scholarly journals Primary Care Clinician perspectives on ADHD care and suggestions for improvement initiatives

2020 ◽  
Author(s):  
Sean O'Dell ◽  
Matthew J. Gormley ◽  
Victoria Schlieder ◽  
Tracey Klinger ◽  
Kathy DeHart ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Treatment Guidelines ◽  
Behavioral Health Care ◽  
Screening Tools ◽  
Care Process ◽  
Future Research ◽  
Evidence Based ◽  
Evidence Based Guidelines ◽  
Current Practices

Abstract Background and Objectives: Despite efficacious treatments and evidence-based guidelines, youth coping with attention deficit hyperactivity disorder (ADHD) receive suboptimal care. Primary care clinicians (PCCs) are frontline providers of ADHD care; however, little is known about PCC perspectives regarding this care gap and how to effectively address it within health systems. We investigated PCC perspectives on determinants of pediatric ADHD care and considerations for improving adherence to evidence-based guidelines. Methods: Semi-structured qualitative interviews were conducted with 26 PCCs representing clinics within a health system on improving adherence to treatment guidelines for pediatric ADHD. Interview guides were based on the Pragmatic Robust Implementation and Sustainability Model (PRISM) to elicit PCC views regarding determinants of current practices and suggestions to guide improvement efforts. We used thematic analysis to identify patterns of responding that were common across participants.Results: We identified 12 themes categorized into two broad domains: Status Quo of Pediatric ADHD Care and Supporting and Constraining Factors for Improvement Initiatives. PCCs identified several internal and external contextual factors as determinants of current practices. Of note, PCCs reported they face challenges at multiple steps in the care process, including mental health stigma, coordinating care across settings, clinical productivity pressures, access to behavioral health care, and insurance mandates regarding medications. PCCs recommended efficient continuing education trainings accompanied by improvements to the electronic health record to include validated screening tools and documentation templates.Conclusions: Future research triangulating these findings may help to more efficiently improve the quality of pediatric ADHD care in health systems.

scholarly journals Young Adult Cancer Survivorship: Recommendations for Patient Follow-up, Exercise Therapy, and Research

2020 ◽  
Author(s):  
Scott C Adams ◽  
Jennifer Herman ◽  
Iliana C Lega ◽  
Laura Mitchell ◽  
David Hodgson ◽  
...  
Keyword(s):  
Young Adult ◽  
Late Effects ◽  
Adolescent And Young Adult ◽  
Future Research ◽  
Evidence Based ◽  
Pediatric Cancer Survivors ◽  
Increased Risk ◽  
Care Guidelines ◽  
Young Adult Cancer ◽  
Evidence Based Guidelines

Abstract Survivors of adolescent and young adult cancers (AYAs) often live 50 to 60 years beyond their diagnosis. This rapidly growing cohort is at increased risk for cancer- and treatment-related late effects that persist for decades into survivorship. Recognition of similar issues in pediatric cancer survivors has prompted the development of evidence-based guidelines for late effects screening and care. However, corresponding evidence-based guidelines for AYAs have not been developed. We hosted an AYA survivorship symposium for a large group of multidisciplinary AYA stakeholders (approximately 200 were in attendance) at Princess Margaret Cancer Centre (Toronto, ON) to begin addressing this disparity. The following overview briefly summarizes and discusses the symposium’s stakeholder-identified high-priority targets for late effects screening and care, and highlights knowledge gaps to direct future research in the field of AYA survivorship. This overview, while not exhaustive, is intended to stimulate clinicians to consider these high-priority screening and care targets when seeing survivors in clinical settings and, ultimately, support the development of evidence-based ‘late effects’ screening and care guidelines for AYAs.

The Care Triangle: Determining the Gaps in the Management of Atopic Dermatitis

2013 ◽  
Vol 17 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Ashley O'Toole ◽  
Bjorn Thomas ◽  
Richard Thomas
Keyword(s):  
Atopic Dermatitis ◽  
Response To Treatment ◽  
Care Process ◽  
Evidence Based ◽  
Previous Response ◽  
Children And Young Adults ◽  
The Individual ◽  
Evidence Based Guidelines ◽  
Based Medicine

Background: Atopic dermatitis (AD) is a chronic, relapsing, intensely pruritic dermatosis that usually affects infants, children, and young adults. The treatment of AD entails an individualized regimen that depends on the age of the patient, the stage and variety of lesions present, the sites and extent of involvement, the presence of infection, and the previous response to treatment. Objectives: To identify the evidence surrounding potential strategies for closing these gaps—ultimately improving the quality of care, the care process itself, and patient outcomes—and to encourage discussions that help develop tools to bridge the gap between suggested therapy and what is done by the patient. Methods: Review of the literature including searches on PubMed Central and Medline and in seminal dermatology texts. Results: There are several disconnections between the evidence-based guidelines in the management of AD, what the individual dermatologist recommends, and what the patient does. Conclusion: Applying the concept of the care triangle requires a balance of evidence-based medicine, the physician's experiences and the patient's needs and expectations in the decisions surrounding appropriate management of the disease.

PTSD Treatment of African American Adults in Primary Care: The Gap Between Current Practice and Evidence-Based Treatment Guidelines

2011 ◽  
Vol 103 (7) ◽  
pp. 585-593 ◽  
Author(s):  
Ruth Elaine Graves ◽  
John R. Freedy ◽  
Notalelomwan U. Aigbogun ◽  
William B. Lawson ◽  
Thomas A. Mellman ◽  
...  
Keyword(s):  
Primary Care ◽  
African American ◽  
Current Practice ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Ptsd Treatment ◽  
African American Adults

Safety, Efficacy, and Cost Effectiveness of Evidence-Based Guidelines for the Management of Acute Low Back Pain in Primary Care

Spine ◽  
2001 ◽  
Vol 26 (23) ◽  
pp. 2615-2622 ◽  
Author(s):  
Brian McGuirk ◽  
Wade King ◽  
Jayantilal Govind ◽  
John Lowry ◽  
Nikolai Bogduk
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Cost Effectiveness ◽  
Evidence Based ◽  
Low Back ◽  
Acute Low Back Pain ◽  
Evidence Based Guidelines

Anticoagulant Use in Real Time

2012 ◽  
Vol 26 (3) ◽  
pp. 270-279 ◽  
Author(s):  
Divyamani Srinivasan ◽  
Bree Watzak
Keyword(s):  
Treatment Guidelines ◽  
Trauma Surgery ◽  
The United States ◽  
Pharmacy Education ◽  
Bleeding Complications ◽  
Clinical Aspects ◽  
Evidence Based ◽  
Inherited Disorders ◽  
Reversal Agents ◽  
Evidence Based Guidelines

Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). Each year, VTE affects about 300 000 to 600 000 people in the United States, and death is the first manifestation in one-fourth of this population.1{Beckman, 2010 #79} Moreover, approximately 10% of the US population has genetic factors that increase their risk for developing thrombosis.1 In addition to inherited disorders, factors that contribute to VTE include prolonged immobilization, trauma, surgery, cancer, and critically ill patients.2 Routine assessment and prophylaxis are recommended in these groups to avoid DVT-related complications.2 Anticoagulants are the mainstay of drugs used in DVT/PE prevention and treatment. Despite the availability of evidence-based guidelines for anticoagulant therapy, there is suboptimal implementation of DVT prophylaxis in hospitalized patients.3 All anticoagulants are “high-alert” drugs, and judicious use is mandatory to prevent bleeding complications.4 This review discusses treatment guidelines, monitoring, side effects, and reversal agents available for some anticoagulant drugs approved for VTE. Dissemination of the knowledge via pharmacy education programs significantly improves the adherence to VTE prophylaxis.5 Understanding the clinical aspects of anticoagulant dispensing as presented in this review is hoped to facilitate implementation of the theoretical knowledge as well as evidence-based guidelines in order to maximize patient benefit.

Ratings of the Effectiveness of Warnings on Consumer Paint Stripper Products

2016 ◽  
Vol 60 (1) ◽  
pp. 480-484 ◽  
Author(s):  
Kenneth Nemire
Keyword(s):  
Methylene Chloride ◽  
National Standards ◽  
Mechanical Turk ◽  
Hazardous Substances ◽  
Amazon Mechanical Turk ◽  
Future Research ◽  
Evidence Based ◽  
Labeling Requirements ◽  
Evidence Based Guidelines ◽  
Study Participants

Accidental inhalation of vapors from paint stripper products containing methylene chloride has resulted in injuries and deaths. Warnings on paint stripper products may play a role in reducing the number and severity of injuries resulting from using them. Warning labels consistent with Federal Hazardous Substances Act (FHSA) and American National Standards Institute (ANSI) Z535.4 formatting were evaluated by 159 university students and by 173 Amazon Mechanical Turk (MTurk) workers. Results indicated that both groups rated the ANSI-formatted warnings as more effective (more likely to be noticed, read, understood, and followed) than the FHSA-formatted warnings, providing support for both use of crowdsourcing as a reliable and valid source for study participants to evaluate warnings, as well as for updating FHSA labeling requirements to include evidence-based guidelines on warning effectiveness. Implications for future research are discussed.

scholarly journals Engaging Parents and Health Care Providers to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Sean M. O'Dell ◽  
Heidi R Fisher ◽  
Victoria Schlieder ◽  
Tracey Klinger ◽  
Rachel L Kininger ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Health Care Providers ◽  
Unmet Needs ◽  
Behavioral Health Care ◽  
Mixed Methods Study ◽  
Targeted Prevention ◽  
Care Providers ◽  
Current Practices

BACKGROUND Despite innovations to integrate behavioral health practitioners in primary care settings and online adaptations of effective parenting programs, access to care gaps persist for youth and families in need. Behavioral intervention technologies (BITs) represent a modality for targeted prevention with promise for transforming primary care behavioral health by empowering parents to take charge of their child’s behavioral health care. In order to realize the potential of BITs, research is needed to understand parental needs in a BIT, as well as the status quo of parent self-help and parent-provider collaboration to identify and address behavioral health challenges. OBJECTIVE Engage parents and health care providers to better understand unmet needs and current practices to inform continued development of a BIT for parents to address common behavioral health challenges. METHODS We conducted a convergence validation mixed methods study in which parent quantitative surveys (N=385) on preferences and current practices related to behavioral health themes to be addressed in a BIT were integrated with focus group interview data on internal and external contextual factors contributing to parental unmet needs and current practices with 48 health care stakeholders in 9 child-serving clinics within a large, predominantly rural health system. We integrated these data using joint displays and synthesized areas of confirmation, expansion, and discordance between parents and health care stakeholders. RESULTS Parents frequently endorsed about half of the available themes in their “top 3”, indicating that BITs may not be the preferred modality for all targeted prevention. Additionally, parents also frequently endorsed themes that were not related to child psychopathology (e.g., parenting stress and family communication), indicating parents are interested in guidance on parenting beyond challenging child behavior. Health care stakeholders indicated that an online platform aligns with how parents already seek behavioral health guidance and suggested that a BIT may connect families with evidence-based guidance sooner. We identified areas of convergence related to overt behavior problems (e.g., disruptive behavior, nutrition and eating), and areas of divergence related to internalizing problems and cross-cutting issues that may be more difficult for health care providers to detect. Data integration helped to expand our understanding with regard to factors that may lead to more effective parent-provider partnerships, including the impact of limited time pressure office visits and a deeper understanding of how unmitigated parenting stress interrelates with qualities of parent help-seeking behavior. CONCLUSIONS These findings provide a rich understanding of the complexity involved in meeting parents’ needs for behavioral health guidance in a primary care setting using BITs. Further triangulation of these findings in user testing studies for BIT prototypes is needed to refine our understanding of how to successfully develop and implement an effective BIT to guide parents in taking charge of their child’s behavioral health care. CLINICALTRIAL N/A

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