scholarly journals Evaluation of the Integrated Primary Care Clinic Into Behavioral Care Setting

2018 ◽  
Vol 10 (11) ◽  
pp. 169
Author(s):  
Jarman Alqahtani ◽  
Daniel West
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Behavioral Health Care ◽  
Patient Survey ◽  
Care Clinic ◽  
New Model ◽  
Care Services ◽  
Primary Care Services ◽  
Short Period

OBJECTIVE: The study has aimed to explore the process, outcomes of primary care, and barriers that make the primary care access difficult for the patients. DESIGN & SETTING: The study has utilized quantitative and qualitative approach and collected data from the clinic and patients. Patient survey was conducted to ask the patients about the possible reasons, which prevent them from accessing primary care services in the past. RESULTS: The mean age of patients was 46 years, among which majority (65%) were males. The results showed that education was the significant factor in determining the health status of a specific population. The clinic was successfully integrated into the behavioral health care setting. Many patients had been enrolled in the clinic for the first time with the help of a care manager that facilitated the identification of those patients. Most commonly, transportation was the main barrier for those populations for not seeking the primary care services. Emergency department use significantly declined after the implementation of the new model that reduced the cost of health services dramatically in a short period of time i.e. 6 months. CONCLUSION: There are susceptical gaps within the fragmented care due to high rates of physical health conditions. Majority of the patients in the study sample were satisfied with the new model; therefore, the new model was termed as effective and efficient.

scholarly journals Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244097
Author(s):  
John Pastor Ansah ◽  
Salman Ahmad ◽  
Lin Hui Lee ◽  
Yuzeng Shen ◽  
Marcus Eng Hock Ong ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Primary Care Clinic ◽  
Public Hospitals ◽  
Care Clinic ◽  
Care Services ◽  
Primary Care Services ◽  
Number Of Patients ◽  
Ed Crowding

Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is temporarily beyond the capacity for which the ED is designed and resourced to manage―a phenomenon called Emergency Department (ED) crowding. ED crowding can impair the quality of care delivered to patients and lead to longer patient waiting times for ED doctor’s consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency physicians have to cope with patient volumes above the safe workload. The purpose of this study is to create a virtual ED that closely maps the processes of a hospital-based ED in Singapore using system dynamics, that is, a computer simulation method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i) co-location of primary care services within the ED, (ii) increase in the capacity of doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and (iv) a combination of policies (i) to (iii). Among the tested policies, the co-location of primary care services has the largest impact on patients’ average length of stay (ALOS) in the ED. This implies that decanting non-emergency lower acuity patients from the ED to an adjacent primary care clinic significantly relieves the burden on ED operations. Generally, in Singapore, there is a tendency to strengthen primary care and to educate patients to see their general practitioners first in case of non-life threatening, acute illness.

A Previsit Screening Checklist Improves Teamwork and Access to Preventive Services in a Medical Home Serving Low-Income Adolescent and Young Adult Patients

2017 ◽  
Vol 57 (7) ◽  
pp. 835-843
Author(s):  
Sophie H. Allende-Richter ◽  
Sydney T. Johnson ◽  
Mariam Maloyan ◽  
Patricia Glidden ◽  
Kerrilynn Rice ◽  
...  
Keyword(s):  
Primary Care ◽  
Young Adults ◽  
Low Income ◽  
Primary Care Clinic ◽  
Team Work ◽  
Adolescents And Young Adults ◽  
Care Clinic ◽  
Care Services ◽  
Primary Care Services ◽  
Publicly Insured

Publicly insured adolescents and young adults experience significant obstacles in accessing primary care services. As a result, they often present to their medical appointments with multiple unmet needs, adding time and complexity to the visit. The goal of this project was to optimize team work and access to primary care services among publicly insured adolescents and young adults attending an urban primary care clinic, using a previsit screening checklist to identify patient needs and delegate tasks within a care team to coordinate access to health services at the time of the visit. We conducted an interventional quality improvement initiative in a PDSA (Plan-Do-Study-Act) cycle format; 291 patients, 13 to 25 years old were included in the study over an 8-months period. The majority of patients were receptive to the previsit screening checklist; 85% of services requested were provided; nonclinician staff felt more involved in patient care; and providers’ satisfaction increased.

scholarly journals Filling Gaps and Setting Boundaries: Examining Utilization of Health and Social services at JeffHOPE Student Run Clinics

2021 ◽  
Vol 12 ◽  
pp. 215013272110375
Author(s):  
Roy Wang ◽  
Amanda Guth ◽  
Alyssa Tate ◽  
Michele Ly ◽  
James Plumb
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Social Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Survey ◽  
Care Services ◽  
Primary Care Services ◽  
Clinic Site ◽  
Care Gaps

The objective of this study was to describe the frequency that healthcare and social support services offered by JeffHOPE, a student run clinic for people experiencing homelessness in Philadelphia, PA, were utilized by patients. This study also aimed to investigate where patients would seek medical care on a given day had they not been able to access JeffHOPE. This study was conducted via mixed methods consisting of retrospective chart review of patient encounter records and a patient survey conducted weekly throughout 2019, both at a single clinic site, and retrospective chart review of January through March 2020 records at 5 clinic sites. This study found that the frequency of services utilized varied between clinic sites, and that Pharmacy and Procedure committees were the most utilized when examining the combined clinic data. Additionally, the survey found that JeffHOPE provided medical care to those that otherwise would not have sought it. Clinics also served as an alternative to accessing care for non-emergent issues in an Emergency Department (ED) for some patients, but for others it replaced seeing their primary care provider (PCP). This study confirmed that the services offered by JeffHOPE are well-utilized by patients experiencing homelessness in Philadelphia. It also revealed that while the organization’s medical services filled care gaps and potentially decreased unnecessary ED visits, they were also sometimes accessed in lieu of a PCP visit. A focused effort on linkage to formal primary care services for all JeffHOPE patients and expanding collection of more granular data to all clinics represent important future endeavors for this student run organization.

Abstract P134: Selected Social Determinants Of Health And Hypertension For Patients Of An Urban Community Primary Care Clinic

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Melvin R Echols ◽  
Paula Pollard-Thomas ◽  
Henry Nuss ◽  
Heartley Egwuogu ◽  
Kristen Hobbs ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
African American ◽  
Food Insecurity ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Clinic ◽  
Financial Strain ◽  
Care Clinic ◽  
Stage 1

Background: Hypertension (HTN) is the most potent cardiovascular disease worldwide and a major public health concern in the U.S. Although Social Determinants of Health (SDoH) are associated with HTN, it is unclear whether these indicators are routinely captured in the primary care setting. We sought to examine the prevalence of any HTN and its association with captured SDoH for new patients (pts) presenting to an urban community primary care clinic for 2019 and 2020. Methods and Results: We identified a cohort-based, cross-sectional sample of 2,577 new pts ≥ 18 years of age in a community clinic in Atlanta, GA, between Jan 2019 and Dec 2020. Electronic health records were reviewed to determine the rate of selected SDoH indicators (financial strain, transportation, medical transportation, and food insecurity) captured at any time and the presenting blood pressure for all new patients. Blood pressure was classified as follows: normal, systolic BP/diastolic BP (SBP/DBP) ≤120/80 mmHg, elevated SBP 120-129mmHg and DBP<80mm, stage 1 SBP 130-139mmHg or DBP 80-90mmHg, and stage 2 SBP ≥ 140mmHg+ or DBP 90mmHg+. Likelihood-ratio Chi-square tests were analyzed to detect an association between SDOH and stages of HTN. Of the 2,577 pts seen, 93% were African American, 72% were female, 59% were single, 77% had BMI ≥ 25, and 85% were insured. Only 41% (n=1062) pts had information of at least one SDoH measure in the entire cohort. Of the SDoH domains evaluated, financial strain and food insecurity were more likely in new pts with stage 1 HTN or higher (χ2= 16.0, df=8, p=0.04; χ2= 27.7, df=12, p=0.006). Conclusion: Routine assessments of SDoH for African American pts presenting for new pt visits are suboptimal in the primary care setting. However, financial strain and food insecurity are significantly associated with stage 1 and 2 HTN in this population. Standardization of intake processes is essential to increase the collection of SDoH indicators and may ultimately guide secondary prevention strategies for HTN interventions.

scholarly journals Implementation of HIV Preexposure Prophylaxis in a Homeless Primary Care Setting at the Veterans Affairs

2020 ◽  
Vol 11 ◽  
pp. 215013272090837
Author(s):  
Elizabeth Gregg ◽  
Carrie Linn ◽  
Emma Nace ◽  
Lillian Gelberg ◽  
Brianna Cowan ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Root Cause ◽  
Preexposure Prophylaxis ◽  
Provider Knowledge ◽  
Improve Access

Objective: Oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV-1 acquisition, yet it is underutilized among at-risk populations. In this pilot quality improvement (QI) initiative, we sought to identify barriers to PrEP implementation and create interventions to improve access to PrEP in a primary care clinic for homeless veterans. Methods: The setting was a large homeless primary care clinic at the Veterans Affairs in an urban area with high HIV prevalence. A root cause analysis was performed to identify barriers to PrEP expansion in the primary care clinic. Targeted interventions to improve provider knowledge and patient access to PrEP were implemented by the QI team. Results: Root cause analysis revealed 3 primary barriers to PrEP expansion in the primary care clinic: institutional limitations for prescribing PrEP, inconsistent screening and recognition of eligible patients by clinic staff, and lack of clinic workflow processes to support PrEP prescription. A multidisciplinary focus group found low levels of PrEP awareness and knowledge, with only 22% of providers reporting comfort discussing PrEP with patients. This improved to 40% of providers following targeted clinic educational interventions. The QI team also developed a pathway for primary care providers to obtain institutional PrEP prescribing privileges and used work groups to develop clinic workflows and protocols for PrEP. At the end of the intervention, at least 50% of primary care providers in the clinic had initiated PrEP in a new patient. Conclusions: We describe a multidisciplinary QI model to implement PrEP within a primary care setting serving Veterans and persons experiencing homelessness. Our program successfully addressed provider knowledge deficits and improved primary care capacity to prescribe PrEP. The primary care clinic can be a viable and important clinical setting to improve access to PrEP for HIV prevention, especially for vulnerable populations.

scholarly journals Evaluation of a Primary Care Weight Loss Program

2017 ◽  
Vol 10 (1) ◽  
pp. 79-84
Author(s):  
Callie Schlicht ◽  
Christine Shaw ◽  
Kristin Haglund ◽  
Susan Breakwell
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Nurse Practitioners ◽  
Chart Review ◽  
Care Setting ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Weight Loss Program ◽  
Strong Positive Correlation ◽  
Care Clinic

Nurse practitioners at a primary care clinic established a weight loss program to address high obesity rates among their African American patients. Interviews and a retrospective chart review were used to evaluate the weight loss program. Number of appointments was the only significant predictor of weight loss, and there was a strong positive correlation between total number of appointments and weight loss. The overall view of the program was positive. This description and evaluation of the program may be useful to nurse practitioners seeking to develop an individualized effective weight loss intervention for African Americans within a primary care setting.

scholarly journals Increasing Diabetes Screening in a Primary Care Setting

2021 ◽  
Author(s):  
Jennifer J. Iyengar ◽  
Mary E.K. Fisher ◽  
Julie E. Ziegler ◽  
Douglas W. Wright ◽  
Meghan C. Monson ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Internal ◽  
Care Services ◽  
Outpatient Visits ◽  
Primary Care Services ◽  
Academic Medical ◽  
Ann Arbor

Michigan Medicine (MM) is a large academic medical center located in Ann Arbor, MI. There are 14 primary care sites within the MM system, with six locations in Ann Arbor and eight locations in surrounding communities in southeast Michigan. Approximately 60–70 general internal medicine physicians and 40–50 family medicine physicians provide primary care within the health system, with additional primary care services provided by geriatrics and obstetrics/gynecology clinicians (1). In total, there are ~2.4 million outpatient visits to the health care system each year, including both primary and specialty care services (2).

Use of Health Care Services by Inner-city Infants in an Early Discharge Program

PEDIATRICS ◽  
1996 ◽  
Vol 98 (4) ◽  
pp. 686-691
Author(s):  
William O. Cooper ◽  
Uma R. Kotagal ◽  
Harry D. Atherton ◽  
Carrie A. Lippert ◽  
Elizabeth Bragg ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Inner City ◽  
Primary Care Clinic ◽  
Early Discharge ◽  
Emergency Department Visits ◽  
Care Clinic ◽  
Children's Hospital ◽  
Care Services ◽  
Children’S Hospital

Objective. To assess the use of health care services by inner-city infants enrolled in an early discharge program who received care in a tertiary care children's hospital primary care clinic. Design. Retrospective cohort study. Setting. Large, metropolitan university hospital and a children's hospital. Patients. Term infants cared for in a single full-term nursery, before and after implementation of a coordinated early discharge program, who received primary care at the children's hospital. Intervention. The coordinated Early Discharge Program was characterized by in-hospital visits by hospitalbased coordinating nurses, home visits by nurses from a home nursing agency, and communication with physicians for necessary adjustments in postdischarge care. Methods. After linking birth hospital records and the children's hospital medical records, a retrospective chart review was performed to obtain maternal demographic information and birth hospital length of stay, as well as the infants' attendance at primary care clinic, immunizations, emergency department visits, and rehospitalization. Main Outcome Measures. Number of primary care visits in the first 3 months of life, completion of one series of immunizations by 3 months of life, and number of emergency department visits and rehospitalization during the first 3 months of life. Results. The early discharge group (n = 253) had a significantly shorter birth hospital length of stay (35 ± 24 hours, mean ± SD) when compared with the control group (n = 212) (52 ± 14 hours). The early discharge group was also younger than the control group at the first primary care visit, with significantly more infants visiting the primary care clinic in the first month of life. There was also a significant difference between the groups in the mean number of emergency department visits (early discharge = .61 visits/patient, control = .79 visits/patient) and the proportion of patients with no emergency department visits during the first 3 months of life (early discharge = 57%, control = 43%). There was no difference between the two groups in the proportion of infants completing one series of immunizations or in the number of infants rehospitalized during the study period. Conclusions. Coordinated early discharge with home nursing visits for inner-city infants may result in earlier use of primary care services. Furthermore, there is a significant decrease in use of the emergency department during the first 3 months of life, and no increase in rehospitalization.

scholarly journals Increasing Diabetes Screening in a Primary Care Setting

2021 ◽  
Author(s):  
Jennifer J. Iyengar ◽  
Mary E.K. Fisher ◽  
Julie E. Ziegler ◽  
Douglas W. Wright ◽  
Meghan C. Monson ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Internal ◽  
Care Services ◽  
Outpatient Visits ◽  
Primary Care Services ◽  
Academic Medical ◽  
Ann Arbor

Michigan Medicine (MM) is a large academic medical center located in Ann Arbor, MI. There are 14 primary care sites within the MM system, with six locations in Ann Arbor and eight locations in surrounding communities in southeast Michigan. Approximately 60–70 general internal medicine physicians and 40–50 family medicine physicians provide primary care within the health system, with additional primary care services provided by geriatrics and obstetrics/gynecology clinicians (1). In total, there are ~2.4 million outpatient visits to the health care system each year, including both primary and specialty care services (2).

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