scholarly journals Randomized Trial to Improve Primary Care Patient Management and Patient Outcomes Using a Drug–Drug Interaction Test: Confirmation of the DECART Simulated Patient Clinical Utility Trial Results

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1266
Author(s):  
John Peabody ◽  
Joshua Schrecker ◽  
Rebecca Heltsley ◽  
David Paculdo ◽  
Enrico de Belen ◽  
...  
Keyword(s):  
Primary Care ◽  
Drug Interactions ◽  
Patient Outcomes ◽  
Real World ◽  
Clinical Utility ◽  
Patient Management ◽  
Primary Care Patient ◽  
Care Patient ◽  
Simulated Patients ◽  
Randomized Controlled

Drug–drug interactions (DDIs) are a serious problem in the healthcare system, leading to excess healthcare utilization and costs. We conducted a second prospective randomized, controlled trial to further establish the real-world clinical utility of a novel assay that objectively identifies potentially serious DDIs in real-world patients. Re-recruiting primary care physicians (PCPs) from our first randomized, controlled, simulated-patients study on DDIs, we experimentally introduced a definitive, urine-based mass spectrometry test intervention that the physicians could use when caring for their eligible patients. Patients were eligible if taking four or more prescription medications or suspected of taking other non-prescribed substances with potential medication interactions. The primary outcome was whether DDI testing changed clinical care. We explored a secondary outcome to see if the change in practice improved symptoms in patients with potential DDIs. A total of 169 control and 162 intervention patients were enrolled in the study, and their medical records were abstracted. In real-world patients, intervention physicians identified and/or treated a DDI at 3.0x the rate in their patient population compared to controls (21.6% vs. 7.1%, p < 0.001). Intervention physicians were more likely to discontinue or adjust the interacting agent compared to controls (62.9% vs. 8.3%, p = 0.001), and patient-reported symptoms also significantly declined (29.6% vs. 20.1%, p = 0.045). These results were nearly identical to concurrent measurements that used simulated patients, wherein intervention was more likely to both make a DDI diagnosis (56.3% vs. 21.6%, p < 0.001) and stop the interacting medications (58.3% versus 26.6%, p < 0.001). Bringing a new diagnostic test to market, particularly for an under-recognized clinical problem, requires robust data on both clinical validity and clinical utility. The results of this follow-up study showed that the use of DDI testing in real-world patients significantly improved (1) primary care patient management of drug interactions and (2) patient outcomes.

Evidence-based practice for acute low back pain in primary care: Patient outcomes and cost of care

Pain ◽  
2006 ◽  
Vol 124 (1) ◽  
pp. 140-149 ◽  
Author(s):  
Michael Feuerstein ◽  
Michael Hartzell ◽  
Heather L. Rogers ◽  
Steven C. Marcus
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Patient Outcomes ◽  
Primary Care Patient ◽  
Care Patient ◽  
Cost Of Care ◽  
Evidence Based ◽  
Low Back ◽  
Acute Low Back Pain

scholarly journals Clinical Utility of Definitive Drug–Drug Interaction Testing in Primary Care

2018 ◽  
Vol 7 (11) ◽  
pp. 384
Author(s):  
John Peabody ◽  
Mary Tran ◽  
David Paculdo ◽  
Joshua Schrecker ◽  
Czarlota Valdenor ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Clinical Utility ◽  
Controlled Trial ◽  
Clinical Care ◽  
Specific Treatment ◽  
Simulated Patients ◽  
Randomized Controlled ◽  
Previous Round ◽  
Interaction Testing

Drug–drug interactions (DDIs) are a leading cause of morbidity and mortality. New tools are needed to improve identification and treatment of DDIs. We conducted a randomized controlled trial to assess the clinical utility of a new test to identify DDIs and improve their management. Primary care physicians (PCPs) cared for simulated patients presenting with DDI symptoms from commonly prescribed medications and other ingestants. All physicians, in either control or one of two intervention groups, cared for six patients over two rounds of assessment. Intervention physicians were educated on the DDI test and given access to these test reports when caring for their patients in the second round. At baseline, we saw no significant differences in making the DDI diagnosis (p = 0.071) or DDI-related treatment (p = 0.640) between control and intervention arms. By round two, providers who accessed the DDI test performed significantly better in making the DDI diagnosis (+41.6%) and performing DDI-specific treatment (+12.2%) than in the previous round, and were 9.8 and 20.4 times more likely to diagnose and identify the DDI (p < 0.001 for all). The introduction of a definitive DDI test significantly increased identification, appropriate management, and counseling of DDIs among PCPs, which has the potential to improve clinical care.

scholarly journals Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042551
Author(s):  
Andrea L Hernan ◽  
Sally J Giles ◽  
Andrew Carson-Stevens ◽  
Mark Morgan ◽  
Penny Lewis ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Patient ◽  
Care Patient ◽  
System Level ◽  
Service Improvement ◽  
Cross Sectional ◽  
Positive Effects ◽  
Contributory Factors ◽  
Safety Incident ◽  
Patient Reported

BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.

scholarly journals Evaluation of the First Contact Physiotherapy (FCP) model of primary care: Patient characteristics and outcomes

Physiotherapy ◽  
2021 ◽  
Author(s):  
S. Stynes ◽  
K.P. Jordan ◽  
J.C. Hill ◽  
G. Wynne-Jones ◽  
E. Cottrell ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Patient ◽  
Patient Characteristics ◽  
Care Patient ◽  
First Contact

Use of a Deprescribing Tool in an Interdisciplinary Primary-Care Patient-Aligned Care Team

2022 ◽  
Vol 37 (1) ◽  
pp. 34-43
Author(s):  
Makayla W. Nelson ◽  
Tara N. Downs ◽  
Gina M. Puglisi ◽  
Brent A. Simpkins ◽  
Amy Schmelzer Collier
Keyword(s):  
Primary Care ◽  
Adverse Drug Events ◽  
Primary Care Patient ◽  
Care Patient ◽  
Care Team ◽  
Record System ◽  
Cost Avoidance ◽  
Increased Risk ◽  
Medication Reviews ◽  
Va Health Care System

Objective: To pilot the VIONE approach in a single Primary Care Patient Aligned Care Team (PACT). The authors aim for the Clinical Pharmacy Specialist (CPS) to perform 20 comprehensive medication reviews (CMRs) and the pilot PACT physician (PCP) to complete 200 VIONE discontinuations. Cost avoidance and CPS recommendations will also be analyzed. Polypharmacy is associated with increased risk of adverse drug events, falls, hospitalizations, and death. VIONE is a deprescribing tool that assists providers in identifying inappropriate medications. Design: Quality Improvement Setting: Single VA Health Care System (VAHCS) Participants: High-risk veterans in pilot PACT Interventions: The CPS educated the PCP regarding VIONE methodology and assisted with CMRs. When deprescribing was warranted, VIONE discontinuation reasons were selected in the Computerized Patient Record System (CPRS). Data were electronically stored in a national dashboard. Results: The authors identified 231 veterans at risk for polypharmacy-related adverse events. The PCP and CPS were able to reach 99 veterans and make 136 medication discontinuations between September 1, 2019, and March 1, 2020. The CPS performed 20 CMRs, resulting in 90 deprescribing recommendations. Thirty-eight CPS recommendations were accepted and contributed $18,835.95 to the sum annualized cost avoidance of $21,904.80. Conclusion: The VIONE methodology was successfully implemented in the pilot PACT. The utilization of the CPS was associated with an increased average number of medication discontinuations per veteran and contributed to cost avoidance.

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