scholarly journals Primary care physicians practicing preventive medicine in the outpatient setting

2016 ◽  
Vol 7 (1) ◽  
pp. 5 ◽  
Author(s):  
David Snipelisky ◽  
Kimberly Carter ◽  
Karna Sundsted ◽  
MCaroline Burton
Keyword(s):  
Primary Care ◽  
Preventive Medicine ◽  
Primary Care Physicians ◽  
Outpatient Setting

History-taking and Preventive Medicine Skills among Primary Care Physicians: An Assessment Using Standardized Patients

1998 ◽  
Vol 104 (2) ◽  
pp. 152-158 ◽  
Author(s):  
Paul G Ramsey ◽  
J.Randall Curtis ◽  
Douglas S Paauw ◽  
Jan D Carline ◽  
Marjorie D Wenrich
Keyword(s):  
Primary Care ◽  
Preventive Medicine ◽  
Primary Care Physicians ◽  
Standardized Patients ◽  
History Taking

A Refresher on Herpes Zoster, Current Status on Vaccination, and the Role of the Dermatologist

2011 ◽  
Vol 15 (4) ◽  
pp. 185-191 ◽  
Author(s):  
Lyn C. Guenther ◽  
Charles W. Lynde
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Herpes Zoster ◽  
Preventive Medicine ◽  
Primary Care Physicians ◽  
Current Status ◽  
Age Group ◽  
Increased Risk

Background: Herpes zoster (HZ) and postherpetic neuralgia (PHN) have a significant impact on quality of life. PHN is often chronic and difficult to treat. Dermatologists have always been involved in making the diagnosis of these conditions and, most recently, teaching the need for early antiviral therapy. Objective: With the introduction of a new vaccine, HZ and its difficult-to-treat complication PHN can be prevented or minimized. Preventive medicine is important and has been supported by dermatologists with sun safety programs. Patients receiving biologics are at increased risk of developing zoster. Conclusion: Dermatologists should embrace zoster vaccination and recommend routine vaccination of immunocompetent individuals > age 60 years, as well as patients of any age who are starting immunosuppressants, including biologics. Given that individuals over age 50 years are at risk for PHN and studies have shown that the vaccine's immunogenicity and safety are maintained in individuals age 50 to 59 years, vaccination in this age group may be considered. Some dermatologists may consider vaccinating their own patients, but most will likely recommend that vaccination be performed by their patients' primary care physicians.

scholarly journals Understanding Clinicians’ Decisions to Assume Prescriptions for Inherited Patients on Long-term Opioid Therapy: A Qualitative Study

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3187-3198 ◽  
Author(s):  
Michelle S Keller ◽  
Alma Jusufagic ◽  
Teryl K Nuckols ◽  
Jack Needleman ◽  
MarySue Heilemann
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Physicians ◽  
Quality Care ◽  
Opioid Therapy ◽  
Outpatient Setting ◽  
Specialized Training ◽  
Primary Care Clinicians ◽  
Opioid Medications

Abstract Objective Given the changing political and social climate around opioids, we examined how clinicians in the outpatient setting made decisions about managing opioid prescriptions for new patients already on long-term opioid therapy. Methods We conducted in-depth interviews with 32 clinicians in Southern California who prescribed opioid medications in the outpatient setting for chronic pain. The study design, interview guides, and coding for this qualitative study were guided by constructivist grounded theory methodology. Results We identified three approaches to assuming a new patient’s opioid prescriptions. Staunch Opposers, mostly clinicians with specialized training in pain medicine, were averse to continuing opioid prescriptions for new patients and often screened outpatients seeking opioids. Cautious and Conflicted Prescribers were wary about prescribing opioids but were willing to refill prescriptions if they perceived the patient as trustworthy and the medication fell within their comfort zone. Clinicians in the first two groups felt resentful about other clinicians “dumping” patients on opioids on them. Rapport Builders, mostly primary care physicians, were the most willing to assume opioid prescriptions and were strategic in their approach to transitioning patients to safer doses. Conclusions Clinicians with the most training in pain management were the least willing to assume responsibility for opioid prescriptions for patients already on long-term opioid therapy. In contrast, primary care clinicians were the most willing to assume this responsibility. However, primary care clinicians face barriers to providing high-quality care for patients with complex pain conditions, such as short visit times and less specialized training.

scholarly journals Chorioretinal lesions in mothers of children with congenital toxoplasmosis in the National Collaborative Chicago-based, Congenital Toxoplasmosis Study

2010 ◽  
Vol 20 (1) ◽  
pp. 20 ◽  
Author(s):  
A. Gwendolyn Noble ◽  
Paul Latkany ◽  
Jaroslaw Kusmierczyk ◽  
Marilyn Mets ◽  
Peter Rabiah ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Outcome Measure ◽  
Congenital Toxoplasmosis ◽  
The United States ◽  
Outpatient Setting ◽  
Ocular Toxoplasmosis ◽  
Main Outcome Measure ◽  
Toxoplasmic Chorioretinitis

AIMS: To determine whether mothers of children with congenital toxoplasmosis have chorioretinal lesions consistent with toxoplasmosis. METHODS: Ophthalmologists in our study have examined 173 children with congenital toxoplasmosis in a hospital outpatient setting. These children were referred to us by their primary care physicians. One hundred and thirty mothers of these children had retina examinations of both eyes at least once. Main outcome measure was lesion(s) consistent with ocular toxoplasmosis. RESULTS: Of 130 mothers examined between 1991-2005, 10 (7.7%, 95% Confidence Interval 3.8%, 13.7%) had chorioretinal lesions which likely represent resolved toxoplasmic chorioretinitis. Most of these were small peripheral chorioretinal lesions. None reactivated between 1991-2005. CONCLUSIONS: Chorioretinal lesions consistent with quiescent ocular toxoplasmosis occur in mothers of children with congenital toxoplasmosis in the United States.

scholarly journals Early Treatment with Hydroxychloroquine Improves Clinical Outcomes and Reduces Hospital Admissions in COVID-19 Associated Pneumonia

2021 ◽  
pp. 15-26
Author(s):  
A. D’Alessio ◽  
M. Cottini ◽  
C. Lombardi ◽  
M. Uccelli ◽  
F. Bracchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Early Treatment ◽  
Primary Care Physicians ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Outpatient Setting ◽  
Oxygen Supplementation ◽  
Independent Variable ◽  
Time Point

Background: Hydroxychloroquine (HCQ) has been used against SARS-CoV-2, but large non randomized studies failed to show any clinical benefit. However, in these studies the drug was started in the hospital setting, a significant time after the onset of symptoms. Aim of the Study: to verify if HCQ, given early after the onset of symptoms and in the outpatient setting, can reduce hospital admissions and improve clinical outcomes of COVID-19 Methods: We performed a retrospective study on 824 patients with COVID-19 pneumonia in the Bergamo province (Lombardy, Italy). Patients were divided in 2 cohorts: the first included 354 outpatients attended by Primary Care Physicians (PCP), the second included 470 patients admitted to an Emergency Department (ED) during the same period. We compared rate of hospital admission and clinical outcomes in patients treated with HCQ within 6 days from the onset of symptoms, with all other patients. Clinical outcomes were evaluated at a 1-month time-point. Results: Patients who received early treatment with HCQ showed a lower rate of hospital admissions (p<0.0001), mechanical ventilation (p<0.0022) and need for oxygen supplementation at home (p=0.002) in the first cohort and improved survival in the second (p=0.03). Early treatment with HCQ was the only independent variable influencing all predefined outcomes on multivariate analysis. Conclusions: Treatment with HCQ, initiated within 6 days from the onset of COVID-19 may improve both clinical outcome and rate of hospital admissions.

scholarly journals Challenges of making a diagnosis in the outpatient setting: a multi-site survey of primary care physicians

2012 ◽  
Vol 21 (8) ◽  
pp. 641-648 ◽  
Author(s):  
Urmimala Sarkar ◽  
Doug Bonacum ◽  
William Strull ◽  
Christiane Spitzmueller ◽  
Nancy Jin ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Outpatient Setting ◽  
Site Survey

scholarly journals Stimulating the Use of OMT in Primary Care Offices Via Point-of-Care Reminders

2020 ◽  
pp. 14-17
Author(s):  
Annabel Agcopra ◽  
Philip Collins Collins ◽  
Stuti Jha ◽  
Alison Mancuso
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Pain Medication ◽  
Outpatient Setting ◽  
Control Group ◽  
Somatic Dysfunction ◽  
Before And After ◽  
Icd 10

Primary care physicians, especially in family medicine, are more prone to use osteopathic manipulative treatment (OMT) than other specialists; however, barriers to OMT use exist. The purpose of this study is to evaluate if the frequency of OMT use in a family medicine outpatient setting is influenced by having posters promoting OMT in exam rooms and waiting rooms. Methods: OMT posters were placed in two of four offices in an academic family medicine practice. Offices without posters served as the control group. Billing patterns were examined for the five months prior to and after poster placement. Report parameters included: age, gender, ethnicity, CPT code for OMT and somatic dysfunction ICD-10 codes. Results: Data before and after poster placement were compared. Results showed a positive correlation between posters advertising OMT and OMT use. There was a 6.5% increase in OMT use in the offices that had posters advertising OMT. Conclusion: This research showed that placing OMT posters in select family medicine offices resulted in an increase in OMT use. Possibilities for this increase include patients becoming more aware of the benefits of OMT and/or simply reminding osteopathic physicians of the benefits of OMT. Increased OMT utilization could lead to a decrease in pain medication prescribing and an increase in functionality through conservative measures.

How we evaluate and treat neutropenia in adults

Blood ◽  
2014 ◽  
Vol 124 (8) ◽  
pp. 1251-1258 ◽  
Author(s):  
Christopher Gibson ◽  
Nancy Berliner
Keyword(s):  
Primary Care ◽  
Adult Patient ◽  
Primary Care Physicians ◽  
Clinical Presentation ◽  
Clinical Status ◽  
Clinical Problem ◽  
Outpatient Setting ◽  
Practical Approach ◽  
Major Focus ◽  
Common Clinical Problem

Abstract Isolated neutropenia is a common clinical problem seen by primary care physicians and hematologists. The evaluation of neutropenia is dictated by the acuity of the clinical presentation and the duration, age, and clinical status of the patient. In this review, we provide a practical approach to the evaluation of the adult patient with neutropenia, with the major focus on the evaluation of neutropenia in the outpatient setting.

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