Detection of Flow Obstruction in Peripheral Arteries by Primary Care Providers: A Population-Based Registry Study

The purpose of this article is to review the current literature describing primary care providers’ (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs’ actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies’ purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs’ attitudes toward LGBTQ people were positive, but a minority of each studies’ participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.

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Successful childhood obesity management in primary care in Canada: what are the odds?

PeerJ ◽

10.7717/peerj.1327 ◽

2015 ◽

Vol 3 ◽

pp. e1327 ◽

Cited By ~ 7

Author(s):

Stefan Kuhle ◽

Rachel Doucette ◽

Helena Piccinini-Vallis ◽

Sara F.L. Kirk

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Secondary Prevention ◽

Weight Management ◽

Systems Approach ◽

Primary Care Providers ◽

Canadian Community Health Survey ◽

Population Based ◽

Care Providers ◽

Obesity Management

Background.The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada.Methods.Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada.Results.We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process.Conclusions.In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.

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Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: A Qualitative Formative Evaluation of a Web-Based Tool (Preprint)

10.2196/preprints.27748 ◽

2021 ◽

Author(s):

Sarah Javier ◽

Justina Wu ◽

Donna L. Smith ◽

Fahisa Kanwal ◽

Lindsey A. Martin ◽

...

Keyword(s):

Primary Care ◽

Management System ◽

Formative Evaluation ◽

Primary Care Providers ◽

Population Based ◽

Veterans Health ◽

Health Administration ◽

Care Providers ◽

Clinical Workflow ◽

Web Based

BACKGROUND Cirrhosis, or scarring of the liver, is a debilitating condition affecting millions of U.S. adults. Early identification, linkage to care, and retention in care are critical to preventing severe complications from cirrhosis and death. OBJECTIVE The purpose of this study was to conduct a pre-implementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management. METHODS Semi-structured interviews were conducted with frontline providers in liver disease and primary care clinics at three Veterans Health Administration medical centers. The Consolidated Framework for Implementation Research guided the development of interview guides. Inductive consensus coding was used to analyze transcribed interviews and abstracted coded passages elucidated themes and insights. RESULTS Ten providers were interviewed, including eight physicians and mid-level providers from liver-related specialty clinics and two primary care providers who managed patients with cirrhosis. Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability. CONCLUSIONS P-CIMS shows promise as a powerful tool for identifying, linking, and retaining in care patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in chronic disease populations.

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Digital ankle-brachial index technology used in primary care settings to detect flow obstruction: a population based registry study

BMC Research Notes ◽

10.1186/1756-0500-6-404 ◽

2013 ◽

Vol 6 (1) ◽

Cited By ~ 3

Author(s):

Tiffini R Diage ◽

Gayle Johnson ◽

Gowtam Ravipati

Keyword(s):

Primary Care ◽

Ankle Brachial Index ◽

Population Based ◽

Registry Study ◽

Primary Care Settings ◽

Population Based Registry

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The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽

10.1027/0227-5910/a000511 ◽

2018 ◽

Vol 39 (5) ◽

pp. 397-405 ◽

Cited By ~ 3

Author(s):

Steven Vannoy ◽

Mijung Park ◽

Meredith R. Maroney ◽

Jürgen Unützer ◽

Ester Carolina Apesoa-Varano ◽

...

Keyword(s):

Primary Care ◽

Low Socioeconomic Status ◽

Thematic Analysis ◽

Older Men ◽

Primary Care Providers ◽

Depression Treatment ◽

Care Providers ◽

Low Socioeconomic ◽

Self Image ◽

The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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