scholarly journals Barriers to End-of-life Discussions in the Primary Care Setting

2020 ◽  
pp. 12-15
Author(s):  
Devon Boydstun ◽  
Shandra Basil ◽  
JIll Porter ◽  
Anand Gupta
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Age Difference ◽  
Advanced Directives ◽  
Healthcare Facilities ◽  
Number Of Patients ◽  
Study Population

Background: The Patient Self Determination Act was passed in 1991 and requires healthcare facilities to present patients with information regarding advanced directives. Since that time, there has been no improvement in the number of patients reported to have had such discussions. Numerous barriers to these discussions exist both on the patient and provider side. This study aims to identify barriers to end of life discussions among providers in the primary care setting. Methods: The study population included practicing primary care physicians in the OhioHealth system. They were administered an anonymous questionnaire addressing demographic information and questions specific to end of life discussions and what barriers exist. Results: A majority of primary care physicians reported engaging in end of life discussions with their patients. A majority of physicians cited lack of time as a barrier to having these discussions. There was a statistically significant age difference among primary care physicians who reported they have end of life discussions with their patients and among these physicians there was a statistically significant increase in their level of comfort having these discussions. Conclusion: Primary care physicians further into their career reported having end of life discussions more frequently and felt more comfortable doing so. Additionally, physicians cite lack of time as the most common barrier to holding end of life discussions.

An Examination of the Prescription Renewal Process and Implications for Primary Care Physicians and Community Pharmacists

2018 ◽  
Vol 33 (2) ◽  
pp. 187-191
Author(s):  
Anthony J. Pattin ◽  
Nathan Devore ◽  
Jonathan Fowler ◽  
David Weldy
Keyword(s):  
Primary Care ◽  
Renewal Process ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Community Pharmacists ◽  
Effective Management ◽  
Physician Practices ◽  
Staff Members ◽  
Inappropriate Medications

In physician practices and pharmacies, staff members work to process prescription renewals so that patients receive a steady supply of medications. These functions are essential to ensure patients have continuous access to medications and remain adherent to prescribed therapies. Despite the incorporation of e-prescribing software programs to ease management of these processes, barriers to effective management of the prescription renewal process exist. Mismanagement of pharmacy adherence programs can ultimately lead to patients receiving inappropriate medications and excessive use of staff resources. The objective of this article is to examine the prescription renewal process in both the primary care setting and the pharmacy and report challenges associated with the process. A literature review was conducted to find studies that describe pharmacists’ and physicians’ handlings of prescription renewals, use of e-prescribing software, and benefits and barriers to using these technologies. Although studies report e-prescribing software improves efficiency in the prescription renewal process, there is a need to reduce technological problems that create challenges in use. It is recommended that staff within physician practices and pharmacies standardize prescription renewal processes and educate patients about the prescription renewal process.

scholarly journals Early identification of the end-of-life in primary care setting

2020 ◽  
Vol 37 (3) ◽  
pp. 429-429
Author(s):  
Yvette Jaffe ◽  
Emily Ching ◽  
Abigail Chan ◽  
Urvi Karamchandani
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
Early Identification ◽  
Care Setting ◽  
Primary Care Setting

scholarly journals Seroprevalence against COVID-19 and follow-up of suspected cases in primary health care in Spain

2020 ◽  
Author(s):  
C Brotons ◽  
J Serrano ◽  
D Fernández ◽  
C Garcia-Ramos ◽  
B Ichazo ◽  
...  
Keyword(s):  
Primary Care ◽  
Regression Analysis ◽  
Care Setting ◽  
Primary Care Setting ◽  
Positive Test ◽  
Positive Test Result ◽  
Study Population ◽  
Asymptomatic Individuals ◽  
Test Result

ABSTRACTBackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic little information has been available about patients with mild or moderate symptoms attended and followed in the primary care setting, most of whom had an unknown status for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.ObjectivesWe aim to measure the seroprevalence of antibodies against SARS-CoV-2 infection in a community sample of asymptomatic individuals and among symptomatic patients (without confirmed diagnosis) followed in a primary care setting.As a secondary objective, we estimated the proportions of symptomatic patients seeing at an emergency department (ED), hospitalized or dying, and identified the most important clinical symptoms associated with a positive infection.MethodsFrom April 21 to April 24 2020, we selected a random sample of 600 individuals stratified by age groups, from a total population of 19,899 individuals from a community area in Barcelona (study population 1). From April 29 to May 5 2020, we also invited all the patients that had been followed by general practitioners (GPs) (study population 2).We used for both populations COVID-19 Rapid lateral flow immunoassay which qualitatively assesses the presence of patient-generated IgG and IgM in approximately 10-15 minutes.The prevalence (95% confidence intervals [CI]) of infection (past and current) was defined as the proportion of individuals with antibody seropositivity. Odds ratios (ORs) for a positive test result were estimated using logistic regression analysis.ResultsThree hundred and eleven asymptomatic individuals from the randomly selected sample accepted to participate in the study. The overall mean age was 43.7 years (SD 21.79, range 1-94) and 55% were women. Seventeen individuals were seropositive for IgM and/or IgG, resulting an overall prevalence of 5,47% (95% CI, 3.44-8.58).Six-hundred and thirty-four symptomatic patients were followed by GPs. The overall mean age was 46.97 years (SD 20.05, range 0-92) and 57.73% were women. Of these, 244 patients (38.49%) were seropositive for IgM and/or IgG.During the follow-up period, 27.13% of symptomatic patients attended the ED, 11.83% were hospitalized and about 2% died.Results of the multivariate logistic regression analysis showed that the OR for a positive test was significantly increased in patients who had fever (>38°C), ageusia and contact with a patient diagnosed with COVID-19.ConclusionsThe seroprevalence of antibodies against SARS-CoV-2 among asymptomatic individuals in the general population was lower than expected.Approximately 40% of the symptomatic patients followed by GPs during the peak months of the pandemic in Barcelona, were positive. Fever (>38°C), anosmia, ageusia and contact with a patient diagnosed with COVID-19 were associated with a positive test result.

scholarly journals Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting

2019 ◽  
Vol 13 (03) ◽  
pp. 219-226
Author(s):  
Alison A Jackson ◽  
Pauline Siew Mei Lai ◽  
Aqtab Mazhar Alias ◽  
Nadia Atiya ◽  
Siti Nurkamilla Ramdzan ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diagnosis And Management ◽  
Prostatic Enlargement ◽  
Suboptimal Adherence

Introduction: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting. Methodology: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist. Results: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available. Conclusion: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.

scholarly journals Childhood chronic cough made easy: a simplified approach for the primary care setting

2021 ◽  
Vol 49 (2) ◽  
pp. 170-177
Author(s):  
Grigorios Chatziparasidis ◽  
Sotirios Fouzas ◽  
Ahmad Kantar
Keyword(s):  
Primary Care ◽  
Chronic Cough ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Defense Mechanism ◽  
Negative Impact ◽  
Care Physician ◽  
Simplified Approach ◽  
Clinical Scenarios

Cough is a defense mechanism, but when it becomes persistent and troublesome, it must be carefully assessed. Chronic cough, that is, cough persisting for more than 4 weeks, has a proven negative impact on a child’s quality of life; it interferes with daily activities, sleep, and schooling and may involve frequent health care visits and long-lasting treatments. Currently, there is a plethora of algorithms in the literature aiming to assist in the assessment of chronic cough in children; however, referring to complex flowcharts may be impractical for the usually busy primary care physician. Herein, we provide a simplified tool for the assessment of children with chronic cough in the primary care setting, presenting a basic approach to the most common causes along with hints to avoid common pitfalls in everyday practice. Finally, the most common clinical scenarios are analyzed, aiming to assist primary care physicians in providing the appropriate care to these patients.

scholarly journals No Ifs, Ands, or Buts: Leveraging Population Health to Focus on the Care of Patients Who Smoke

2017 ◽  
Vol 4 ◽  
pp. 238212051773501
Author(s):  
Jenny K Cohen ◽  
Allison Bakamjian ◽  
Lisa Leng ◽  
Mili Adhikari ◽  
Davida Flattery ◽  
...  
Keyword(s):  
Primary Care ◽  
Smoking Cessation ◽  
Population Health ◽  
Care Setting ◽  
Primary Care Setting ◽  
Clinical Knowledge ◽  
Smoking Cessation Counseling ◽  
Panel Management ◽  
Number Of Patients ◽  
Before And After

We developed a multidisciplinary curriculum to improve our residents’ proficiency with smoking cessation counseling and prescribing of nicotine replacement therapy (NRT). The curriculum included a didactic portion, informational handouts, and a panel management component during which residents did telephone outreach and clinic in-reach to address high rates of smoking among patients. Residents rated their confidence with smoking cessation counseling and clinical knowledge before and after the intervention. We also tracked the number of patients flagged in the electronic medical record as smokers, the number of patients contacted, and the number of patients who received counseling. Although we did not make statistically significant improvements in perceived confidence with prescribing NRT, we found that there is an urgent need to address smoking cessation in the primary care setting and that working with a clinical pharmacist and psychologist offered a comprehensive approach. Furthermore, by anchoring the intervention with a population health component, almost 200 patients benefited from outreach efforts.

Consultation-Liaison Psychiatry Fellowship in Primary Care

1996 ◽  
Vol 26 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Maurice D. Steinberg ◽  
Steven A. Cole ◽  
Stephen M. Saravay
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Liaison Psychiatry ◽  
Service Staff ◽  
Consultation Liaison Psychiatry ◽  
Primary Care Practitioners ◽  
Primary Care Medicine ◽  
Selection Of

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. Results: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. Conclusions: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

scholarly journals Audit of a psychiatric liaison service – the value of general practice casenotes

1990 ◽  
Vol 14 (12) ◽  
pp. 727-729 ◽  
Author(s):  
Sheila M. Curran ◽  
Ian M. Pullen
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Number Of Patients

The practice of out-patient psychiatry has undergone a number of significant developments in recent years: the number of patients referred by general practitioners has steadily increased: a large number of psychiatrists are now seeing patients in the primary care setting and more patients are being seen on one occasion only.

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