scholarly journals Neuromuscular Exercise for Chronic Musculoskeletal Pain in Older People: A Randomized Clinical Trial

2020 ◽  
pp. bjgp20X714053
Author(s):  
Regina Wing-shan Sit ◽  
Shirley Yue Kwan Choi ◽  
Bo Wang ◽  
Dicken Chan ◽  
Daisy, Dexing Zhang ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Self Efficacy ◽  
Primary Care Physicians ◽  
Short Form ◽  
Handgrip Strength ◽  
Controlled Trial ◽  
Primary Care Clinic ◽  
Control Group ◽  
Care Clinic

Abstract Background: Exercise therapy is commonly prescribed by primary care physicians (PCPs) in the management of chronic musculoskeletal (MSK) pain. Aims: We evaluated the clinical effectiveness of a supervised neuromuscular (NM) exercise program in older people with chronic MSK pain. Design: A 12-week, two-arm randomized controlled trial comparing 6 weeks supervised NM exercise versus waiting list control. Setting: We enrolled 72 participants with chronic MSK pain in a primary care clinic. Methods: Participants were randomly allocated (block size of 12) in 1:1 ratio to the NM (N=36) and control group (N=36). Data were collected at baseline, 6 and 12 weeks. The primary outcome was the Brief Pain Inventory (BPI) score at 6 weeks (post-intervention). Secondary outcomes included the Pain Self-Efficacy Questionnaire (PSEQ), Short form of Health Survey (SF-12), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) scores, and functional measurement using the Timed-Up-and-Go test and handgrip strength. Results: Compared with the control group at 6 weeks, the NM group demonstrated a significantly greater improvement in the BPI-severity pain (between-group difference -1.27, 95% CI = -2.08 to -0.45, P = 0.002) and PSEQ (between-group difference 6.50, 95% CI = 2.022 to 10.77, P = 0.003). Participants who complied to the protocol also demonstrated statistical significant improvement in the SF-12-physical score and PHQ-9 score. Conclusion and implications: NM exercise has the potential of reducing pain, improving self-efficacy, physical function and mood in older people with chronic MSK pain. It can be an option to PCPs in exercise prescriptions.

Parasitology Screening of Latin American Children in a Primary Care Clinic

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 279-283
Author(s):  
Joel L. Bass ◽  
Kishor A. Mehta ◽  
Bonnie Eppes
Keyword(s):  
Primary Care ◽  
Latin American ◽  
Primary Care Physicians ◽  
Screening Program ◽  
Primary Care Clinic ◽  
The United States ◽  
Common Finding ◽  
Parasitic Infections ◽  
Screening Process ◽  
Care Clinic

A screening program based in a Massachusetts community hospital primary care clinic, which included 124 children from 12 different Latin American countries, demonstrated that nearly 35% were carriers of pathogenic parasites. The large majority (83.7%) of these children were asymptomatic at the time of the examination. Although there may be considerable variation based on country of origin, the present results, as well as a review of the literature, suggest this is likely to be a common finding among children born in most regions of Latin America. Compliance with the screening process was significantly higher in groups with higher infection rates and the successive yield in those patients who submitted two or more stool samples revealed that most pathogens were identified in the first sample. Schoolage children were found to have the highest risk for both roundworm infections and multiple parasitic infections. For those children with identified pathogens, nearly 90% received treatment. Current trends in immigration, international adoptions, and special circumstances including day care, family shelters, and increasing numbers of human immunodeficiency virus-infected children have made an appreciation of the extent of parasitosis, and awareness of possible management approaches, an important consideration for primary care physicians in the United States.

Health after cancer: Early patient experience in a pilot survivorship clinic embedded in primary care.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 180-180
Author(s):  
Lidia Schapira ◽  
Marcy Winget ◽  
Siqi WU ◽  
Jennifer Kim ◽  
Cati Brown-Johnson
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Cancer Survivorship ◽  
Primary Care Physicians ◽  
Expert Knowledge ◽  
Primary Care Clinic ◽  
Breast Cancer Patients ◽  
Care Clinic

180 Background: Prior research has identified barriers to provision of quality survivorship care in primary care settings such as lack of expert knowledge and training, primary care burden and insufficient communication with oncologists. We implemented a survivorship clinic at an academic medical center in the primary care division with the goal of defining the elements required for a seamless transition and co-management. Methods: The primary care physician received training in cancer survivorship based on the ASCO Curriculum, shadowing of 3 breast medical oncologists and 1 gynecologic oncologist, attendance at the 2018 Cancer Survivorship Symposium and NCCN’s Cancer Survivorship Advocacy Meeting. Patients with breast and gynecologic cancers were referred by their oncologists or APP (PA or NP) at various points in their cancer trajectory. Clinical characteristics of patients were abstracted from the electronic medical record and in-depth interviews were conducted with 2 patients. Results: 41 patients attended the survivorship clinic. The majority (88%) were breast (63%) or gynecologic (24%) cancer survivors. Patient age was evenly distributed with 8 age < 46, 11 age 46-59, and 7 age > = 60. 23 (56%) patients had stage < 3 at diagnosis. 21 (51%) had been cancer-free for five years + and 4 were referred by their oncologist to help with patient co-management during cancer treatment. Of the 8 breast cancer patients < 46 years old, 6 had a genetic mutation and 7 were interested in fertility. 15/26 breast cancer patients are currently on endocrine therapy. Interviewed patients expressed appreciation for receiving whole-person care and knowing there is bidirectional communication between clinicians. Conclusions: Cancer survivors are open to and interested in a survivorship visit based in a primary care clinic; this includes both patients who have been cancer-free > 5 years as well as those recently treated with curative intent. Greater efforts are needed to train primary care physicians to deliver survivorship visits that are customized to meet the needs of cancer survivors.

scholarly journals Effects of App-based Transitional Care on Self-efficacy and Quality of Life of Patients with Spinal Cord Injury in China: Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Ting Liu ◽  
Sumei Xie ◽  
Yingmin Wang ◽  
Jie Tang ◽  
Xiaokuo He ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Transitional Care ◽  
Short Form ◽  
Controlled Trial ◽  
Control Group ◽  
Effect Analysis ◽  
Simple Effect ◽  
Cord Injury ◽  
Short Form Health

BACKGROUND Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of patients with SCI and the current community care system. With the prevalence of mobile terminals, the usage of mobile health applications (apps) has the potential to fill this gap by extending the qualified medical resources to the families of patients with SCI. Our team developed an app, named Together, for the transitional care of home-dwelling patients with SCI at home in China. OBJECTIVE This study aimed to evaluate the effects of the app-based transitional care on self-efficacy and QOL of patients with SCI in China. METHODS A multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who lived at home following discharge were recruited and randomly assigned to the study group (n=49) and control group (n=49) using the randomized number list in four research centers. Patients in both groups received systematic discharge education prior to discharge. The study group received five follow-ups conducted by trained nurses through the app which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-efficacy Scale and the 36-item Short Form Health Survey. Data collection was implemented prior to discharge, and at weeks 12 and 24 following discharge. Differences between the two groups were tested by repeated-measure analysis of variance and simple effect analysis. RESULTS The Moorong Self-efficacy Scale scores did not reveal differences between the two groups in time and group effects (all P>.05). However, differences in the interaction effects were statistically significant (all P<.001). After the simple effect analysis, the total scores and three-factor structure scores at 24 weeks following discharge were significantly higher than those of the control group (all P≤.010). Based on the 36-item Short Form Health Survey scores, differences in the time effects of total scores and physical component summary scores were statistically significant (both P<.05). However, there was no difference between the two groups in the time effects in the mental component summary, interaction effects, and group effects (all P>.05). CONCLUSIONS This study confirmed that app-based transitional care improves the self-efficacy of patients with SCI; nevertheless, improvement in QOL is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects of app-based transitional care. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR-IPR-17012317; www.chictr.org.cn/index.aspx

scholarly journals Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial

10.2196/16266 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16266 ◽  
Author(s):  
Yeoree Yang ◽  
Eun Young Lee ◽  
Hun-Sung Kim ◽  
Seung-Hwan Lee ◽  
Kun-Ho Yoon ◽  
...  
Keyword(s):  
Primary Care ◽  
Mobile Phone ◽  
Diabetes Management ◽  
Primary Care Clinic ◽  
Intervention Group ◽  
Glucose Monitoring ◽  
Feedback System ◽  
Control Group ◽  
Care Clinic ◽  
Cluster Randomized

Background Recent evidence of the effectiveness of mobile phone–based diabetes management systems is generally based on studies conducted in tertiary hospitals or professional diabetes clinics. Objective This study aimed to evaluate the clinical efficacy and applicability of a mobile phone–based glucose-monitoring and feedback system for the management of type 2 diabetes mellitus (T2DM) in multiple primary care clinic settings. Methods In this multicenter, cluster-randomized controlled, open trial, 13 primary care clinics in Seoul and other large cities in South Korea were voluntarily recruited. Overall, 150 (9 clinics) and 97 (4 clinics) participants with T2DM were assigned to the intervention and control groups, respectively (2:1 allocation). Every month, participants in both groups attended face-to-face physicians’ consultation for the management of diabetes in the clinic. For the intervention group, participants were required to upload their daily self-monitoring of blood glucose (SMBG) results using the mobile phone app in addition to outpatient care for 3 months. The results were automatically transmitted to the main server. Physicians had to check their patients’ SMBG results through an administrator’s website and send a short feedback message at least once a week. At baseline and 3 months, both groups had anthropometry and blood tests, including hemoglobin A1c (HbA1c), and responded to questionnaires about treatment satisfaction and compliance. Results At 3 months, participants in the intervention group showed significantly more improvement in HbA1c (adjusted mean difference to control −0.30%, 95% CI −0.50 to −0.11; P=.003) and fasting plasma glucose (−17.29 mg/dL, 95% CI −29.33 to −5.26; P=.005) than those in the control group. In addition, there was significantly more reduction in blood pressure, and the score regarding treatment satisfaction and motivation for medication adherence increased more in the intervention group than in the control group. In the subgroup analyses, the effect on glycemic control was more significant among younger patients and higher baseline HbA1c levels. Conclusions The mobile phone–based glucose-monitoring and feedback system was effective in glycemic control when applied in primary care clinic settings. This system could be utilized effectively with diverse institutions and patients. Trial Registration Clinical Research Information Service (CRIS) https://tinyurl.com/tgqawbz

Outcomes of Recognizing Depressed Chinese American Patients in Primary Care

2005 ◽  
Vol 35 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Albert Yeung ◽  
Winnie W. Kung ◽  
Jessica L. Murakami ◽  
David Mischoulon ◽  
Jonathan E. Alpert ◽  
...  
Keyword(s):  
Primary Care ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Primary Care Physicians ◽  
Primary Care Clinic ◽  
Chinese American ◽  
Chinese Americans ◽  
Major Depressive ◽  
Care Clinic ◽  
Treatment Of Depression

Purpose: This study aims to examine the effect of identifying Chinese American patients as having major depressive disorder (MDD) to their primary care physicians (PCPs) on the latter's attention given to the treatment of depression. Methodology: Forty Chinese American patients from a primary care clinic were identified as having major depressive disorder (MDD), and their primary care physicians (PCPs) were notified of the diagnosis by letter. Three months later, medical records of subjects in the study were reviewed to see if their PCPs had intervened through referral and/or initiated treatment of depression. Results: PCPs documented intervention in 19 patients (47%) regarding their depression. Two of these patients (11%) were started on an antidepressant. Four (21%) accepted and 13 (68%) declined referral to mental health services. No intervention was recorded for 21 (53%) patients. Conclusion: We conclude that recognition alone of MDD among Chinese Americans in the community primary care setting does not lead to adequate initiation of treatment for depression by PCPs.

To Screen or Not to Screen: Symptoms Identifying Primary Care Medical Patients in Need of Screening for Depression

1998 ◽  
Vol 28 (3) ◽  
pp. 293-302 ◽  
Author(s):  
Cheryl N. Carmin ◽  
John W. Klocek
Keyword(s):  
Primary Care ◽  
Beck Depression Inventory ◽  
Primary Care Physicians ◽  
Depressive Symptomatology ◽  
Primary Care Clinic ◽  
Office Visit ◽  
Medical Patients ◽  
Care Clinic ◽  
Professional Mental Health ◽  
Primary Care Patients

Objective: It is estimated that 5 percent to 10 percent of primary care patients meet criteria for Major Depressive Disorder with an additional 10 percent to 30 percent experiencing significant subclinical depression. However, only 18 percent to 50 percent of depressed primary care patients are so diagnosed by their primary care physicians and even fewer receive professional mental health care. The current study proposes a quick and efficient means to assist physicians in determining for which patients the resource intensive process of thoroughly screening for depression should be engaged. Method: The present study examined responses of 358 consecutively reporting patients to a midwest university-based primary care clinic on the Beck Depression Inventory. Results: Among individuals reporting high levels of depressive symptomatology, five questions from the Beck Depression Inventory were endorsed by 90 percent or greater of the participants. Analyses by gender indicated that while the same five items were endorsed by males and females, three additional items were frequently endorsed by males. Conclusions: These findings suggest that a means for efficiently identifying individuals who warrant screening for depression may be readily available to primary care physicians. Surprisingly, this screening was found to emphasize psychological rather than vegetative symptoms. Thus, attending to these symptoms and/or complaints during the course of an office visit may serve as an indicator that a thorough screening for depression, or possibly referral, is warranted.

scholarly journals Primary Care Clinic Nurse Activities with a Telehealth Monitoring System

2020 ◽  
Vol 43 (1) ◽  
pp. 5-12
Author(s):  
Chelsea Howland ◽  
Laurel Despins ◽  
Jeri Sindt ◽  
Bonnie Wakefield ◽  
David R. Mehr
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Monitoring System ◽  
Controlled Trial ◽  
Primary Care Clinic ◽  
Home Monitoring ◽  
Direct Care ◽  
Care Clinic ◽  
Home Based ◽  
Communication Processes

The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients who used a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those who assumed usual care. Data were extracted from electronic medical records from individuals who participated in a randomized controlled trial comparing in-home monitoring and usual care in patients with Type 2 diabetes and hypertension being treated in a primary care clinic. Data about nursing activities initiated by primary care clinic nurses were compared between groups using descriptive statistics and independent t-tests. Significant differences between groups were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up. This study provides evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.

scholarly journals A Brief Mindfulness-Based Intervention for Primary Care Physicians: A Pilot Randomized Controlled Trial

2016 ◽  
Vol 12 (1) ◽  
pp. 83-91 ◽  
Author(s):  
David A. Schroeder ◽  
Elizabeth Stephens ◽  
Dharmakaya Colgan ◽  
Matthew Hunsinger ◽  
Dan Rubin ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trial ◽  
Primary Care Physicians ◽  
Controlled Trial ◽  
Well Being ◽  
Control Group ◽  
Randomized Controlled ◽  
Patient Reported ◽  
The Impact

Primary care physicians experience high rates of burnout, which results in diminished quality of life, poorer quality of care, and workforce attrition. In this randomized controlled trial, our primary aim was to examine the impact of a brief mindfulness-based intervention (MBI) on burnout, stress, mindfulness, compassion, and resilience among physicians. A total of 33 physicians completed the baseline assessment and were randomized to the Mindful Medicine Curriculum (MMC; n = 17) or waitlist control group (n = 16). Participants completed self-report measures at baseline, post-MBI, and 3-month follow-up. We also analyzed satisfaction with doctor communication (DCC) and overall doctor rating (ODR) data from patients of the physicians in our sample. Participants in the MMC group reported significant improvements in stress (P < .001), mindfulness (P = .05), emotional exhaustion (P = .004), and depersonalization (P = .01) whereas in the control group, there were no improvements on these outcomes. Although the MMC had no impact on patient-reported DCC or ODR, among the entire sample at baseline, DCC and ODR were significantly correlated with several physician outcomes, including resilience and personal achievement. Overall, these findings suggest that a brief MBI can have a positive impact on physician well-being and potentially enhance patient care.

scholarly journals The Association of Social Support, Self-Efficacy with the Duration and Complications of Type 2 Diabetes Mellitus (T2DM) in Patients of a Malaysian Primary Care Clinic

2019 ◽  
pp. 55
Author(s):  
Aneesa Abdul Rashid ◽  
Zuhra Hamzah ◽  
Chai Eng Tan ◽  
Navin Kumar Devaraj
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Self Efficacy ◽  
Primary Care Clinic ◽  
Significant Negative Correlation ◽  
Cardiovascular Complications ◽  
Cross Sectional ◽  
Care Clinic ◽  
Mortality And Morbidity

Introduction: T2DM is a major cause of mortality and morbidity worldwide. Many factors need to be considered when managing patients with T2DM. Social support and self-efficac y are among the components associated with good diabetic self-care, which in turn lead to good diabetic outcomes. These factors are often overlooked but play an important role in patients’ management. This study aimed to determine the association of social support and diabetic selfefficacy of T2DM patients with the duration and complications of T2DM in a governme nt primary care clinicMethods: This is a cross sectional questionnaire study, involving 329 patients with T2DM in an urban Malaysian primary care clinic, using the Medical Outcome Study (MOS) Social Support Survey and Diabetic Management Self-Efficacy Scale (DMSES). The scores were analysed with clinical characteristic of the patients (duration and complications of T2DM) using descriptive and inferential statistics.Results: The mean duration of T2DM were 6.2 + 4.8 years, 57.8% of patients had no complications. Majority of patients had only 1 complication (33.1%) and 1 patient had 4 complications (0.3%). The complications were retinopathy (18.2%), nephropathy (14.6%), peripheral neuropathy (12.8%) and cardiovascular complications (4.3%). There was a significant correlation for social support with the duration of T2DM (r= -0.129, p = 0.02). There were no significant findings for the diabetic self-efficacy scores with duration and complications of T2DM.Conclusion: We found a significant negative correlation between the duration of T2DM and social support, which suggests that those with a longer duration of diabetes usually requires lesser social support.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 55

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