Impact of Sleep Telementorship in Primary Care: Sleep VA-ECHO (Veterans Affairs-Extension for Community Healthcare Outcomes)

Sleep VA-ECHO (Veterans Affairs–Extension for Community Healthcare Outcomes) is a national telementorship program intended to improve knowledge about sleep disorders among non-specialty providers. The project goal was to describe the characteristics of Sleep VA-ECHO participants from primary care and their use of program-obtained knowledge in practice. Sleep VA-ECHO consisted of 10 voluntary, 75-min teleconference sessions combining didactics and case discussion. Out of 86 participants, 21 self-identified as primary care team members and completed a program evaluation. Participants self-reported their application of knowledge gained, including changes to practice as a result of program participation. These 21 participants represented 18 sites in 11 states and attended a median of 5.0 sessions. They included physicians (29%), nurse practitioners (24%), and registered nurses (24%). Nearly all participants (95%) reported using acquired knowledge to care for their own patients at least once a month; 67% shared knowledge with colleagues at least once a month. Eighty-five percent reported improved quality of sleep care for their patients, and 76% reported an expanded clinical skillset. The greatest self-reported change in practice occurred in patient education about sleep disorders (95%) and non-pharmacologic management of insomnia (81%).

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2.28 Using the Project Extension for Community Healthcare Outcomes Model to Train Rural Primary Care Clinicians to Deliver Child Mental Health Services in Oregon

Journal of the American Academy of Child & Adolescent Psychiatry ◽

10.1016/j.jaac.2017.09.108 ◽

2017 ◽

Vol 56 (10) ◽

pp. S186-S187

Author(s):

Keith Cheng ◽

Ajitkumar N. Jetmalani ◽

Behjat Sedighi ◽

Maggie M. McDonnell ◽

Teri Pettersen

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Child Mental Health ◽

Healthcare Outcomes ◽

Community Healthcare ◽

Child Mental Health Services ◽

Rural Primary Care ◽

Primary Care Clinicians

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A Comparison on Quality of Care and Practice Patterns of Primary Care Physicians, Nurse Practitioners, and Physician Assistants for Medicaid Patients in New York

Health Services Research ◽

10.1111/1475-6773.13454 ◽

2020 ◽

Vol 55 (S1) ◽

pp. 88-88

Author(s):

S. Wang ◽

R. Martiniano

Keyword(s):

Primary Care ◽

New York ◽

Quality Of Care ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

Practice Patterns ◽

Physician Assistants

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Association of State-Level Restrictions in Nurse Practitioner Scope of Practice With the Quality of Primary Care Provided to Medicare Beneficiaries

Medical Care Research and Review ◽

10.1177/1077558717732402 ◽

2017 ◽

Vol 76 (5) ◽

pp. 597-626 ◽

Cited By ~ 12

Author(s):

Jennifer Perloff ◽

Sean Clarke ◽

Catherine M. DesRoches ◽

Monica O’Reilly-Jacob ◽

Peter Buerhaus

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

Primary Care Physicians ◽

Scope Of Practice ◽

Care Nurse ◽

State Regulations ◽

Primary Care Nurse ◽

Quality Of Primary Care

Context: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. Method: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Findings: Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. Conclusion: State regulations restricting NP SoP do not improve the quality of care.

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Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review

BMJ Open ◽

10.1136/bmjopen-2019-029227 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029227 ◽

Cited By ~ 3

Author(s):

Helena Carreira ◽

Rachael Williams ◽

Helen Strongman ◽

Krishnan Bhaskaran

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Sexual Dysfunction ◽

Sleep Disorders ◽

Cognitive Dysfunction ◽

Life Outcomes ◽

Fatigue Syndrome ◽

Self Harm ◽

The Uk

ObjectivesTo summarise the definitions and combinations of codes used to identify outcomes of anxiety, depression, fatigue, cognitive dysfunction (including mild cognitive dysfunction and dementia), sexual dysfunction, pain, sleep disorders, and fatal and non-fatal self-harm in studies using electronic health records from primary care databases in the UK.DesignSystematic review.Data sourcesMedline, Embase and lists of publications of the main primary care databases in the UK.Eligibility criteriaIncluded data from a UK primary care database and studied outcome(s) of interest.Data extraction and synthesisWe abstracted information on the outcomes definition and codelists. When necessary, authors were contacted to request codelists.Results120 studies were eligible. Codelists were available for 17/42 studies of depression; 21/41 studies of fatal and non-fatal self-harm; 17/27 studies of dementia/cognitive dysfunction; 5/12 studies of anxiety; 4/8 studies of pain; 3/6 studies of fatigue and sexual dysfunction; 1/2 studies of sleep disorders. Depression was most often defined using codes for diagnoses (37/42 studies) and/or antidepressants prescriptions (21/42 studies); six studies reported including symptoms in their definition. Anxiety was defined with codes for diagnoses (12/12 studies); four studies also reported including symptoms. Fatal self-harm was ascertained in primary care data linked to the Office for National Statistics mortality database in nine studies. Most studies of cognitive dysfunction included Alzheimer’s disease, and vascular and frontotemporal dementia. Fatigue definitions varied little, including chronic fatigue syndrome, neurasthenia and postviral fatigue syndrome. All studies of sexual dysfunction focused on male conditions, principally erectile dysfunction. Sleep disorders included insomnia and hypersomnia. There was substantial variability in the codelists; validation was carried out i21/120 studies.ConclusionsThere is a need for standardised definitions and validated list of codes to assess mental health and quality of life outcomes in primary care databases in the UK.

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Dermatology ECHO: A case presentation demonstrating benefits of specialty telementoring in primary care

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18780562 ◽

2018 ◽

Vol 25 (8) ◽

pp. 506-509 ◽

Cited By ~ 1

Author(s):

Ryan Ladd ◽

Mirna Becevic ◽

Hope Misterovich ◽

Karen Edison

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Healthcare Outcomes ◽

Care Providers ◽

Community Healthcare ◽

Rural Primary Care ◽

Timely Access ◽

New Treatment ◽

Allergic Contact ◽

Improve Patient

Allergic contact dermatitis (ACD) is a common dermatologic disorder that is estimated to affect 15–20% of the general population. Because of its prevalence, it may be expected that ACD should be easily recognized. However, it can present with many clinical variations that may complicate diagnosis. Although ACD is a treatable condition, patients from rural and underserved areas suffer if timely access to specialty care is limited. Dermatology Extension for Community Healthcare Outcomes (Dermatology ECHO) telemedicine sessions were created to mentor rural primary care providers (PCPs). To illustrate their benefit, we present the case of a 19-year-old female patient who suffered from worsening undiagnosed ACD for over nine months following a laparoscopic appendectomy. During that time, the surgeon and multiple PCPs treated her with antibiotics, antivirals, and Scabicide without improvement in her condition. The de-identified patient case was presented by her PCP during the Dermatology ECHO session. The Dermatology ECHO specialty team mentored and educated the PCP in the diagnosis and treatment of ACD. After making the diagnosis, the patient received new treatment and her condition improved significantly. Dermatology ECHO provides a knowledge-sharing network for participating PCPs that may improve patient outcomes and reduce patient suffering.

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Job Satisfaction of Primary Care Team Members and Quality of Care

American Journal of Medical Quality ◽

10.1177/1062860610373378 ◽

2010 ◽

Vol 26 (1) ◽

pp. 18-25 ◽

Cited By ~ 31

Author(s):

David C. Mohr ◽

Gary J. Young ◽

Mark Meterko ◽

Kelly L. Stolzmann ◽

Bert White

Keyword(s):

Primary Care ◽

Job Satisfaction ◽

Quality Of Care ◽

Care Team ◽

Primary Care Team ◽

Team Members

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Developing Interprofessional Primary Care Teams: Alumni Evaluation of the Department of Veterans Affairs Centers of Excellence in Primary Care Education Program

Journal of Medical Education and Curricular Development ◽

10.1177/2382120519875455 ◽

2019 ◽

Vol 6 ◽

pp. 238212051987545

Author(s):

Nancy D Harada ◽

Shruthi Rajashekara ◽

Shubhada Sansgiry ◽

Kathryn Wirtz Rugen ◽

Samuel King ◽

...

Keyword(s):

Primary Care ◽

Training Program ◽

Nurse Practitioners ◽

Training Programs ◽

Veterans Affairs ◽

Advanced Training ◽

Department Of Veterans Affairs ◽

Centers Of Excellence ◽

Care Education ◽

Primary Care Education

Purpose: The Centers of Excellence in Primary Care Education (CoEPCE) is an interprofessional graduate training program within the Department of Veterans Affairs (VA). In this project, we describe career paths of CoEPCE graduates, their perceptions of CoEPCE program value, their overall satisfaction with the training, and suggestions for program improvement to enhance interprofessional education and workforce development. Methods: The Graduate Participant Survey was developed and administered in 2018 to CoEPCE graduates from 2012 to 2017. Quantitative data from closed-ended questions were analyzed through descriptive and non-parametric statistics to test for significant differences by profession. Qualitative data from the single open-ended question were analyzed using content analysis with inductive and deductive approaches. Results: The survey was completed by 180 graduates. Greater proportions of pharmacists and psychologists than nurse practitioners and physicians were employed in VA, and greater proportions of nurse practitioners and pharmacists than physicians and psychologists were employed in primary care. Although smaller proportions of physicians were currently employed in primary care ( P < .0001), a greater proportion completed advanced training programs ( P < .0001). Overall, graduates perceived that their CoEPCE training was highly valued by advanced training programs and employers and improved their chances of finding a job. They reported high levels of satisfaction (mean = 4.3 ± 0.9 out of 5 total) with the training program, continued to use skills they learned during training, and believe their CoEPCE experiences made them better health care providers. Conclusions: Ninety-four percent of the CoEPCE graduates were employed at the VA and/or primary care at the completion of their training, although there were significant differences by profession. Graduates continued to practice interprofessional skills learned during their training and were highly satisfied with the program. Taken together, the findings indicate that continued enhancements to the interprofessional clinical learning environment are warranted.

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