scholarly journals A Resident-Led QI Project to Improve Dental Health at a Primary Care Pediatric Practice

2020 ◽  
Vol 12 (5) ◽  
pp. 571-577
Author(s):  
Lauren T. Roth ◽  
Laura Robbins-Milne ◽  
Dana Sirota ◽  
Mariellen Lane
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Outcome Measure ◽  
Dental Health ◽  
Primary Care Providers ◽  
Fluoride Varnish ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Care Providers ◽  
The Past

ABSTRACT Background Dental caries are the most common chronic condition of childhood and have significant medical, psychological, and financial consequences. The American Academy of Pediatrics (AAP) recommends primary care physicians apply fluoride varnish (FV) every 3 to 6 months from tooth emergence through age 5. Objective Through a resident-led quality improvement (QI) project, we aimed to provide FV to 50% of patients ages 1 through 5 who did not have a dental visit in the preceding 6 months or receive FV elsewhere in the past month. Methods From May 2017 through April 2018, we conducted 7 monthly plan-do-study-act cycles to improve our primary outcome measure (FV application), secondary outcome measure (percentage of patients who had routine dental care), and process measure (percentage of dental referrals). Balancing measures included time taken away from other clinical priorities and reimbursement rates. Results Fluoride varnish application improved from 3.6% to 44% with a 54% peak. The percentage of patients under 6 who had seen a dentist in the past 6 months increased from 30% to 47%. The percentage of dental referrals increased from 17% to 33%. Conclusions Application of FV is a quick, cost-effective way for primary care providers to improve dental health. This resident-led QI project increased rates of FV application, dental referrals, and dental visits while meeting ACGME guidelines for experiential learning in QI. By adapting to state-specific guidelines and workflows of each clinic, this QI project could be nationally reproduced to improve adherence to AAP and United States Preventive Services Task Force guidelines.

scholarly journals Paging the eCardiologist: insights into referral behaviour of primary care physicians from qualitative analysis of a cardiology eConsult service

2018 ◽  
Vol 4 ◽  
pp. 205520761879214
Author(s):  
Elizabeth Chan ◽  
Christopher B Johnson ◽  
Clare Liddy ◽  
Erin Keely ◽  
Nadine Gauthier ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Analysis ◽  
Care Provider ◽  
Primary Care Provider ◽  
Primary Care Physicians ◽  
Positive Family History ◽  
Primary Care Providers ◽  
Secondary Outcome ◽  
Care Providers ◽  
Convenience Sample

Objective The purpose of this study is to investigate determinants of primary care physician cardiology referrals by performing qualitative analysis of questions asked by primary care physicians in cardiology electronic consultation services (eConsults). Setting A health region in eastern Ontario, Canada, where primary care providers have had access to an eConsult service since 2010. Participants We included all consecutive cardiology eConsults initiated by registered primary care provider users of our eConsult service and who initiated one or more eConsult between July 2014 and January 2015. We excluded eConsults in which the primary care provider attached a document without asking a question. A convenience sample of 100 consecutive eConsults initiated by 61 primary care providers was analysed after excluding 14 eConsults. Primary and secondary outcome measures: Primary care provider eConsult questions are categorised into thematic categories based on the constant comparison method of qualitative analysis with external validation by content experts. Secondary outcomes include sample primary care provider eConsult questions to illustrate each theme and any emergent subthemes. Results Thematic saturation occurred after analysis of 30 eConsults. An additional 70 eConsults were coded with no new emergent themes. Themes include exceptions to clinical guidelines ( n=13), non-cardiac treatment in a cardiac patient ( n=13), specific investigation/management ( n=18), interpretation of diagnostic testing ( n=46), clinical concerns despite normal testing ( n=4) and screening for positive family history ( n=6). Subthemes include multiple comorbidities and mild abnormalities on cardiac tests. Conclusions We report categories of clinical questions that drive primary care provider cardiology eConsults. Multimorbidity leads to cardiology eConsults as primary care providers try to apply treatment guidelines in medically complex patients. Mild test abnormalities unrelated to clinical problems commonly lead to cardiology eConsult requests. Further research is needed to determine how guidelines can better account for multimorbidity, and how cardiologists can better communicate with primary care providers to put cardiac test results in clinical context.

scholarly journals Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

2021 ◽  
Vol 8 ◽  
pp. 237437352110077
Author(s):  
Daliah Wachs ◽  
Victoria Lorah ◽  
Allison Boynton ◽  
Amanda Hertzler ◽  
Brandon Nichols ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Waiting Times ◽  
Wait Time ◽  
Primary Care Providers ◽  
Wait Times ◽  
Care Providers ◽  
Female Physicians ◽  
Online Ratings ◽  
And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

Are primary care physicians aware of peripheral artery disease risk reduction and management in the Saudi healthcare transformation era? A health cluster observational study

Vascular ◽  
2021 ◽  
pp. 170853812110443
Author(s):  
Sultan Alsheikh ◽  
Hesham AlGhofili ◽  
Omar A Alayed ◽  
Abdulkareem Aldrak ◽  
Kaisor Iqbal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Saudi Arabia ◽  
Risk Reduction ◽  
Peripheral Artery Disease ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Care Providers ◽  
Peripheral Artery ◽  
Artery Disease

Introduction Patients with peripheral artery disease (PAD) are often underdiagnosed and undertreated. This study aimed to assess the knowledge of the recommended target levels of blood pressure, low-density lipoprotein cholesterol, glycosylated hemoglobin A1C, and knowledge and attitude about PAD risk reduction therapies among physicians working in primary care settings in Saudi Arabia. Methods This observational cross-sectional study included family medicine consultants, residents, and general practitioners working in a health cluster in the capital city of Saudi Arabia using a self-administered questionnaire. Results Of the 129 physicians who completed the survey, 55% had completed PAD-related continuing medical education hours within the past 2 years. Despite this, the knowledge score of the recommended target levels was high in only 13.2% of the participants. Antiplatelet therapy was prescribed by 68.2% of the participants. Conclusion Here we identified the knowledge and action gaps among primary care providers in Saudi Arabia. Physicians had an excellent attitude about screening for and counseling about risk factors. However, they showed less interference in reducing these risk factors. We recommend addressing these knowledge gaps early in medical school and residency programs.

scholarly journals Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fabienne N. Jaeger ◽  
Nicole Pellaud ◽  
Bénédicte Laville ◽  
Pierre Klauser
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Care Providers ◽  
Key Factors ◽  
Cross Sectional ◽  
Interpreter Use ◽  
Health Authorities ◽  
Professional Interpreter ◽  
Paediatric Primary Care

Abstract Background The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. Methods Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. Results 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. Conclusions Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.

scholarly journals Effect of a Cooperation Strategy between Primary Care Physicians and Hospital Liver Units on HBV Care in Campania, Italy

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Rosa Zampino ◽  
Nicolina Capoluongo ◽  
Adriana Boemio ◽  
Margherita Macera ◽  
Martina Vitrone ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Endemic Area ◽  
Primary Care Providers ◽  
Hbv Infection ◽  
Care Providers ◽  
Financial Difficulties ◽  
Liver Disease Progression ◽  
Patients At Risk ◽  
Cooperation Strategy

Aims. This study is aimed at assessing the efficacy of an active search and treat strategy for HBV-infected subjects in an endemic area (Campania, Italy). To do this, we created a cooperation bundle between 24 General Practitioners (GPs) and 3 Hospital Liver Units (HLU). We assessed whether this strategy improved the detection of HBV infection in patients at risk and the overall quality of care, with the aim of reducing liver disease progression. Methods. We estimated that, among about 20,000 patients cared for by the 24 GPs, approximately 280 patients unaware of or underestimating HBV infection would be found. Identified patients were to be referred to the HLU for clinical evaluation and treatment from February 2016 for 12 months. Results. Unexpectedly, screening and enrolment were poor (48 patients only). GP workloads, patient financial difficulties, and patients' refusal were the major causes of enrolment failure according to GPs. All patients referred to HLU completed the program; most of them were HBV inactive carriers. Conclusions. This program failed to scavenge chronic HBV-infected patients in an endemic area and establish a successful clinical collaboration between GPs and HLU. Underlying reasons are diverse and call for new strategies to implement cooperation between primary care providers and hospital specialists.

Barriers To Diagnosis In Myeloproliferative Neoplasms

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5248-5248
Author(s):  
Raymond H L Yip ◽  
Lynda M Foltz
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Primary Care Physicians ◽  
Myeloproliferative Neoplasms ◽  
Diagnostic Testing ◽  
Primary Care Providers ◽  
Care Providers ◽  
Average Delay ◽  
Delay In Diagnosis ◽  
Hemorrhagic Complications

Abstract Background Timely diagnosis of patients (pts) with polycythemia vera (PV) and essential thrombocythemia (ET) is important given the risks of thrombotic and hemorrhagic complications, disease progression and associated symptoms.  Pts often present initially to primary care physicians, who may have limited previous experience with PV/ET given the low prevalence.  Little is known about the timeliness of referral or diagnostic testing after identification of abnormal blood test results or if delays in diagnosis affect patient outcomes. Objectives To determine the time from initial lab abnormality to referral, diagnosis and treatment of pts with PV and ET. Methods Pts at a single Canadian academic institution newly diagnosed with PV or ET from Jan 2010 to May 2013 were identified.  Retrospective data was collected including demographics, lab values, diagnostic testing and treatments. Results Demographics: 26 pts with PV and 34 with ET were identified.  Median age was 67.5 (44-89) y for PV and 66.5 (34-92) y for ET. Delay in Referral and Diagnosis: 98% of pts were referred directly to a hematologist by their primary care physician.  69% of PV pts were referred within 30 days and 92% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 98 (0-221) days.  41% of ET pts were referred within 30 days and 56% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 121 (8-638) days.  PV pts were referred sooner, median 20 (0-187) days, than ET pts, median 67 (0-3743) days (p=0.01).  The median delay from referral until hematology assessment was 51 days for PV compared to 78 days for ET (p=0.08).  After assessment by the hematologist, it required a median of 35 days to make a diagnosis of PV and 25 days for a diagnosis of ET (p=0.31). Referrals by platelet (plt) count: There was a trend to earlier referral of ET pts with higher platelet (plt) counts.  15/20 (75%) ET pts with plt count >600 were referred within 90 days of initial lab abnormality whereas only 4/14 (29%) of pts with plt count 450-600 were referred within 90 days (p=0.056). Treatment of PV pts: 22/26 (85%) pts received phlebotomy at or after referral at the direction of a hematologist.  Average delay in referral (and phlebotomy initiation) for patients treated with phlebotomy was 32 days.  13/26 (50%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 142 days.   11/26 (42%) pts were receiving ASA prior to the initial hematological consultation.  12/26 (46%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 90 days in this subgroup. Treatment of ET pts: 8/34 (24%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 790 days. 17/34 (50%) pts were receiving ASA prior to the initial hematological consultation.  15/34 (44%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 355 days in this subgroup. No thrombotic or major hemorrhagic complications occurred in any PV/ET pts between the time of initial lab abnormality and diagnosis. Discussion This study demonstrates the marked variability in time from lab abnormality to referral and diagnosis for PV/ET pts.  Primary care providers were more likely to promptly refer PV pts than ET pts, and particularly tended to overlook referral and investigation of pts with modestly elevated plt counts of 450-600.  This is a concern, as risk of thrombosis in ET pts is independent of plt count.  Delays were also apparent in wait times for hematology appointments and subsequent diagnostic tests.   The delay in diagnosis led to a delay in initiation of therapy to reduce risk of thrombosis in both PV and ET pts.  Possible strategies to expedite diagnosis include targeted education of primary care physicians focusing on identification of lab features of PV/ET.  Directive comments on lab reports by community hematopathologists may also facilitate prompt referral and investigation. Disclosures: No relevant conflicts of interest to declare.

Compliance, capacity, and quality in colonoscopy screening for CRC: A novel solution.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 357-357 ◽  
Author(s):  
S. C. Lloyd
Keyword(s):  
Primary Care ◽  
Training Program ◽  
Primary Care Physicians ◽  
African American Men ◽  
Primary Care Providers ◽  
Care Providers ◽  
Adenoma Detection ◽  
Before And After ◽  
Outstanding Quality

357 Background: CRC is predominately preventable with high quality colonoscopy screenings. Unfortunately, less than half of Americans are “up-to-date.” When referred by primary care providers, less than half complete the process. We proposed to include the primary care provider (PCP) in a novel training program to extend skills from sigmoidoscopy to full colonoscopy in a “mentored and monitored” model. We know that quality in colonoscopy can vary widely (ten fold within a single 12-man group). The protective benefits of colonoscopy reflect the thoroughness of the removal of polyps. Unfortunately, the ACS projections for 2010 predict an increase of 4,400 deaths from CRC over 2009, an 8% rise! Furthermore the death rate for African American men has RISEN 28% since 1960. We are loosing a battle for which we posses the tools to win. To achieve victory we must successfully address all three factors: compliance, capacity and quality. Methods: Thirty primary care physicians in two states (SC, FL) were recruited. We measured compliance rates within the practice before and after enrollment. We further evaluated quality of the colonoscopies as reflected in completion, yield and complications. Results: Compliance more than doubled (38% to 84%). As a compliance enhancement tool, the results were outstanding. The evaluation of quality then became of paramount importance. The gross completion rate was 98.3%, the adenoma detection rate (reflecting polyp yield) was 38%. In over 20,000 cases there were only 5 perforations, substantially below published rates. The quality was consistently at the level of experienced conscientious gastroenterologists. The details of the training program and the use of the “two-man” colonoscopy technique have been reviewed elsewhere (MEDICAL CARE, Aug 2010). Conclusions: If replicated nationally, this model has the potential for saving 25,000 lives annually. The participation of the patient's PCP is a powerful influence for improved compliance. The availability of an “expert” for mentoring and monitoring results in outstanding and consistent quality. The model has the potential to dramatically enhance compliance simultaneously increasing capacity while maintaining outstanding quality. No significant financial relationships to disclose.

Faster and better: Improving the diagnostic phase of lung cancer at a system level.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 115-115
Author(s):  
Melissa Kaan ◽  
Claire Holloway ◽  
Julie Gilbert ◽  
Vicky Simanovski ◽  
Garth Matheson
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Patient Experience ◽  
Cancer Care ◽  
Primary Care Providers ◽  
Diagnostic Process ◽  
Care Providers ◽  
The Past ◽  
Rule Out

115 Background: For many patients going through diagnostic testing for cancer, the time from suspicion to diagnosis or rule-out, can be a confusing and anxious time. In 2007, Cancer Care Ontario began investing in the implementation of diagnostic assessment programs (DAPs) across Ontario, Canada to improve the quality of care during the diagnostic phase of lung cancer. DAPs consist of multidisciplinary healthcare teams that manage and coordinate a patient’s diagnostic care from testing to a definitive diagnosis. The objectives of the DAPs are to: 1) decrease time from suspicion to diagnosis or resolution; 2) optimize the patient’s experience during the diagnostic process; 3) optimize satisfaction and experience among primary care providers and specialists; and 4) provide a sustainable solution by offering good value for money. Today over 35,000 patients have been diagnosed in one of the 18 lung DAPs that exist across the province. Methods: The implementation of DAPs featured the introduction of a patient navigator to act as the primary point of contact for patients, improve the patient experience and ensure their patients were progressing through any required diagnostic imaging and consultations in a timely manner. Cancer Care Ontario also engaged with primary care providers to refer patients with findings suspicious for lung cancer to DAPs as early as possible to ensure they benefited from organized assessment. Cancer Care Ontario has collected patient level data to measure wait times and implemented a patient survey to assess patient experience. Results: In the past five years, the median wait time from referral to a lung DAP to diagnosis or rule out has decreased by 19% to 24 days and the 90th %tile has decreased by 28% to 51 days. The large majority of patients have had a positive experience with their DAPs, with 95% of patients scoring their experience in the diagnostic process as “good” or “excellent”. Conclusions: The implementation of DAPs across the province is seen as a valuable component of quality of care by improving the diagnostic phase of cancer. The sustainability of the DAP model is demonstrated by the continued improvements in access and maintained patient experience in spite of growing volumes (91% increase in the past five years).

Educating primary care physicians in the management of Alzheimer's disease: using practice guidelines to set quality benchmarks

2009 ◽  
Vol 21 (S1) ◽  
pp. S44-S52 ◽  
Author(s):  
Debra L. Cherry ◽  
Carol Hahn ◽  
Barbara G. Vickrey
Keyword(s):  
Alzheimer’S Disease ◽  
Primary Care ◽  
Alzheimer's Disease ◽  
Practice Guidelines ◽  
Primary Care Physicians ◽  
Care Management ◽  
Primary Care Providers ◽  
Dementia Care ◽  
Care Providers

ABSTRACTThis paper presents a strategy for training primary care physicians in the identification, diagnosis and management of Alzheimer's disease and related disorders. The strategy uses evidence-based practice guidelines to establish quality benchmarks and then provides training and other interventions to improve the quality of care received by these patients. The three projects described in this paper assumed that training of primary care physicians alone would not be sufficient to achieve the quality benchmarks derived from guidelines. The projects used creative training strategies supplemented by provider “tool kits”, provider checklists, educational detailing, and endorsement from organizational leadership to reinforce what the primary care providers learned in educational sessions. Each project also implemented a system of dementia care management to “wrap around” traditional primary care to ensure that quality benchmarks would be achieved. Outcomes of two completed studies support the premise that it is possible to improve quality of dementia care through physician education that occurs in association with a coordinated system of dementia care management and in collaboration with community agencies to access guideline-recommended social services.

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