12. Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Pediatric Primary Care
Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well-positioned to provide these services, but often face barriers. Practice facilitation (PF) is an evidence-based approach to improve primary care outcomes through a relationship between an external facilitator and a primary care practice. The aim of this study was to use PF to build quality improvement (QI) capacity within community pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventiv...
Source: Journal of Pediatric and Adolescent Gynecology - March 29, 2020 Category: OBGYN Authors: Elise Berlan, Olivia Valenti, William Long, Angela Abenaim, Heather Maciejewski, Christina Toth, Charitha Gowda Source Type: research

New Resource for Managing Patients Receiving Long-term Opioid Therapy
The Agency for Healthcare Research and Quality (AHRQ) recently updated a toolkit for primary care practices who treat patients with chronic pain who take opioids. As AHRQ noted, most patients taking opioids for chronic pain are managed by primary care practitioners and their staffs. (Source: JAMA)
Source: JAMA - March 24, 2020 Category: General Medicine Source Type: research

IJERPH, Vol. 17, Pages 2164: Cohort Profile: Effectiveness of a 12-Month Patient-Centred Medical Home Model Versus Standard Care for Chronic Disease Management among Primary Care Patients in Sydney, Australia
thy Tannous Evidence suggests that patient-centred medical home (PCMH) is more effective than standard general practitioner care in improving patient outcomes in primary care. This paper reports on the design, early implementation experiences, and early findings of the 12-month PCMH model called ‘WellNet’ delivered across six primary care practices in Sydney, Australia. The WellNet study sample comprises 589 consented participants in the intervention group receiving enhanced primary care in the form of patient-tailored chronic disease management plan, improved self-management support, and re...
Source: International Journal of Environmental Research and Public Health - March 24, 2020 Category: Environmental Health Authors: James Rufus John Amanda Jones A. Munro Neville Shima Ghassempour Federico Girosi W. Kathy Tannous Tags: Article Source Type: research

IJERPH, Vol. 17, Pages 2154: Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices
Phillips Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates ...
Source: International Journal of Environmental Research and Public Health - March 24, 2020 Category: Environmental Health Authors: Choi Simon Barrow Palmer Basu Phillips Tags: Article Source Type: research

Communities of Practice: An Innovative Approach to Building Academic –Practice Partnerships
This article describes how an academic–practice partnership was established using the Communities of Practice as a framework. The project outcome was successful in many ways, including recruiting and enhancing preceptors and creating opportunities for NP students to learn about community-based health care and practice in underserved primary care practice. (Source: The Journal for Nurse Practitioners)
Source: The Journal for Nurse Practitioners - March 18, 2020 Category: Nursing Authors: Blanca Iris Padilla, Kathryn Evans Kreider Tags: Original Research Source Type: research

Dedicated Workforce Required to Support Large-Scale Practice Improvement
Conclusions: Supporting a large-scale facilitation workforce requires creating an infrastructure, including initial training, and ongoing support and monitoring, often borrowing from other ongoing initiatives. Facilitation that recognizes the need to support the vital integrating functions of primary care might be more efficient and effective than this fragmented approach to quality improvement. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - March 16, 2020 Category: Primary Care Authors: Sweeney, S. M., Hemler, J. R., Baron, A. N., Woodson, T. T., Ono, S. S., Gordon, L., Crabtree, B. F., Cohen, D. J. Tags: Original Research Source Type: research

Designing and Evaluating a Prediabetes Shared Decision Aid
Discussion: It was feasible to cocreate a prediabetes shared decision aid within a PASAC and implement the tool within a primary care setting. Patients and clinicians reported a prediabetes discussion, which may mitigate rates of progression to diabetes and associated complications. Future research should evaluate which of the intervention components most effectively promotes discussion of prediabetes within a primary care setting. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - March 16, 2020 Category: Primary Care Authors: Careyva, B. A., Shaak, K., Burgess, N. M., Johnson, M. B., Banerjee, E. S., Chung, Y., Davis, A. N., Payton, C. Tags: Brief Report Source Type: research

Re: Primary Care Practices Implementation of Patient-Team Partnership: Findings from EvidenceNOW Southwest
(Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - March 16, 2020 Category: Primary Care Authors: Bitencourt, S. E., Rodrigues de Aguiar, D., Baggio, A., Marcon, C. E. M. Tags: Correspondence Source Type: research

A stepped-wedge randomized trial protocol of a community intervention for increasing lung screening through engaging primary care providers (I-STEP)
This study uses a stepped-wedge implementation design. Screening centers are randomized by readiness level to enter the intervention phase in three-month “steps” with pre-intervention data serving as the control. (Source: Contemporary Clinical Trials)
Source: Contemporary Clinical Trials - March 14, 2020 Category: Radiology Authors: Ana S. Salazar, Subhjit Sekhon, Karthik W. Rohatgi, Akua Nuako, Jingxia Lu, Courtney Harriss, Ellen Brennan, Dareld LaBeau, Ibrahim Abdalla, Christopher Schulze, Jackie Muenks, Dave Overlot, Jeri Ann Higgins, Linda S. Jones, Colleen Swick, Stacia Goings, Source Type: research

Effects of 2 Forms of Practice Facilitation on Cardiovascular Prevention in Primary Care: A Practice-randomized, Comparative Effectiveness Trial
Conclusion: Facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone. (Source: Medical Care)
Source: Medical Care - March 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Use of an Online Breast Cancer Risk Assessment and Patient Decision Aid in Primary Care Practices
Journal of Women's Health, Ahead of Print. (Source: Journal of Women)
Source: Journal of Women - March 10, 2020 Category: OBGYN Authors: Karen B. Eden Ilya Ivlev Katherine L. Bensching Gabriel Franta Alyssa R. Hersh James Case Rongwei Fu Heidi D. Nelson Source Type: research

[How do young general practitioners experience the transition to general practice? A qualitative study].
CONCLUSIONS: Our findings confirm that young doctors' initial views on medical care are strongly shaped by the clinical focus of medical schools and hospital work. Working in general practice is perceived as being very different from working in a hospital. PMID: 32139305 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen)
Source: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen - March 8, 2020 Category: Health Management Tags: Z Evid Fortbild Qual Gesundhwes Source Type: research

Evaluation of a very brief pedometer-based physical activity intervention delivered in NHS Health Checks in England: The VBI randomised controlled trial
ConclusionsIn this large well-conducted trial, we found no evidence of effect of a plausible very brief pedometer intervention embedded in NHS Health Checks on objectively measured activity at 3-month follow-up. Trial registrationCurrent Controlled Trials (ISRCTN72691150). (Source: PLoS Medicine)
Source: PLoS Medicine - March 6, 2020 Category: Internal Medicine Authors: Wendy Hardeman Source Type: research

Recruitment and reach in a pragmatic behavioral weight loss randomized controlled trial: implications for real-world primary care practice
Obesity is a major risk factor behind some of the most common problems encountered in primary care. Although effective models for obesity treatment have been developed, the ‘reach’ of these interventions is po... (Source: BMC Family Practice)
Source: BMC Family Practice - March 3, 2020 Category: Primary Care Authors: Christie A. Befort, Danny Kurz, Jeffrey J. VanWormer and Edward F. Ellerbeck Tags: Research article Source Type: research

Scripts and Strategies for Discussing Stopping Cancer Screening with Adults & gt;  75 Years: a Qualitative Study
ConclusionsTo increase PCP comfort and capability to discuss stopping cancer screening with older adults, we developed scripts and strategies that PCPs may use for discussing stopping cancer screening. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - March 3, 2020 Category: Internal Medicine Source Type: research

The association between organizational cultural competence and teamwork climate in a network of primary care practices
Background: A health system's commitment to delivering culturally competent care is essential in creating a culture of respect for patients, clinicians, and administrative staff. As the diversity of the health care workforce grows, gaining an understanding of the perspectives among different health care personnel and the value that they place on organizational cultural competence is a first step in developing more effective team environments. Purpose: The aim of the study was to determine whether an association exists between perceptions of organizational cultural competence and teamwork climate among employees in a h...
Source: Health Care Management Review - February 29, 2020 Category: American Health Tags: Features Source Type: research

Increasing uptake of hepatitis C virus infection case-finding, testing, and treatment in primary care: evaluation of the HepCATT (Hepatitis C Assessment Through to Treatment) trial.
CONCLUSION: When supported by a complex intervention, primary care can play a crucial role in identifying and caring for patients with HCV infection, to help stem the HCV epidemic, and prevent HCV-related illness. PMID: 32094220 [PubMed - as supplied by publisher] (Source: The British Journal of General Practice)
Source: The British Journal of General Practice - February 24, 2020 Category: Primary Care Authors: Horwood J, Clement C, Roberts K, Waldron CA, Irving WL, Macleod J, Hickman M Tags: Br J Gen Pract Source Type: research

An Automated Telephone Call System Improves the Reach and Cost-effectiveness of Panel Management Outreach for Cancer Screening
This implementation and comparative effectiveness study compared an automated call system (ACS)-assisted method to enhance staff efficiency in panel management cancer screening outreach compared with standard outreach using manual calls. One panel manager assisted by the ACS at the intervention primary care practice completed outreach workflows for 43% more patients than 2 unassisted panel managers at comparison practices, with 78% more patients in the ACS-assisted panel management program ultimately having a preventive screening gap closed. Outreach cost per completion of 1 or more cancer screenings was $45.39 under stand...
Source: The Journal of Ambulatory Care Management - February 19, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Cardiovascular Disease Guideline Adherence: An RCT Using Practice Facilitation
The objective of the study is to determine whether practice facilitation is effective in increasing the proportion of patients meeting the Million Hearts ABCS outcomes: (A) aspirin when indicated, (B) blood pressure control, (C) cholesterol management, and (S) smoking screening and cessation intervention.DesignThe study used a stepped-wedge cluster RCT design with 4 intervention waves. Data were extracted for 13 quarters between January 1, 2015 and March 31, 2018, which encompassed the control, intervention, and follow-up periods for all waves, and analyzed in 2019.Setting/participantsA total of 257 small independent prima...
Source: American Journal of Preventive Medicine - February 15, 2020 Category: International Medicine & Public Health Source Type: research

Use of Mustard Seed Footbaths for Respiratory Tract Infections: A Pilot Study.
Conclusions: This study could provide a first insight into a possible strategy to improve symptoms regarding RTI by using mustard seed footbaths. PMID: 32047526 [PubMed] (Source: Evidence-based Complementary and Alternative Medicine)
Source: Evidence-based Complementary and Alternative Medicine - February 13, 2020 Category: Complementary Medicine Tags: Evid Based Complement Alternat Med Source Type: research

Variability in Diagnosed Asthma in Young Children in a Large Pediatric Primary Care Network
Publication date: Available online 7 February 2020Source: Academic PediatricsAuthor(s): Chén C. Kenyon, Mitchell G. Maltenfort, Rebecca A. Hubbard, Leah H. Schinasi, Anneclaire J. De Roos, Sarah E. Henrickson, Tyra C. Bryant-Stephens, Christopher B. ForrestAbstractObjectivesOur objectives were to (1) quantify the frequency of wheezing episodes and asthma diagnosis in young children in a large pediatric primary care network and (2) assess the variability in practice-level asthma diagnosis, accounting for common asthma risk factors and comorbidities. We hypothesized that significant variability in practice-level asthm...
Source: Academic Pediatrics - February 9, 2020 Category: Pediatrics Source Type: research

Building quality chronic illness care: implementation of a web-based care plan.
Abstract Structured, multidisciplinary approaches to chronic disease management (CDM) in primary care, supported by eHealth tools, show improved clinical outcomes, yet the uptake of eHealth tools remains low. The adoption of cdmNet, an eHealth tool for chronic disease management, in general practice settings, was explored. This was a qualitative case study in three general practice clinics in Melbourne, Australia. Methods included non-participant observation, reflexive note taking and semi-structured interviews with GPs, non-GP clinical staff, administrative staff and patients with chronic conditions. Data were an...
Source: Primary Care - February 7, 2020 Category: Primary Care Authors: Vasi S, Advocat J, Adaji A, Russell G Tags: Aust J Prim Health Source Type: research

Group Medical Visits: experiences with patient and resident implementation.
Conclusion: The GMV model offers patients the setting to interact and exchange experiences with each other as well as to receive feedback from providers and the health-care team.  The incorporation of the GMV program into residency training provides a continuity group care experience and an alternative practice model. PMID: 31990589 [PubMed - as supplied by publisher] (Source: Expert Review of Endocrinology and Metabolism)
Source: Expert Review of Endocrinology and Metabolism - January 30, 2020 Category: Endocrinology Tags: Expert Rev Endocrinol Metab Source Type: research

The Cost of Pharmaceutical Company Detailing Visits and Medication Samples
In this issue of JAMA Internal Medicine, King and colleagues report on the frequency of pharmaceutical company detailing visits and the use of medication sample closets in the United States. Of the primary care practices surveyed in 2017 through 2018, around 50% reported weekly detailing visits and approximately 60% had sample closets. Most of the practices were independent and had small numbers of physicians (
Source: JAMA Internal Medicine - January 27, 2020 Category: Internal Medicine Source Type: research

A Co-localized Hepatitis C Virus Clinic in a Primary Care Practice Improves Linkage to Care in a High Prevalence Population
We report the Hepatitis C prevalence and evaluate the impact of the integrated clinic on the Hepatitis C cascade of care. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 24, 2020 Category: General Medicine Authors: Paul C Adamson, Janet Miceli, Bethel Shiferaw, Merceditas S Villaneuva, Joseph E. Canterino Tags: Clinical Research Study Source Type: research

A Colocalized Hepatitis C Virus Clinic in a Primary Care Practice Improves Linkage to Care in a High Prevalence Population
We report the prevalence of HCV and evaluate the impact of the integrated clinic on the HCV cascade of care. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 24, 2020 Category: General Medicine Authors: Paul C. Adamson, Janet Miceli, Bethel Shiferaw, Merceditas S. Villanueva, Joseph E. Canterino Tags: Clinical Research Study Source Type: research

Cost-effectiveness of Practice Team-Supported Exposure Training for Panic Disorder and Agoraphobia in Primary Care: a Cluster-Randomized Trial
ConclusionThe PARADISE intervention is cost effective. This conclusion is valid for total costs, generic health care (direct) costs, disease-specific health care costs.Trial RegistrationGerman Clinical Trials Register: DRKS00004386Current Controlled Trials: ISRCTN64669297 (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 21, 2020 Category: Internal Medicine Source Type: research

Clinical Ontologies Improve Case Finding of Primary Biliary Cholangitis in UK Primary and Secondary Care
ConclusionsUtilization of the UK National RCGP RSC database supported by novel ontology score has successfully helped us identify (i) new cases of PBC not known to local/regional secondary care providers and (ii) de novo PBC cases. There are many PBC probable cases whose data merit further careful evaluation. (Source: Digestive Diseases and Sciences)
Source: Digestive Diseases and Sciences - January 17, 2020 Category: Gastroenterology Source Type: research

Beyond BMI: a feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMRs).
CONCLUSION: Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration. PMID: 31939632 [PubMed - in process] (Source: Health Promotion and Chronic Disease Prevention in Canada)
Source: Health Promotion and Chronic Disease Prevention in Canada - January 16, 2020 Category: International Medicine & Public Health Tags: Health Promot Chronic Dis Prev Can Source Type: research

The Primary Cares Initiative: Value-Based Redesign of Primary Care
On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) rolled out the Primary Cares Initiative, a collection of voluntary payment model options in support of high value primary care.1 The first element of the initiative, Primary Care First, is to engage advanced primary care practice sites via two performance-based payment model options.1 The second element of the initiative, Direct Contracting, aims to involve larger primary care entities via three risk-assuming payment model options. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 15, 2020 Category: General Medicine Authors: Haley E. Bliss, Paul George, Eli Y. Adashi Tags: Commentary Source Type: research

Defining and measuring imaging appropriateness in low back pain studies: a scoping review
ConclusionGreater clarity is needed on how we define and measure imaging appropriateness for LBP, which also accounts for the problem of failing to image when indicated. An internationally agreed methodology for imaging appropriateness studies would ultimately lead to an improvement in the care delivered to patients.Graphic abstract These slides can be retrieved under Electronic Supplementary Material. (Source: European Spine Journal)
Source: European Spine Journal - January 14, 2020 Category: Orthopaedics Source Type: research

131. Utilization of a Ride Share Service to Improve Missed Appointment Rate in an Adolescent Clinic
Adolescent primary care practices serve populations at higher risk for health disparities. Missed appointment rates have been shown to be higher in this population and directly affect access to care and lost revenue. Transportation has been identified as a major cause of missed appointments in this population and is also recognized as a social determinant of health. Therefore, we sought to reduce the missed appointment rate in our clinic by providing a free rideshare service to our patients to improve access to care. (Source: Journal of Adolescent Health)
Source: Journal of Adolescent Health - January 11, 2020 Category: Child Development Authors: Justin Triemstra, Christina Pries, Sarah Lickiss, Adam Nicholson, Lisa Lowery Source Type: research

251. Practice-Level Barriers and Facilitators to Universal Chlamydia Screening Among Young Women in Pediatric Primary Care Clinics
Chlamydia trachomatis infection is highly prevalent among adolescents and young adults with potential for long-term health consequences, especially for young women. Despite a strong recommendation by the United States Preventive Services Task Force for routine chlamydia screening in sexually active women aged 24 years or less, screening rates remain low, particularly in pediatric primary care practices. Prior research has advanced our understanding of patient-, family- and provider-level barriers to screening young women, including inadequate assessment of patients ’ sexual history and concerns about confidentiality....
Source: Journal of Adolescent Health - January 11, 2020 Category: Child Development Authors: Amy Collins, Pamela Schoemer, Alison Culyba, Elizabeth Miller, Loreta Matheo Source Type: research

Primary Care Opioid Taper Plans Are Associated with Sustained Opioid Dose Reduction
AbstractBackgroundPrimary care providers prescribe most long-term opioid therapy and are increasingly asked to taper the opioid doses of these patients to safer levels. A recent systematic review suggests that multiple interventions may facilitate opioid taper, but many of these are not feasible within the usual primary care practice.ObjectiveTo determine if opioid taper plans documented by primary care providers in the electronic health record are associated with significant and sustained opioid dose reductions among patients on long-term opioid therapy.DesignA nested case-control design was used to compare cases (patient...
Source: Journal of General Internal Medicine - January 6, 2020 Category: Internal Medicine Source Type: research

Physician-Nurse Practitioner Teamwork in Primary Care Practices in New York: A Cross-Sectional Survey
ConclusionsThis study produced evidence about NP-physician teamwork in primary care practices. We found the vast majority of NPs and physicians reported favorable teamwork, and that teamwork affects clinician job satisfaction and intent to leave as well as perceived quality of care in their practices. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - January 6, 2020 Category: Internal Medicine Source Type: research

Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index
ConclusionsChildren's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management. (Source: Academic Pediatrics)
Source: Academic Pediatrics - January 3, 2020 Category: Pediatrics Source Type: research

The Effect of Hypertension Duration and the Age of Onset on CV Risk Factors Expression in Perimenopausal Women.
Conclusion: Hypertension onset at the time around menopause appears together with abdominal obesity and may be a driving force for CV risk factor accumulation in postmenopausal women. PMID: 31885899 [PubMed] (Source: International Journal of Hypertension)
Source: International Journal of Hypertension - January 1, 2020 Category: Cardiology Tags: Int J Hypertens Source Type: research

A Blueprint for Planning and Implementing a Transgender Health Program.
This article presents a blueprint for planning and implementing a transgender health program within a primary care practice in order to enhance the capacity of the health care system to meet the medical and mental health needs of this underserved population. The steps described, with emphasis on elements specific to transgender care, include conducting a community needs assessment, gaining commitment from leadership and staff, choosing a service model and treatment protocols, defining staff roles, and creating a welcoming environment. PMID: 31937536 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - January 1, 2020 Category: Primary Care Authors: Morenz AM, Goldhammer H, Lambert CA, Hopwood R, Keuroghlian AS Tags: Ann Fam Med Source Type: research

Differences in Diabetes Care With and Without Certification as a Medical Home.
Abstract PURPOSE: The purpose of this study was to assess whether primary care practices certified as medical homes differ in having the practice systems required for that designation and in attaining favorable outcomes for their patients with diabetes, and whether those systems are associated with better diabetes outcomes. METHODS: We undertook a cross-sectional observational study, Understanding Infrastructure Transformation Effects on Diabetes (UNITED), of 586 Minnesota adult primary care practices, comparing those that were certified vs uncertified as medical homes in 2017, with analyses supplemented by p...
Source: Annals of Family Medicine - January 1, 2020 Category: Primary Care Authors: Solberg LI, Carlin C, Peterson KA, Eder M Tags: Ann Fam Med Source Type: research

Comparison of Primary Care Experience in Hospital-Based Practices and Community-Based Office Practices in Japan.
CONCLUSIONS: Our study elucidates differences in the strengths and challenges of primary care between hospital-based practices and community-based office practices, with a focus on patient centeredness. Improving community orientation in hospital-based practices and improving accessibility, including out-of-hours care, in community-based office practices may enhance the quality of primary care and promote standardization of care across settings. PMID: 31937529 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - January 1, 2020 Category: Primary Care Authors: Aoki T, Yamamoto Y, Fukuhara S Tags: Ann Fam Med Source Type: research

How Radiology Maintains Relative Value Units But Could Lose Big in Reimbursement: The Power of the Conversion  Factor
Within health care reform, it is widely accepted that primary care practice transformation and delivery are essential  to achieving the nation’s quadruple aim—improving patient and provider experience and the health of the population while decreasing cost. Although accountable care organizations and alternative payment models have been lauded as the summit of this proverbial value escalator [1], much of our cu rrent health care system can be found at lower levels on the ascent [2]. For those who are not there yet, how does CMS adjust how primary care services are paid in a fee-for-service environment ...
Source: Journal of the American College of Radiology : JACR - December 31, 2019 Category: Radiology Authors: Lauren Parks Golding, Andrew B. Rosenkrantz, Gregory N. Nicola, Kurt A. Schoppe, Joshua A. Hirsch Tags: Opinion Source Type: research

Using the Consolidated Framework for Implementation Research (CFIR) to evaluate implementation effectiveness of a facilitated approach to an asthma shared decision making intervention.
Conclusions: The CFIR was used to evaluate the asthma SDM intervention implementation at 10 facilitator-led practices. While there was no significant correlation between higher implementation effectiveness and greater improvement in clinical outcomes, practices with a higher proportion of pediatric patients did experience a significant reduction in overall exacerbations post-implementation. PMID: 31868043 [PubMed - as supplied by publisher] (Source: Journal of Asthma)
Source: Journal of Asthma - December 25, 2019 Category: Respiratory Medicine Tags: J Asthma Source Type: research

A multicomponent intervention to improve adherence to opioid prescribing and monitoring guidelines in primary care.
Authors: Huang KTL, Blazey-Martin D, Chandler D, Wurcel A, Gillis J, Tishler J Abstract OBJECTIVE: Guidelines for appropriate management of chronic opioid therapy are underutilized by primary care physicians (PCPs). The authors hypothesized that developing a multicomponent, team-based opioid management system with electronic health record (EHR) support would allow our clinicians to improve adherence to chronic opioid prescribing and monitoring guidelines. DESIGN: This was a retrospective pre-post study. SETTING: The authors performed this intervention at our large, urban, academic primary care practice. ...
Source: Journal of Opioid Management - December 19, 2019 Category: Addiction Tags: J Opioid Manag Source Type: research

Treatment of Cystitis by Hungarian General Practitioners: A Prospective Observational Study
Conclusions: Many aspects of suboptimal cystitis management were identified (e.g. unnecessarily broad spectra agents, too long antibiotic courses). In this study, patient characteristics has weakly influenced fluoroquinolone prescribing. Based on these results there is considerable room for improvement in primary care antibiotic therapy of cystitis in Hungary. (Source: Frontiers in Pharmacology)
Source: Frontiers in Pharmacology - December 19, 2019 Category: Drugs & Pharmacology Source Type: research

Physician and nurse practitioner perceptions of social worker and community health worker roles in primary care practices caring for frail elders: Insights for social work
. (Source: Social Work in Health Care)
Source: Social Work in Health Care - December 17, 2019 Category: International Medicine & Public Health Authors: Julie Berrett-Abebe Karen Donelan Barbara Berkman David Auerbach Peter Maramaldi Source Type: research

Integrating Community Health Workers into Safety-Net Primary Care for Diabetes Prevention: Qualitative Analysis of Clinicians ’ Perspectives
ConclusionsClinicians found CHWs appropriate for diabetes prevention in safety-net settings. However, disseminating high-quality evidence about CHWs ’ effectiveness and operations is needed to overcome concerns about integrating CHWs in primary care. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - December 17, 2019 Category: Internal Medicine Source Type: research

Threats to safe transitions from hospital to home: a consensus study in North West London primary care.
CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise. PMID: 31848201 [PubMed - as supplied by publisher] (Source: The British Journal of General Practice)
Source: The British Journal of General Practice - December 17, 2019 Category: Primary Care Authors: Markiewicz O, Lavelle M, Lorencatto F, Judah G, Ashrafian H, Darzi A Tags: Br J Gen Pract Source Type: research

Is delayed cardioversion the better approach in recent-onset atrial fibrillation? Yes
AbstractAtrial fibrillation is the most common sustained arrhythmia encountered in primary care practice and represents a significant burden on the health care system with a higher than expected hospitalization rate from the emergency department. The first goal of therapy is to assess the patient ’s symptoms and hemodynamic status. There are multiple acute management strategies for atrial fibrillation including heart rate control, immediate direct-current cardioversion, or pharmacologic cardioversion. Given the variety of approaches to acute atrial fibrillation, it is often difficult to co nsistently provide cost-eff...
Source: Internal and Emergency Medicine - December 13, 2019 Category: Emergency Medicine Source Type: research

Lung Screen Uptake Trial (LSUT): Randomised Controlled Trial Testing Targeted Invitation Materials.
Abstract RATIONALE: Low uptake of low-dose CT (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity. OBJECTIVES: To compare the effect of a 'targeted, low burden and stepped' invitation strategy versus control, on uptake of hospital-based 'Lung Health Check' appointments offering (LDCT) screening. METHODS: A two-arm, blinded, between-subjects, randomised controlled trial. 2012 participants were selected from 16 primary care practices using these criteria: i) aged 60-75, ii) recorded as a current smoker within the last seven yea...
Source: American Journal of Respiratory and Critical Care Medicine - December 11, 2019 Category: Respiratory Medicine Authors: Quaife SL, Ruparel M, Dickson JL, Beeken RJ, McEwen A, Baldwin DR, Bhowmik A, Navani N, Sennett K, Duffy SW, Waller J, Janes SM Tags: Am J Respir Crit Care Med Source Type: research

Translating CKD Research into Primary Care Practice: a Group-Randomized Study
AbstractBackgroundChronic kidney disease (CKD) is common in the primary care setting. Early interventions may prevent progression of renal disease and reduce risk for cardiovascular complications, yet quality gaps have been documented. Successful approaches to improve identification and management of CKD in primary care are needed.ObjectiveTo assess whether implementation of a primary care improvement model results in improved identification and management of CKDDesign18-month group-randomized studyParticipants21 primary care practices in 13 US states caring for 107,094 patientsInterventionsTo promote implementation of CKD...
Source: Journal of General Internal Medicine - December 10, 2019 Category: Internal Medicine Source Type: research