scholarly journals Pharmacogenomics for Primary Care: An Overview

Genes ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 1337 ◽  
Author(s):  
Victoria Rollinson ◽  
Richard Turner ◽  
Munir Pirmohamed
Keyword(s):  
Primary Care ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Academic Hospital ◽  
Direct To Consumer ◽  
Gradual Introduction ◽  
Barriers To Implementation ◽  
Primary Healthcare Providers ◽  
Future Practice

Most of the prescribing and dispensing of medicines happens in primary care. Pharmacogenomics (PGx) is the study and clinical application of the role of genetic variation on drug response. Mounting evidence suggests PGx can improve the safety and/or efficacy of several medications commonly prescribed in primary care. However, implementation of PGx has generally been limited to a relatively few academic hospital centres, with little adoption in primary care. Despite this, many primary healthcare providers are optimistic about the role of PGx in their future practice. The increasing prevalence of direct-to-consumer genetic testing and primary care PGx studies herald the plausible gradual introduction of PGx into primary care and highlight the changes needed for optimal translation. In this article, the potential utility of PGx in primary care will be explored and on-going barriers to implementation discussed. The evidence base of several drug-gene pairs relevant to primary care will be outlined with a focus on antidepressants, codeine and tramadol, statins, clopidogrel, warfarin, metoprolol and allopurinol. This review is intended to provide both a general introduction to PGx with a more in-depth overview of elements relevant to primary care.

The role of a remote knowledge broker from an academic setting using an adaptive approach to implement evidence-based practice in primary care settings: A case study of integrating mood management interventions for treatment seeking tobacco users.

2020 ◽  
Author(s):  
Nadia Minian ◽  
Sheleza Ahad ◽  
Laurie Zawertailo ◽  
Arun Ravindran ◽  
Claire de Oliveira ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare Providers ◽  
Family Health ◽  
Practice Change ◽  
Knowledge Broker ◽  
Local Context ◽  
Knowledge Brokering ◽  
Mood Management ◽  
Management Interventions

Abstract Background: Knowledge brokering is an emerging knowledge translation strategy used within healthcare to bridge the gap between evidence and practice. Reported studies indicate that the day-to-day role of a knowledge broker often involves in-person communication with frontline workers and decision makers. However, travelling to primary care sites can be cost- and resource-intensive and thus not feasible. In this paper, we describe the role and experience of a remote knowledge broker (rKB) working in an academic health sciences centre, delivering tailored one-on-one support to end-users using phone and email communications. Methods: A rKB was hired to support (n = 62) English-speaking Family Health Teams (FHTs) across Ontario with implementing mood management interventions as part of an existing smoking cessation program, the Smoking Treatment for Ontario Patients (STOP) program. We describe the eight categories of tasks performed by the rKB over a 12-month period, as well as their experience communicating via technology to develop relationships with healthcare providers (HCPs). Results: Sixty-one of the 62 FHTs (n = 73 HCPs) were provided rKB services. The total number of successful phone and email communications with the rKB ranged from 3-98 interactions over 12 months. Common barriers to implementation reported by FHTs were associated with the Inner and Outer Setting domains of the Consolidated Framework for Implementation Research (CFIR) and included lack of time, resources, and patient engagement. Conclusions: The role of the rKB involved building relationships with HCPs, identifying and helping to problem solve barriers, and building capacity in the field. Similar to traditional knowledge brokering, this analysis shows that developing a meaningful relationship between a remotely situated KB and HCPs could take anywhere between 1-6 months. Using implementation frameworks such as CFIR can help the rKB identify barriers and be ready to address them. In addition, hiring a rKB with previous engagements and knowledge of the local context may facilitate clinical practice change. Our future work will evaluate the cost-effectiveness of rKBs to inform its potential to be scaled up.

scholarly journals Should the healthcare compass in Australia point towards value-based primary healthcare?

2017 ◽  
Vol 41 (1) ◽  
pp. 98 ◽  
Author(s):  
Jodie Oliver-Baxter ◽  
Lynsey Brown ◽  
Paresh Dawda
Keyword(s):  
Quality Improvement ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Health Networks ◽  
Policy Makers ◽  
Primary Health ◽  
Australian Context

This paper provides an overview of quality improvement in healthcare in an Australian context. Specifically, the paper considers issues around defining, quantifying, recording and incentivising quality improvement and accountability in primary healthcare. The role of newly emerging Primary Health Networks provides a context for the discussion. The paper draws on international learnings that provide a framework for examining the important elements of quality improvement among reforming primary healthcare organisations in order to support healthcare providers and offer an evidence base for policy makers and peak bodies moving forward.

“We Had to Keep Pushing”: Caregivers' Perspectives on Autism Screening and Referral Practices of Black Children in Primary Care

2018 ◽  
Vol 56 (5) ◽  
pp. 321-336 ◽  
Author(s):  
Sarah Dababnah ◽  
Wendy E. Shaia ◽  
Karen Campion ◽  
Helen M. Nichols
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Racial Bias ◽  
Healthcare Providers ◽  
Black Children ◽  
Autism Spectrum ◽  
Theory Approach ◽  
Early Intervention Services ◽  
Primary Healthcare Providers

Abstract Black children with autism spectrum disorder (ASD) are diagnosed later than their White peers, are more likely to be misdiagnosed, and are less likely to receive early intervention services or a developmental evaluation by three years old. Using a grounded theory approach, we solicited the perspectives of parents and other primary caregivers of Black children with ASD on barriers and facilitators to ASD screening and referrals in primary care. A socioeconomically diverse sample of 22 female caregivers participated. Four themes emerged. First, while some caregivers noted their child's primary healthcare providers facilitated a timely ASD diagnosis, other participants reported these providers ignored early concerns about child developmental delays. Second, many participants felt racial bias negatively impacted caregiver-primary healthcare provider interactions. Third, legal/custodial issues slowed caregivers' abilities to follow up on referrals from their primary healthcare providers. Finally, caregivers described denial, shame, and stigma relating to ASD in the Black community as possible factors for delayed follow up to referrals. Differences based on socioeconomic status are discussed. Efforts to improve family-centered, culturally relevant care for all Black caregivers raising children with or at-risk for ASD are needed, particularly for those families experiencing the multiple effects of poverty.

scholarly journals Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks

2020 ◽  
Vol 4 ◽  
pp. 239920262092250
Author(s):  
Natalie Kennie-Kaulbach ◽  
Rachel Cormier ◽  
Olga Kits ◽  
Emily Reeve ◽  
Anne Marie Whelan ◽  
...  
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Behavior Change ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
System Level ◽  
Care Providers ◽  
Behavior Change Wheel ◽  
Primary Healthcare Providers

Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.

School Nurses on the Front Lines of Medicine: When You Don’t Need to “STOP AT AN ER STAT!”—The Role of Urgent Care Centers in the Management of Students With Nonemergent Chief Complaints

2019 ◽  
Vol 35 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Rachel Rothstein ◽  
Kevin Zhen ◽  
Robert P. Olympia
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Healthcare Providers ◽  
School Nurses ◽  
Chief Complaint ◽  
Urgent Care ◽  
Chief Complaints ◽  
Pediatric Services ◽  
Urgent Care Centers

In the midst of our nation’s growing primary care provider shortage and subsequent overutilization of the emergency room (ER), urgent care centers represent an accessible, convenient, and affordable alternative for the management of “urgencies” or nonemergent illnesses and injuries. Despite the presence of competent healthcare providers and a wide array of services at urgent care centers, patients continue to pursue care in the ER for urgencies. School nurses may utilize urgent care centers for the evaluation and management of students with nonemergent medical or traumatic chief complaints. This article discusses the field of urgent care medicine, describes the pediatric services provided at urgent care centers, and summarizes the capabilities of centers to deal with potential urgencies versus emergencies in children and adolescents based on their chief complaint.

Putting urban Aboriginal and Torres Strait Islander food insecurity on the agenda

2017 ◽  
Vol 23 (5) ◽  
pp. 415 ◽  
Author(s):  
Leigh Bramwell ◽  
Wendy Foley ◽  
Tanya Shaw
Keyword(s):  
Food Insecurity ◽  
Torres Strait Islander ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Torres Strait Islander People ◽  
Social Wellbeing ◽  
Primary Health ◽  
Health Advice ◽  
Torres Strait ◽  
Primary Healthcare Providers

Food insecurity adversely affects diet quality, physical, mental and social wellbeing and the capacity to act on health advice recommended by primary healthcare providers. In this article, an overview of the neglected issue of food insecurity in urban Aboriginal and Torres Strait Islander communities is provided. Policy and action on food security for urban Aboriginal and Torres Strait Islander people is reviewed, and it is argued that for primary health care to better address food insecurity, an evidence base is needed to understand the experiences of individuals and households and how to work effectively to support food insecure clients.

scholarly journals Primary Care Doctors’ Role in Antenatal Detection and Management of Fetal Bilateral Pleural Effusions: A Report of 2 Cases

2021 ◽  
Author(s):  
Chai Li Tay ◽  
Noor Afiqah AW
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Healthcare Providers ◽  
Hydrops Fetalis ◽  
Pleural Effusions ◽  
Maternal Complications ◽  
Primary Care Doctors ◽  
Antenatal Detection ◽  
Primary Healthcare Providers

Introduction: Fetal pleural effusion is rarely seen in primary care setting. It is more commonly diagnosed among women with diabetes mellitus in pregnancy. Method: This report illustrates two patients with fetal bilateral pleural effusions, detected at 18-week and 24-week period of amenorrhea (POA) during routine antenatal scans by primary care doctors. Result: These two pregnancies were complicated with hydrops fetalis and resulted in fresh stillbirth and intra-uterine death. Conclusion: Primary healthcare providers play an important role in the early diagnosis of fetal congenital anomaly, counseling regarding the ultrasonography findings, neonatal outcome, and referral to obstetrician for further management and monitoring for maternal complications, such as polyhydramnios, preeclampsia, mirror syndrome, and depression as a result of hydrops fetalis.

scholarly journals Lightweight Mobile Automated Assistant-to-physician for Global Lower-resource Areas

2021 ◽  
Author(s):  
Chao Zhang ◽  
Hanxin Zhang ◽  
Atif Khan ◽  
Ted Kim ◽  
Olasubomi Omoleye ◽  
...  
Keyword(s):  
Primary Care ◽  
Real Time ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Learning System ◽  
Care Providers ◽  
Wide Range ◽  
Multiple Data Sets ◽  
Primary Healthcare Providers

Importance: Lower-resource areas in Africa and Asia face a unique set of healthcare challenges: the dual high burden of communicable and non-communicable diseases; a paucity of highly trained primary healthcare providers in both rural and densely populated urban areas; and a lack of reliable, inexpensive internet connections. Objective: To address these challenges, we designed an artificial intelligence assistant to help primary healthcare providers in lower-resource areas document demographic and medical sign/symptom data and to record and share diagnostic data in real-time with a centralized database. Design: We trained our system using multiple data sets, including US-based electronic medical records (EMRs) and open-source medical literature and developed an adaptive, general medical assistant system based on machine learning algorithms. Main outcomes and Measure: The application collects basic information from patients and provides primary care providers with diagnoses and prescriptions suggestions. The application is unique from existing systems in that it covers a wide range of common diseases, signs, and medication typical in lower-resource countries; the application works with or without an active internet connection. Results: We have built and implemented an adaptive learning system that assists trained primary care professionals by means of an Android smartphone application, which interacts with a central database and collects real-time data. The application has been tested by dozens of primary care providers. Conclusions and Relevance: Our application would provide primary healthcare providers in lower-resource areas with a tool that enables faster and more accurate documentation of medical encounters. This application could be leveraged to automatically populate local or national EMR systems.

scholarly journals A survey of the involvement of primary care doctors in HIV prevention and care in a low-prevalence, high-income setting

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Greta Tam ◽  
Ngai Sze Wong ◽  
Shui Shan Lee
Keyword(s):  
Primary Care ◽  
Hong Kong ◽  
High Risk ◽  
Hiv Prevention ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
High Income ◽  
High Involvement ◽  
Primary Care Doctors ◽  
Primary Healthcare Providers

Abstract Background In high-income countries with a low HIV prevalence, primary care doctors are likely the first point of medical contact for people at high risk of HIV. One of the key factors for successful implementation of preventive measures is the cooperation of primary healthcare providers. Hong Kong’s population mostly seek primary care in the private sectors. Our study evaluated the involvement of private primary healthcare providers in HIV prevention and care. Methods A cross-sectional postal structured questionnaire was administered to 1102 private primary care doctors in Hong Kong in December 2017. Responses were received via postal mail, fax or online. Non-respondents received a phone-call reminder to complete the survey. Descriptive analyses were performed for all the question items. Chi-square test was used to assess the association between participants’ level of involvement in HIV prevention and care and their demographics and medical practice characteristics. Results The response rate was 17.9% (197/1102). Most of the respondents were Chinese (95%) and have obtained their primary medical qualifications in Hong Kong (72%). More than half of the doctors have practiced in the private sector for more than 20 years (54%). Six aspects were used to evaluate practices or involvements in HIV prevention or care: Most of the responding doctors had offered advice (61%) and/or HIV test (76%) to patients with high-risk behaviors. However, fewer doctors had diagnosed HIV (27%), provided care for HIV positive patients (21%), reported HIV cases (19%) or prescribed antiretrovirals (4%). Nine (4.5%) did not answer all six questions on their practices or involvements in HIV prevention or care. The remaining respondents were then categorized into no/low involvement group and high involvement group. Overall,71% had no/low involvement (133/188) compared to 29% who had high involvement (55/188). Factors associated with high involvement included being in the 50–59 age group (OR: 2.48, 95% CI: 1.12–5.5), and belonging to a large practice (OR: 3.16, 95% CI: 1.4–7.12). Conclusions Overall, most private primary care doctors in Hong Kong have no or low involvement in HIV prevention and care. However, most were willing and experienced in providing general preventive services, such as HIV testing and advice.

Promoting competition in Swedish primary care

2015 ◽  
Vol 29 (1) ◽  
pp. 25-38 ◽  
Author(s):  
Lars Norén ◽  
Agneta Ranerup
Keyword(s):  
Primary Healthcare ◽  
Healthcare Providers ◽  
Invisible Hand ◽  
Mixed Method Research ◽  
Content Type ◽  
Quality Differentiation ◽  
Selection Processes ◽  
Provider Quality ◽  
Primary Healthcare Providers

Purpose – The purpose of this paper is to examine the role of accreditation documents (ADs) in the competition based on provider quality in a quasi-market for primary healthcare. Design/methodology/approach – The paper uses a mixed-method research methodology to analyse two primary healthcare ADs in two Swedish regions. In total, 19 interviews were conducted with actors involved in the creation and use of such documents. Findings – This paper points to the crucial role of ADs in the identification of quality differences that influence the competition in primary healthcare. This finding contrasts with the commonly held laissez-faire idea that competition causes providers to develop their own service concepts and where the invisible hand creates quality differences. The paper adds to the discussion with its detailed description of how ADs create competition among primary healthcare providers through selection processes, quality differentiation, and ranking. Research limitations/implications – The paper does not explore quality differences in the medical treatment of patients in primary healthcare centres. Practical implications – The paper provides insights for politicians on how to use ADs to control competition and regulate choice. Originality/value – The paper takes an innovative approach to the examination of how ADs increase the competition in primary healthcare choice.

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