clinics to identify older adult patients at risk for falls due to chronic opioid or BZD use. The primary program aim is to test the efficacy of a targeted consultant pharmacist service to reduce the dose burden of these medications in the targeted population. Impact of this intervention on the risk of falls in this population will also be assessed. Licensed clinical pharmacists will review at-risk patients’ medical records weekly and make recommendations through the EHR to primary care providers for opioid or BZD dose adjustments, alternate medications, and/or adjunctive therapies to support deprescribing for approximately 1265 patients in the first two cohorts of intervention clinics. One thousand three hundred eighty four patients in the control clinics will receive usual care. Outcome measures will include reduction or discontinuation of opioids and BZDs and falls risk reduction as measured by the Stop Elderly Accidents, Death and Injuries (STEADI) Questionnaire. Primary care provider adoption of pharmacists’ recommendations and satisfaction with the consult service will also be reported.

Understanding Adolescent Expressions of Sadness: A Qualitative Exploration

2020 ◽  
Vol 34 (4) ◽  
pp. 321-339
Author(s):  
Daniela A. Terrizzi ◽  
Huma A. Khan ◽  
Allison Paulson ◽  
Zach Abuwalla ◽  
Nitza Solis ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Depressive Disorder ◽  
Primary Care Providers ◽  
Epidemiologic Studies ◽  
Empirical Literature ◽  
Subthreshold Depression ◽  
Care Providers ◽  
Structured Interviews ◽  
Risk For Depression

PurposePrimary care providers are positioned to identify adolescents at risk for depression and prevent major depressive disorder. To identify subthreshold depression, we examined the language adolescents use to describe their symptoms.MethodsAdolescents ages 13–18 with elevated levels on the Center for Epidemiologic Studies Depression (CES-D) scale and/or a history of depression who were part of a large randomized clinical trial to prevent depressive disorder were included. We used content analysis to analyze transcripts of semi-structured interviews.ResultsSaturation was reached at 37 interviews. Adolescents self-identified as African American (N = 15), Hispanic (N = 10), and White (N = 21). Three domains were revealed; external sources of stress, adolescent expressions of sadness, and seeking help and care. Within these domains, 12 distinct themes emerged contextualizing these domains. No variations in the expression of the themes identified for subthreshold depression were found between the three ethno-cultural groups.Implications for PracticeOur study identifies, in adolescents' own words, how adolescents with subthreshold depression express feelings and cope with symptoms, and may guide primary care providers to recognize subthreshold depression early. These findings are a step toward filling the gap in the empirical literature needed to improve identification of adolescents at risk for depression in nonspecialist settings.

scholarly journals Stakeholders’ views on identifying patients in primary care at risk of dying: a qualitative descriptive study using focus groups and interviews

2018 ◽  
Vol 68 (674) ◽  
pp. e612-e620 ◽  
Author(s):  
Robin Urquhart ◽  
Jyoti Kotecha ◽  
Cynthia Kendell ◽  
Mary Martin ◽  
Han Han ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Focus Groups ◽  
Early Identification ◽  
Primary Care Providers ◽  
Descriptive Study ◽  
Comparative Approach ◽  
Team Approach ◽  
Care Providers ◽  
Qualitative Descriptive

BackgroundStrategies have been developed for use in primary care to identify patients at risk of declining health and dying, yet little is known about the perceptions of doing so or the broader implications and impacts.AimTo explore the acceptability and implications of using a primary care-based electronic medical record algorithm to help providers identify patients in their practice at risk of declining health and dying.Design and settingQualitative descriptive study in Ontario and Nova Scotia, Canada.MethodSix focus groups were conducted, supplemented by one-on-one interviews, with 29 healthcare providers, managers, and policymakers in primary care, palliative care, and geriatric care. Participants were purposively sampled to achieve maximal variation. Data were analysed using a constant comparative approach.ResultsSix themes were prevalent across the dataset: early identification is aligned with the values, aims, and positioning of primary care; providers have concerns about what to do after identification; how we communicate about the end of life requires change; early identification and subsequent conversations require an integrated team approach; for patients, early identification will have implications beyond medical care; and a public health approach is needed to optimise early identification and its impact.ConclusionStakeholders were much more concerned with how primary care providers would navigate the post-identification period than with early identification itself. Implications of early identification include the need for a team-based approach to identification and to engage broader communities to ensure people live and die well post-identification.

scholarly journals Variation in Diabetes Management: A National Assessment of Primary Care Providers

2019 ◽  
Vol 14 (1) ◽  
pp. 70-76
Author(s):  
John W. Peabody ◽  
Enrico de Belen ◽  
Jeffrey R. Dahlen ◽  
Maria Czarina Acelajado ◽  
Mary T. Tran ◽  
...  
Keyword(s):  
Primary Care ◽  
Glycemic Control ◽  
Diabetes Management ◽  
Glycemic Variability ◽  
Primary Care Providers ◽  
The United States ◽  
Poor Glycemic Control ◽  
Simulated Patients ◽  
Evidence Based ◽  
Care Providers

Background:Glucose control is monitored primarily through ordering HbA1c levels, which is problematic in patients with glycemic variability. Herein, we report on the management of these patients by board-certified primary care providers (PCPs) in the United States.Methods:We measured provider practice in a representative sample of 156 PCPs. All providers cared for simulated patients with diabetes presenting with symptoms of glycemic variability. Provider responses were reviewed by trained clinicians against evidence-based care standards and accepted standard of care protocols.Results:Care varied widely—overall quality of care averaged 51.3%±10.6%—with providers performing just over half the evidence-based practices necessary for their cases. More worryingly, provider identified the underlying etiology of the poor glycemic control only 36.3% of the time. HbA1c was routinely ordered in 91.3% of all cases but often (59.5%) inappropriately. Ordering other tests of glycemic control (done in 15% of cases) led to significant increases in identifying the etiology of the hyperglycemia. Correctly modifying their patient’s treatment was more likely to occur if doctors first identified the underlying etiology (65.9% vs 49.0%, P<0.001). We conservatively estimated a US $65/patient/visit in unnecessary testing and US $389 annually in additional care costs when the etiology was missed, translating potentially into millions of dollars of wasteful spending.Conclusion:Despite established evidence that HbA1c misses short-term changes in diabetes, we found PCPs consistently ordered HbA1c, rarely using other available blood tests. However, if the factors leading to poor glycemic control were recognized, PCPs were more likely to correctly alter their patient’s hypoglycemic therapy.

scholarly journals Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study

2020 ◽  
pp. ebmental-2020-300199
Author(s):  
Milton L Wainberg ◽  
Maria Lídia Gouveia ◽  
Melissa Ann Stockton ◽  
Paulino Feliciano ◽  
Antonio Suleman ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mobile Applications ◽  
Health Workers ◽  
Systems Of Care ◽  
Scale Up ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Care Providers ◽  
The Future

ObjectiveTo report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications.Design and SettingThe Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications.Main outcome measuresWe examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPsParticipantsPsychiatric technicians and primary care providers trained in the EBPs.ResultsPRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment.ConclusionsThe future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.

Abstract P077: Missed Opportunities for Behavioral Counseling by Primary Care Providers

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
John D Omura ◽  
Susan A Carlson ◽  
Prabasaj Paul ◽  
Kathleen B Watson ◽  
Fleetwood Loustalot ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
At Risk ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Counseling ◽  
The Metabolic Syndrome ◽  
Patients At Risk ◽  
Risk Patients ◽  
Counseling Practices

Background: In 2014, the US Preventive Services Task Force recommended adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Hypothesis: We hypothesized that primary care providers (PCPs) who discussed physical activity with most of their at risk patients would have a higher prevalence of offering select components than PCPs who discussed physical activity less frequently. Methods: DocStyles 2015, a Web-based panel survey of 1251 PCPs (response rate=76.8%), assessed physical activity counseling practices with patients at risk for CVD (overweight or obese and with hypertension, dyslipidemia, impaired fasting glucose, or the metabolic syndrome). Results: Overall, 55.9% (SE=1.4) of PCPs discussed physical activity with most of their patients at risk for CVD. Among respondents who discussed physical activity with any at risk patients (N=1244), the prevalence of components offered when they counseled ranged from 92.6% encouraging increased physical activity to 15.8% referring to intensive behavioral counseling (Table). PCPs who discussed physical activity with most at risk patients had a higher prevalence of offering all counseling components assessed than PCPs who discussed physical activity less frequently, except for referring to intensive behavioral counseling where no difference was found. Of all PCPs, 8.4% both discussed physical activity with most of their at risk patients and referred them to intensive behavioral counseling. Conclusion: Just over half of PCPs surveyed discussed physical activity with most patients at risk for CVD. These PCPs more frequently offered select components when they counseled with the exception of referral to intensive behavioral counseling. Both the low levels of counseling and referral to intensive behavioral counseling present important opportunities for improving counseling practices.

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