scholarly journals Stimulating the Use of OMT in Primary Care Offices Via Point-of-Care Reminders

2020 ◽  
pp. 14-17
Author(s):  
Annabel Agcopra ◽  
Philip Collins Collins ◽  
Stuti Jha ◽  
Alison Mancuso
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Pain Medication ◽  
Outpatient Setting ◽  
Control Group ◽  
Somatic Dysfunction ◽  
Before And After ◽  
Icd 10

Primary care physicians, especially in family medicine, are more prone to use osteopathic manipulative treatment (OMT) than other specialists; however, barriers to OMT use exist. The purpose of this study is to evaluate if the frequency of OMT use in a family medicine outpatient setting is influenced by having posters promoting OMT in exam rooms and waiting rooms. Methods: OMT posters were placed in two of four offices in an academic family medicine practice. Offices without posters served as the control group. Billing patterns were examined for the five months prior to and after poster placement. Report parameters included: age, gender, ethnicity, CPT code for OMT and somatic dysfunction ICD-10 codes. Results: Data before and after poster placement were compared. Results showed a positive correlation between posters advertising OMT and OMT use. There was a 6.5% increase in OMT use in the offices that had posters advertising OMT. Conclusion: This research showed that placing OMT posters in select family medicine offices resulted in an increase in OMT use. Possibilities for this increase include patients becoming more aware of the benefits of OMT and/or simply reminding osteopathic physicians of the benefits of OMT. Increased OMT utilization could lead to a decrease in pain medication prescribing and an increase in functionality through conservative measures.

Direct observation of depression screening: identifying diagnostic error and improving accuracy through unannounced standardized patients

Diagnosis ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 251-256 ◽  
Author(s):  
Alan Schwartz ◽  
Steven Peskin ◽  
Alan Spiro ◽  
Saul J. Weiner
Keyword(s):  
Primary Care ◽  
Clinical Performance ◽  
Standardized Patients ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Control Group ◽  
Care Providers ◽  
Real Patient ◽  
Before And After ◽  
Icd 10

AbstractBackgroundDepression is substantially underdiagnosed in primary care, despite recommendations for screening at every visit. We report a secondary analysis focused on depression of a recently completed study using unannounced standardized patients (USPs) to measure and improve provider behaviors, documentation, and subsequent claims for real patients.MethodsUnannounced standardized patients presented incognito in 217 visits to 59 primary care providers in 22 New Jersey practices. We collected USP checklists, visit audio recordings, and provider notes after visits; provided feedback to practices and providers based on the first two visits per provider; and compared care and documentation behaviors in the visits before and after feedback. We obtained real patient claims from the study practices and a matched comparison group and compared the likelihood of visits including International Classification of Diseases, 10th Revision (ICD-10) codes for depression before and after feedback between the study and comparison groups.ResultsProviders significantly improved in their rate of depression screening following feedback [adjusted odds ratio (AOR), 3.41; 95% confidence interval (CI), 1.52–7.65; p = 0.003]. Sometimes expected behaviors were documented when not performed. The proportion of claims by actual patients with depression-related ICD-10 codes increased significantly more from prefeedback to postfeedback in the study group than in matched control group (interaction AOR, 1.41; 95% CI, 1.32–1.50; p < 0.001).ConclusionsUsing USPs, we found significant performance issues in diagnosis of depression, as well as discrepancies in documentation that may reduce future diagnostic accuracy. Providing feedback based on a small number of USP encounters led to some improvements in clinical performance observed both directly and indirectly via claims.

scholarly journals Do electronic reminders alter recorded diagnoses in primary care office-hours practices of health centers: A register-based study in a Finnish city

2021 ◽  
Vol 9 ◽  
pp. 205031212110361
Author(s):  
Mika Lehto ◽  
Kaisu Pitkälä ◽  
Ossi Rahkonen ◽  
Merja K Laine ◽  
Marko Raina ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Health Centers ◽  
Health Record ◽  
Record System ◽  
Electronic Reminder ◽  
Primary Health ◽  
Primary Care Health ◽  
Before And After ◽  
Care Health

Objectives: One purpose of electronic reminders is improvement of the quality of documentation in office-hours primary care. The aim of this study was to evaluate how implementation of electronic reminders alters the rate and/or content of diagnostic data recorded by primary care physicians in office-hours practices in primary care health centers. Methods: The present work is a register-based longitudinal follow-up study with a before-and-after design. An electronic reminder was installed in the electronic health record system of the primary health care of a Finnish city to remind physicians to include the diagnosis code of the visit in the health record. The report generator of the electronic health record system provided monthly figures for the number of various recorded diagnoses by using the International Classification of Diseases, 10th edition, and the total number of visits to primary care physicians, thus allowing the calculation of the recording rate of diagnoses on a monthly basis. The distribution of diagnoses before and after implementing ERs was also compared. Results: After the introduction of the electronic reminder, the rate of diagnosis recording by primary care physicians increased clearly from 39.7% to 87.2% (p < 0.001). The intervention enhanced the recording rate of symptomatic diagnoses (group R) and some chronic diseases such as hypertension, type 2 diabetes and other soft tissue disorders. Recording rate of diagnoses related to diseases of the respiratory system (group J), injuries, poisoning and certain other consequences of external causes (group S), and diseases of single body region of the musculoskeletal system and connective tissue (group M) decreased after the implementation of electronic reminders. Conclusion: Electronic reminders may alter the contents and extent of recorded diagnosis data in office-hours practices of the primary care health centers. They were found to have an influence on the recording rates of diagnoses related to chronic diseases. Electronic reminders may be a useful tool in primary health care when attempting to change the behavior of primary care physicians.

scholarly journals Perbandingan Tindakan Massage Counterpressure dan Pemberian Dark Chocolate terhadap Penurunan Nyeri Haid (Dismenorea)

2019 ◽  
Vol 3 (1) ◽  
pp. 281-291
Author(s):  
Rindang Fitriana Ulfa ◽  
Agus Suwandono ◽  
Kamilah Budhi
Keyword(s):  
Pain Medication ◽  
Dark Chocolate ◽  
Control Group ◽  
Menstrual Pain ◽  
Control Group Design ◽  
Group Design ◽  
A Value ◽  
Before And After ◽  
Massage Group ◽  
Quasi Experimental

The purpose of this study was to see the comparison between the administration of Massage Counterpressure and the provision of dark chocolate to reduce menstrual pain (dysmenorrhoea). The design uses a quasi-experimental design with two groups of pretest and posttest with control group design. The results showed that in the dark chocolate and anti-pain medication group, massage counterressure and anti-pain medicine obtained ρ value of 0,000. there are significant differences before and after the administration of action. The results of the man whitney test found that there were differences between the 2 groups with a value of ρ value of 0,000. Conclusion, there is a difference of influence between the dark chocolate group and the counterpressure massage group on the intensity of menstrual pain. Giving 100 grams of dark chocolate for 2 days and anti-pain medication is more effective than a 20-minute counterpressure massage for 2 days and anti-pain medication for menstrual pain intensity.   Keywords: Dark Chocolate, Massage counterprssure, Menstrual pain

scholarly journals Primary Care Tracks in Medical Schools

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Maribeth P. Williams ◽  
Denny Fe Agana ◽  
Benjamin J. Rooks ◽  
Grant Harrell ◽  
Rosemary A. Klassen ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Positive Impact ◽  
Medical Schools ◽  
Clerkship Director ◽  
Medicine Clerkship ◽  
Faculty Mentorship

Introduction: With the estimated future shortage of primary care physicians there is a need to recruit more medical students into family medicine. Longitudinal programs or primary care tracks in medical schools have been shown to successfully recruit students into primary care. The aim of this study was to examine the characteristics of primary care tracks in departments of family medicine.  Methods: Data were collected as part of the 2016 CERA Family Medicine Clerkship Director Survey. The survey included questions regarding the presence and description of available primary care tracks as well as the clerkship director’s perception of impact. The survey was distributed via email to 125 US and 16 Canadian family medicine clerkship directors.  Results: The response rate was 86%. Thirty-five respondents (29%) reported offering a longitudinal primary care track. The majority of tracks select students on a competitive basis, are directed by family medicine educators, and include a wide variety of activities. Longitudinal experience in primary care ambulatory settings and primary care faculty mentorship were the most common activities. Almost 70% of clerkship directors believe there is a positive impact on students entering primary care.  Conclusions: The current tracks are diverse in what they offer and could be tailored to the missions of individual medical schools. The majority of clerkship directors reported that they do have a positive impact on students entering primary care.

scholarly journals Optimizing Antibiotic Prescribing for Acute Respiratory Tract Infection in German Primary Care: Study Protocol for Evaluation of the RESIST Program (Preprint)

2020 ◽  
Author(s):  
Christin Löffler ◽  
Antje Krüger ◽  
Anne Daubmann ◽  
Julia Iwen ◽  
Marc Biedermann ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tract Infection ◽  
Statutory Health Insurance ◽  
Antibiotic Prescription ◽  
Acute Respiratory Tract Infection ◽  
Control Group ◽  
Antibiotic Prescribing ◽  
Prescription Rate ◽  
Before And After

BACKGROUND The emergence and increased spread of microbial resistance is a major challenge to all health care systems worldwide. In primary care, acute respiratory tract infection (ARTI) is the health condition most strongly related to antibiotic overuse. OBJECTIVE The RESIST program aims at optimizing antibiotic prescribing for ARTI in German primary care. By completing a problem-orientated online training course, physicians are motivated and empowered to utilize patient-centered doctor-patient communication strategies, including shared decision making, in the treatment of patients with ARTI. METHODS RESIST will be evaluated in the form of a nonrandomized controlled trial. Approximately 3000 physicians of 8 (out of 16) German federal states can participate in the program. Patient and physician data are retrieved from routine health care data. Physicians not participating in the program serve as controls, either among the 8 participating regional Associations of Statutory Health Insurance Physicians (control group 1) or among the remaining associations not participating in RESIST (control group 2). Antibiotic prescription rates before the intervention (T0: 2016, 1st and 2nd quarters of 2017) and after the intervention (T1: 3rd quarter of 2017 until 1st quarter of 2019) will be compared. The primary outcome measure is the overall antibiotic prescription rate for all patients insured with German statutory health insurance before and after provision of the online course. The secondary outcome is the antibiotic prescription rate for coded ARTI before and after the intervention. RESULTS RESIST is publicly funded by the Innovations funds of the Federal Joint Committee in Germany and was approved in December 2016. Recruitment of physicians is now completed, and a total of 2460 physicians participated in the intervention. Data analysis started in February 2020. CONCLUSIONS With approximately 3000 physicians participating in the program, RESIST is among the largest real-world interventions aiming at reducing inadequate antibiotic prescribing for ARTI in primary care. Long-term follow up of up to 21 months will allow for investigating the sustainability of the intervention. CLINICALTRIAL ISRCTN Registry ISRCTN13934505; http://www.isrctn.com/ISRCTN13934505 INTERNATIONAL REGISTERED REPORT RR1-10.2196/18648

Billing Codes Determine Lower Physician Income for Primary Care and Non-Procedural Specialties

2019 ◽  
Vol 22 (2) ◽  
Author(s):  
Arielle L. Langer ◽  
Miriam Laugesen
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Direct Consequence ◽  
Medical Specialties ◽  
Income Differences ◽  
Income Gap ◽  
Physician Income ◽  
The Difference ◽  
The Relationship

Abstract The income gap between specialists and primary care physicians and among specialists is well established, but the drivers of this difference are not well delineated. Using the Community Tracking Study (CTS) Physician Survey, we sought to isolate and compare premiums paid to physicians for specialization and the proportion of time spent on offices visit rather than procedures. We divided medical subspecialties according the proportion of Medicare billing for Evaluation and Management (E&M) codes for the specialty as a whole. We report substantial differences in income across physician specialty, and over 70 percent of the difference in income remained controlling for factors that may confound the relationship between income and specialty including gender, location and type of practice, and hours. We note a large variation in premiums for specialization: 11.3–46.8 percent above family medicine after controlling for confounders. Classifying medical subspecialties by E&M billing as procedural versus non-procedural specialties revealed clear income differences. Controlling for confounders, procedural medical specialties earned 37.5 percent more than family medicine, as compared with 15.3 percent for non-procedural medical specialties. This analysis suggests that differences in physician income and resulting incentives are a direct consequence of the payment structure itself, rather than compensation for additional years of training or a reflection of different underlying demographics.

scholarly journals 2057. Outpatient Antibiotic Stewardship “Bundles up” in Winter with Peer Comparison, URI Order Set and Education: Is It Enough to Weather the Storm?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S693-S693
Author(s):  
Okan I Akay ◽  
Rohini Dave ◽  
Amit Khosla ◽  
CherylAnn Kraska ◽  
Brian J Hopkins ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Drug Events ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Control Group ◽  
Upper Respiratory Infection ◽  
Primary Care Clinics ◽  
Ed Visits ◽  
The Impact ◽  
Order Set

Abstract Background Inappropriate antibiotic use is a growing problem in the outpatient setting. Approximately 90% of all antibiotics are prescribed in outpatient practices. Nonetheless, 30–70% of antibiotic prescriptions (ARx) are unnecessary. Outpatient antimicrobial stewardship (AS) is much needed and the best approach is unknown. We used a bundle approach to outpatient AS during the winter months, by implementing a peer comparison (PC) report, upper respiratory infection (URI) order set and broad education. Methods This is a quasi-experimental project during the period October 2018 to March 2019 (FY19) to evaluate the impact of a bundled intervention in primary care clinics at the VA Maryland Health Care System. A historical control group from the same period the previous year (FY18) was used for comparison. The intervention included an AS directed didactic and URI order set followed by an email in 1/2019 with: (1) censored PC report (ARx/1,000 encounters) with outliers defined as above 1.5 × interquartile range, (2) URI order set reminder, and (3) education. The primary outcome was total ARx per 1,000 encounters in primary care clinics. A random sampling of 200 charts was done to compare proportion of antibiotic appropriateness and number of emergency department (ED) visits and adverse drug events (ADEs) in FY19 Q1 and FY19 Q2. Poisson regression was carried out, in addition to Χ2-statistic. Results There were 3,799 vs. 3,429 ARx in FY18 and FY19, respectively, with a rate difference of 3.3 ARx per 1,000 encounters (P = 0.0056). Q1 to Q2 ARx rate increased by 7.8 and 8.0 ARx per 1,000 encounters in FY18 and FY19, respectively. Forty-eight percent (28/58) of the providers confirmed receipt of email. There were 3 and 4 outliers in FY19 Q1 and Q2, respectively. Appropriate ARx for FY19 Q1 and Q2 was found to be 45% and 35% (P = 0.44), respectively. The most common indications were URI (18% vs. 18%), urinary tract infection (13% vs. 21%). ED visits (10% vs. 6%) were uncommon and there were no ADEs. Conclusion E-mail communication with bundled approach had no effect on ARx or antibiotic appropriateness; however general AS presence and URI order set tempered some use. Removing peer censoring, providing face-to-face education and intensifying antibiotic order sets are additional interventions to be implemented. Disclosures All authors: No reported disclosures.

Information Technology in Primary Care Practice in the United States

2011 ◽  
pp. 131-163
Author(s):  
James G. Anderson ◽  
E. Andres Balas
Keyword(s):  
Primary Care ◽  
Information Technology ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Medical Specialty ◽  
The United States ◽  
Care Practice ◽  
It Applications ◽  
The Cost ◽  
Privacy And Confidentiality

The objective of this study was to assess the current level of information technology used by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools and electronic communication with patients. This indicates a slow rate of adoption since 2000-2001. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members as to the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

Compliance, capacity, and quality in colonoscopy screening for CRC: A novel solution.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 357-357 ◽  
Author(s):  
S. C. Lloyd
Keyword(s):  
Primary Care ◽  
Training Program ◽  
Primary Care Physicians ◽  
African American Men ◽  
Primary Care Providers ◽  
Care Providers ◽  
Adenoma Detection ◽  
Before And After ◽  
Outstanding Quality

357 Background: CRC is predominately preventable with high quality colonoscopy screenings. Unfortunately, less than half of Americans are “up-to-date.” When referred by primary care providers, less than half complete the process. We proposed to include the primary care provider (PCP) in a novel training program to extend skills from sigmoidoscopy to full colonoscopy in a “mentored and monitored” model. We know that quality in colonoscopy can vary widely (ten fold within a single 12-man group). The protective benefits of colonoscopy reflect the thoroughness of the removal of polyps. Unfortunately, the ACS projections for 2010 predict an increase of 4,400 deaths from CRC over 2009, an 8% rise! Furthermore the death rate for African American men has RISEN 28% since 1960. We are loosing a battle for which we posses the tools to win. To achieve victory we must successfully address all three factors: compliance, capacity and quality. Methods: Thirty primary care physicians in two states (SC, FL) were recruited. We measured compliance rates within the practice before and after enrollment. We further evaluated quality of the colonoscopies as reflected in completion, yield and complications. Results: Compliance more than doubled (38% to 84%). As a compliance enhancement tool, the results were outstanding. The evaluation of quality then became of paramount importance. The gross completion rate was 98.3%, the adenoma detection rate (reflecting polyp yield) was 38%. In over 20,000 cases there were only 5 perforations, substantially below published rates. The quality was consistently at the level of experienced conscientious gastroenterologists. The details of the training program and the use of the “two-man” colonoscopy technique have been reviewed elsewhere (MEDICAL CARE, Aug 2010). Conclusions: If replicated nationally, this model has the potential for saving 25,000 lives annually. The participation of the patient's PCP is a powerful influence for improved compliance. The availability of an “expert” for mentoring and monitoring results in outstanding and consistent quality. The model has the potential to dramatically enhance compliance simultaneously increasing capacity while maintaining outstanding quality. No significant financial relationships to disclose.

scholarly journals The Role of Primary Care Physicians (DLP) in Community Care

2018 ◽  
Vol 1 (1) ◽  
pp. 3
Author(s):  
Dhanasari Vidiawati Trisna Sanyoto ◽  
Nur Afrainin Syah
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Medical Training ◽  
The United States ◽  
Care Physician ◽  
Main Body ◽  
Family Doctors ◽  
Postgraduate Medical Training ◽  
Care Services

Dokter Layanan Primer (DLP) or Primary Care Physician (PCP) is a newly introduced term by the Indonesian government in 2013 since the enforcement of Medical Education Law 20/2013. DLP is a physician who solidifies his/ her education and career in primary care. They have postgraduate medical training in primary care and are experts in this field. In most countries, to be a generalist physician practising at primary care facilities such as health centres and primary care clinics, medical school graduates have to take postgraduate medical training to be proficient in terms of knowledge and skills in primary care services. Family medicine is the main body of knowledge of the primary care postgraduate training program in those countries even though their graduates are called differently among countries. These physicians are called family doctors or family physicians in the United States of America (USA), general practitioners (GPs) in Commonwealth countries, huisarts in the Netherlands. In Indonesia, where social, economic, and cultural diversity is very high in various regions, in addition to Family Medicine, Community Medicine and Public Health....

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