scholarly journals A Practical Approach to the Patient with Obesity

2021 ◽  
Vol 47 (5) ◽  
pp. 13-20
Author(s):  
Yuan Ling Amanda Lim
Keyword(s):  
Primary Care ◽  
Weight Gain ◽  
Goal Setting ◽  
Primary Care Physicians ◽  
Care Plan ◽  
Weight History ◽  
Prevalence Of Obesity ◽  
Individualised Care ◽  
Subsequent Patient ◽  
Secondary Causes

The prevalence of obesity and obesity-related comorbidities is rising. Primary care physicians are the frontline of healthcare and play a central role in the management of obesity. In this article, we discuss the 5As framework (Ask, Assess, Advise, Agree, and Assist) as a practical framework for obesity counselling, focusing on initiating the conversation and assessing the person with obesity. The assessment includes taking a weight history, excluding secondary causes, understanding lifestyle factors contributing to weight gain and assessing for complications of obesity. This assessment then makes it possible for subsequent patient engagement, including advising, agreeing (goal setting), and assisting the patient on an individualised care plan.

scholarly journals How primary care can help survivors of transient ischaemic attack and stroke return to work: focus groups with stakeholders from a UK community

2020 ◽  
Vol 70 (693) ◽  
pp. e294-e302
Author(s):  
Chantal Balasooriya-Smeekens ◽  
Andrew Bateman ◽  
Jonathan Mant ◽  
Anna De Simoni
Keyword(s):  
Primary Care ◽  
Return To Work ◽  
Focus Groups ◽  
Transient Ischaemic Attack ◽  
Primary Care Physicians ◽  
Local Community ◽  
Electronic Record ◽  
Care Plan ◽  
Framework Analysis ◽  
Ischaemic Attack

BackgroundEvidence about how primary care can best enable survivors of transient ischaemic attack (TIA)/stroke return to work is limited.AimThis study explored the role of primary care in supporting survivors of transient ischaemic attack (TIA)/stroke return to work with stakeholders from a local UK community.DesignA qualitative study using framework analysis.MethodFour focus groups were carried out in Cambridgeshire, UK, between September and November 2015. The 18 participants included survivors of TIA/stroke, carers, an employer representative, GPs, occupational therapists (OTs), and clinical commissioners.ResultsThere was a mismatch between patient and carer needs and what is provided by primary care. This included: lack of GP awareness of invisible impairments; uncertainty how primary care could help in time-limited consultations; and complexity of return-to-work issues. Primary care physicians were not aware of relevant services they could refer patients to, such as OT support. In addition, there was an overall lack of coordination between different stakeholders in the return-to-work process. Linking with other services was considered important but challenging because of ongoing changes in service structure and the commissioning model. Suggestions for improvement include: a central contact in primary care for signposting to available services; a rehabilitation assessment integrated with the electronic record; and a patient-held shared-care plan at discharge from stroke wards.ConclusionImproving the role for primary care in helping survivors of TIA/stroke return to work is challenging. However, primary care could play a central role in initiating/coordinating vocational rehabilitation. Through focus group discussions with stakeholders from a local community, patients, carers, and clinical commissioners were able to put forward concrete proposals to address the barriers identified.

Abstract 184: Self-reported Hypertension Treatment Practices Among Primary Care Physicians and Cardiologists

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Brent Egan ◽  
John Flack ◽  
Sofia Lombera ◽  
Mehul Patel
Keyword(s):  
Primary Care ◽  
Heart Rate ◽  
Weight Gain ◽  
Primary Care Physicians ◽  
Performance Metrics ◽  
Heart Rate Reduction ◽  
Hypertension Treatment ◽  
Rate Reduction ◽  
Β Blocker ◽  
Β Blockers

Objectives: This study was conducted to examine perceptions, knowledge, and rationale for prescribing β-blockers among physicians who treat patients with hypertension. Methods: In August/September 2016, 103 primary care physicians (PCPs) and 59 cardiologists participated in a 20-minute quantitative, online survey regarding their use and perceptions of β-blockers. Significant between-group differences were examined via t-tests and z-tests. Results: Significantly more cardiologists chose β-blockers as first-line therapy than PCPs (30% vs 17%, P <0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. When choosing a β-blocker, cardiologists rated “impact on fatigue and energy” and “arterial vasodilation” as more important treatment features than PCPs ( P <0.05 and P <0.01, respectively). Physicians’ awareness of vasodilation was greater for carvedilol (52% [84/162]) than nebivolol (31%[51/162]). A large proportion of cardiologists and PCPs were unaware that any β-blockers cause weight gain (cardiologists, 34%[20/59]; PCPs, 39%[40/103]) or increased glucose (42% each, cardiologists [25/59], PCPs [43/103]). Overall, physicians associated atenolol and metoprolol with weight gain and clinically relevant changes in glucose, while nebivolol was least associated with either outcome. Only 10% of cardiologists (6/59) and 2% of PCPs (2/103) associated carvedilol with weight gain ( P <0.05). Among β-blocker features, nebivolol was closely associated with: β 1 -selectivity; efficacy in patients aged >60 years; efficacy in African-American patients; and arterial vasodilation. Metoprolol was closely associated with heart rate reduction, and atenolol was associated with heart rate reduction, fatigue, erectile dysfunction, and impact on mood. Physicians had a positive response to using drugs other than metoprolol or atenolol that could lower the risk of new onset diabetes for pre-diabetic or obese patients. Clinical practice guidelines influenced prescribing behaviors more than formulary or performance metrics; continuing medical education and publications were commonly accessed materials for hypertension education. Conclusions: This survey highlights several educational gaps, including differences between PCPs and cardiologists, on the perceptions of β-blockers for hypertension treatment. Future efforts should include physician education on relevant evidence-based differences between β-blockers, given their heterogeneity.

scholarly journals The Metamorphosis of a Horse into a Zebra: A Case of Primary Eosinophilic Gastroenteritis

2016 ◽  
Vol 29 (1) ◽  
pp. 46
Author(s):  
Jason N. Salamon ◽  
Deborah Sherman
Keyword(s):  
Primary Care ◽  
Gastrointestinal Tract ◽  
Primary Care Physicians ◽  
Chronic Diarrhea ◽  
Eosinophilic Gastroenteritis ◽  
Clinical Consideration ◽  
Secondary Causes

Chronic diarrhea is a common diagnostic entity faced by many primary care physicians. Primary eosinophilic gastroenteritis (PEG), a relatively rare but not uncommon cause of chronic nonbloody diarrhea, presents with nonspecific symptoms, making clinical consideration and diagnosis extremely challenging. In PEG, eosinophils selectively target the gastrointestinal tract, where they degranulate, causing inflammation and irritation. We report the case of a 46-year-old female with recurrent hospitalizations for nausea, vomiting, and diarrhea over a nine-month period. After an extensive workup ruling out secondary causes of eosinophilia, she was diagnosed with PEG. 

scholarly journals Evaluation of Obesity Management Recorded in Electronic Clinical History: A Cohort Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2345
Author(s):  
Nuria Trujillo-Garrido ◽  
María Ángeles Bernal-Jiménez ◽  
María J. Santi-Cano
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Clinical History ◽  
Evidence Based ◽  
Therapeutic Guidelines ◽  
Close Proximity ◽  
Prevalence Of Obesity ◽  
Clinical Records ◽  
Practice Methods

Background: The prevalence of obesity is increasing worldwide. Because of their close proximity to the population, primary care physicians and nurses are in a unique position to motivate and advise patients with obesity on a healthy diet and increased physical activity. Drawing from information recorded in electronic clinical records, we evaluated how the general recommendations included in obesity guidelines are being implemented in routine clinical practice. Methods: This study drew from the following data from a cohort of 209 patients with obesity that attended primary care consultations: electronic clinical records, body mass index (BMI), waist circumference (WC), cardiovascular risk factors, comorbidities and whether their health professional documented compliance with the recommendations of the evidence-based obesity guidelines in their electronic history. Results: Only 25.4% of the clinical records met all the criteria established in the therapeutic guidelines regarding diet prescription, 1.4% for physical activity and 1.5% for behavioral change activities. The patients whose records mentioned diet prescription and physical activity and who received follow-up consultations for both factors had lower average BMI and WC, although this relationship was not significant after adjusting for baseline. Conclusions: We found that only a small number of records in the electronic clinical histories followed the evidence-based obesity guidelines. Recording dietetic prescription and physical exercise in the patient’s clinical record is associated with better control of obesity.

scholarly journals The prevalence of obesity documentation in Primary Care Electronic Medical Records

2017 ◽  
Vol 26 (01) ◽  
pp. 67-79 ◽  
Author(s):  
Ahmed Mattar ◽  
David Carlston ◽  
Glen Sariol ◽  
Tongle Yu ◽  
Ahmad Almustafa ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
International Classification Of Diseases ◽  
Morbidly Obese ◽  
Problem List ◽  
Cumulative Number ◽  
Exercise Counseling ◽  
Classification Of Diseases ◽  
Prevalence Of Obesity ◽  
And Gender

Summary Background: Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient’s problem list for patients with eligible body mass indexes (BMI) as contained in the patients’ electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. Method: This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Results: Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Conclusion: Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese.

scholarly journals The Role of the Primary Care Physician in the Management of Parkinson’s Disease Dementia

2021 ◽  
Author(s):  
Xin-Nong Li ◽  
Dawei Zheng
Keyword(s):  
Primary Care ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Care Plan ◽  
Parkinson’S Disease Dementia ◽  
Ongoing Care

Dementia is a frequent complication of Parkinson’s disease with an annual incidence of around 10% of patients with Parkinson’s disease. If dementia occurs in patients with Parkinson’s disease, it is typically many years or decades after the onset of Parkinson’s disease. It is devastating for both patient and family or caretaker when a patient with Parkinson’s disease develops dementia. Primary care physician is at the center of the care team for the patient. This chapter discusses the pivotal role of the primary care physicians in the management of patients with Parkinson’s disease dementia. A guide is provided to emphasize the art of practice for Primary care physicians which consists of knowing when and how to introduce a comprehensive ongoing care plan for individual patient with Parkinson’s disease dementia. Recommendations for maintaining some patients with Parkinson’s disease dementia in a status of relative independence are discussed. Indications for initiation of palliative care are also discussed.

Designing a Cancer Prevention Collaborative Goal Setting Application for Primary Care Patients: An Iterative, Patient-led Process (Preprint)

2021 ◽  
Author(s):  
Daniel Resnick ◽  
Matthew D Kearney ◽  
Jazmine M Smith ◽  
Allison Bautista ◽  
Liz Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Prevention ◽  
Goal Setting ◽  
Mobile Application ◽  
Primary Care Physicians ◽  
Structured Interviews ◽  
Health Goals ◽  
System Usability Scale ◽  
Primary Care Patients ◽  
Beta Version

BACKGROUND There remains a need to engage at-risk primary care populations in cancer prevention behaviors, yet primary care physicians often lack the time or resources to discuss these behaviors with their patients. OBJECTIVE The objective of the study was to evaluate the content, usability, and acceptability of a mobile application that leverages insights from goal-setting and social networks literature to facilitate cancer prevention goal setting, tracking, and sharing between Non-Hispanic Black primary care patients and their social ties. METHODS We recruited participants from two primary care clinics in Philadelphia using non-probabilistic purposive sampling. We conducted semi-structured interviews with 5 to 7 participants over three weeks to solicit feedback on paper mock-ups of the application, iteratively adapting these mock-ups after each set of interviews. Thereafter, and informed by initial feedback, we created an electronic beta-version of the application and sought acceptability and usability feedback from a different set of participants. Then we conducted content analysis of all user responses to search for unifying themes on acceptability and usability of both the initial mock-ups and beta-version of the application. We further assessed application usability using questions derived from the System Usability Scale (SUS). RESULTS Thirty-three Non-Hispanic Black primary care patients participated in the study. The mean age was 49 (SD ± 13) and 79% identified as female. Semi-structured interviews revealed three primary generalizable insights from our target population: 1) the framing of each goal and its relevance to cancer impacted the likelihood the goal would be chosen; 2) participants thought that sharing health goals with others facilitates health behaviors; and 3) most participants found it motivating to see other users’ goal progress, while still collaborating with these users on their health goals. An overarching insight that permeated across each theme was the participants’ desire to customize and personalize the app. Usability testing revealed that 100% of participants found the application easy to use and 76% of participants reported they would like to use this application frequently. CONCLUSIONS Cancer prevention in the modern era must include options that are accessible to all, but this does not mean that all options must be universal. This study’s iterative process led to the development of a cancer prevention mobile application that Non-Hispanic Black primary care patients deemed usable and acceptable and yielded a number of noteworthy insights about what intended end-users value in setting and accomplishing health goals.

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