Identifying frailty in primary care: A systematic review
ConclusionsThere is a lack of psychometrically sound and clinically useful frailty markers. There is a need for further research to identify highly sensitive, specific and accurate markers that are feasible to use in the context of busy primary care practice. Geriatr Gerontol Int 2017; ••: ••–••. (Source: Geriatrics and Gerontology International)
Source: Geriatrics and Gerontology International - April 12, 2017 Category: Geriatrics Authors: Linda Lee, Tejal Patel, Loretta M. Hillier, Niraj Maulkhan, Karen Slonim, Andrew Costa Tags: Review Article Source Type: research

Improving CKD Diagnosis and Blood Pressure Control in Primary Care: A Tailored Multifaceted Quality Improvement Programme
Conclusions: Participating practices identified large numbers of “missing” CKD patients with comparator data showing they outperformed non-QI practices locally and nationally over similar timeframes. Improved BP control also occurred through this intervention, but overall achievement of the tighter BP target in proteinuric patients was notably less.Nephron Extra 2017;7:18 –32 (Source: Nephron Extra)
Source: Nephron Extra - April 11, 2017 Category: Urology & Nephrology Source Type: research

Incentivised chronic disease management and the inverse equity hypothesis: findings from a longitudinal analysis of Scottish primary care practice-level data
The inverse equity hypothesis asserts that new health policies initially widen inequality, then attenuate inequalities over time. Since 2004, the UK ’s pay-for-performance scheme for chronic disease management ... (Source: BMC Medicine)
Source: BMC Medicine - April 11, 2017 Category: Internal Medicine Authors: Richard Lowrie, Alex McConnachie, Andrea E. Williamson, Evangelos Kontopantelis, Marie Forrest, Norman Lannigan, Stewart W. Mercer and Frances S. Mair Source Type: research

Primary Care Practice Location and the Provision of Low-Value Care
This study of a nationally representative sample of primary care visits assesses the association of hospital location and hospital ownership with the provision of low-value health services. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - April 10, 2017 Category: Internal Medicine Source Type: research

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine [Physician Practice]
This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians’ use of time. We used data on physicians’ time allocation patterns captured by over thirty-one million EHR transactions in the period 2011–14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Tai-Seale, M., Olson, C. W., Li, J., Chan, A. S., Morikawa, C., Durbin, M., Wang, W., Luft, H. S. Tags: Physicians, Health Information Technology Physician Practice Source Type: research

Application of Primary Care Guideline for Chronic Low Back Pain in the Emergency Department
Chronic low back pain (CLBP) is a primary care condition that overflows into the emergency department (ED). No ED-specific practice guideline exists for the management of patients with CLBP in the ED setting. Back pain is a common chief complaint, with cases of CLBP making up to 50% of the patients seen with back pain in an urban, freestanding ED affiliated with a multicampus health system in the Midwest where 25% of patients live below the poverty line and 21.8% do not have primary care. Kolcaba's Theory of Comfort guides the implementation of an evidence-based practice application project. The Guideline for the Evidence-...
Source: Advanced Emergency Nursing Journal - April 1, 2017 Category: Emergency Medicine Tags: Cases of Note Source Type: research

Extent of diagnostic agreement among medical referrals
Abstract Rationale, aims and objectivesDiagnostic uncertainty is often encountered in a medical practice. Patients with ambiguous, uncertain, and undiagnosed problems are frequently referred for second opinions. Comparing referral diagnoses to final diagnoses provides an opportunity to determine how frequently final diagnoses vary and changes the direction of medical care. MethodsA retrospective study was done at a single academic medical center using a sample of 286 patients referred by physician assistants, nurse practitioners, and physicians from primary care practices from January 1, 2009 to December 31, 2010. Patients...
Source: Journal of Evaluation in Clinical Practice - April 1, 2017 Category: Journals (General) Authors: Monica Van Such, Robert Lohr, Thomas Beckman, James M. Naessens Tags: ORIGINAL ARTICLE Source Type: research

Can scribes boost FPs' efficiency and job satisfaction?
Conclusion: In an outpatient family medicine clinic, the use of scribes substantially improved physicians' efficiency, job satisfaction, and productivity without negatively impacting the patient experience. PMID: 28375393 [PubMed - in process] (Source: The Journal of Family Practice)
Source: The Journal of Family Practice - April 1, 2017 Category: Practice Management Authors: Earls ST, Savageau JA, Begley S, Saver BG, Sullivan K, Chuman A Tags: J Fam Pract Source Type: research

Provider type and management of common visits in primary care.
CONCLUSIONS: In the multidisciplinary primary care practice of this health maintenance organization, NP/PAs attending visits for N/B pain or ARI were less likely than PCPs to order advanced diagnostic radiology imaging services, to prescribe narcotic analgesics, and/or to prescribe broad-spectrum antibiotics. PMID: 28554207 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2017 Category: Health Management Authors: Roblin DW, Liu H, Cromwell LF, Robbins M, Robinson BE, Auerbach D, Mehrotra A Tags: Am J Manag Care Source Type: research

The Relationships among Socio-Demographics, Perceived Health, and Happiness
This article explores explore the relationships among socio-demographics, perceived health, and happiness in a patient population of 221 adults recruited from 39 primary care practices in Alabama. We also explored whether the relationship between socio-demographics and happiness is mediated by perceived health. The dependent variable, happiness, was dichotomized as happy versus unhappy. Independent variables or correlates of happiness included race (Black or White), age (
Source: Applied Research in Quality of Life - March 31, 2017 Category: Global & Universal Source Type: research

Abstract 013: Using the Diabetes Collaborative Registry (DCR) to Estimate the Potential Real-world Impact of the Iris Trial on Improving Outcomes in Patients With Cerebrovascular Disease [Session Title: Poster Session I]
Background: Thiazolidinediones use has markedly decreased since concerns arose regarding the CV safety of rosiglitazone. Recently, however, the IRIS trial demonstrated that pioglitazone reduced the risk of MI and stroke in patients with recent stroke or TIA and insulin resistance but without overt type 2 diabetes (T2D). We estimated the current use and potential impact of pioglitazone in patients enrolled in the Diabetes Collaborative Registry (DCR).Methods: DCR is a US-based outpatient registry of patients with diabetes or prediabetes seen in cardiology, endocrinology, and primary care practices and currently encompasses ...
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Arnold, S. V., Inzucchi, S. E., Tang, F., McGuire, D. K., Mehta, S. N., Maddox, T. M., Goyal, A., Sperling, L. S., Einhorn, D., Wong, N. D., Kosiborod, M. Tags: Session Title: Poster Session I Source Type: research

Abstract 070: A Precision Medicine Test Influenced Costs of Care Among Patients Presenting With Stable Symptoms Suggestive of Obstructive Coronary Artery Disease: Economic Endpoint Analysis From the PRESET Registry [Session Title: Poster Session I]
Background: Because of diagnostic uncertainty, patients with symptoms suggestive of obstructive coronary artery disease (CAD) are referred at high rates to cardiologists and advanced cardiac testing. This evaluation process may also expose patients to appreciable costs and health risks. A previously validated, blood-based test incorporating age, sex and genomic expression into an algorithmic score (1-40) has shown clinical validity in assessing the likelihood of obstructive CAD (≥50% luminal diameter stenosis by quantitative coronary angiography) early in the cardiac workup. This test has also shown clinical utility in ...
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Ladapo, J., Budoff, M., Sharp, D., Azarmina, P., Huang, L., Maniet, B., Herman, L., Monane, M. Tags: Session Title: Poster Session I Source Type: research

Abstract 135: Assessing the Personalization of Glycemic Management Strategies Through the Diabetes Collaborative Registry [Session Title: Poster Session I]
We examined patient factors associated with use of these groups of meds using 4 hierarchical (for both specialty and site) modified Poisson models, adjusting for HbA1c, number of T2D meds, and insurance.Results: Overall, 157,551 patients with T2D were prescribed a med for glycemic control: metformin 75%, sulfonylurea 34%, insulin 28%, DPP-4i 18%, TZD 11%, GLP-1 RA 6.4%, SGLT2i 4.8%. After adjusting patient factors, glycemic control, and insurance status, patients with higher BMIs were more likely treated with medications prone to cause weight gain (obesity class I/II: rate ratio [RR] 1.02, 95% CI 1.00-1.03; obesity class I...
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Arnold, S. V., Inzucchi, S. E., McGuire, D. K., Tang, F., Mehta, S. N., Goyal, A., Sperling, L. S., Maddox, T. M., Einhorn, D., Wong, N. D., Hammer, N., Fenici, P., Sheehan, J. J., Kosiborod, M. Tags: Session Title: Poster Session I Source Type: research

Primary Care Practice Reengineering and Associations With Patient Portal Use, Service Utilization, and Disease Control Among Patients With Hypertension and/or Diabetes.
We describe the role of primary care reengineering in the Ochsner Health System (OHS) patient portal implementation strategy and compare subsequent trends in service utilization and disease control among portal users vs nonusers within this context. METHODS: This retrospective cohort study includes 101,019 patients with hypertension or diabetes who saw an OHS primary care provider (PCP) between 2012 and 2014. Inverse probability treatment weighting was used to reduce case-mix differences between study groups. We used generalized estimating equation modeling to compare changes in encounter rates (PCP, telephone, special...
Source: Ochsner Journal - March 25, 2017 Category: Journals (General) Tags: Ochsner J Source Type: research

Evaluating CollaboRATE in a clinical setting: analysis of mode effects on scores, response rates and costs of data collection
Background Shared decision-making (SDM) has become a policy priority, yet its implementation is not routinely assessed. To address this gap we tested the delivery of CollaboRATE, a 3-item patient reported experience measure of SDM, via multiple survey modes. Objective To assess CollaboRATE response rates and respondent characteristics across different modes of administration, impact of mode and patient characteristics on SDM performance and cost of administration per response in a real-world primary care practice. Design Observational study design, with repeated assessment of SDM performance using CollaboRATE in a primar...
Source: BMJ Open - March 24, 2017 Category: Journals (General) Authors: Barr, P. J., Forcino, R. C., Thompson, R., Ozanne, E. M., Arend, R., Castaldo, M. G., O'Malley, A. J., Elwyn, G. Tags: Open access, Health services research, Patient-centred medicine Source Type: research

Attributes of primary care in relation to polypharmacy: a multicenter cross-sectional study in Japan
ConclusionsWe found that a higher level of community-oriented primary care is associated with a lower prevalence of polypharmacy in outpatients at the clinic level. These findings may be useful in developing community-based interventions to minimize polypharmacy. (Source: International Journal for Quality in Health Care)
Source: International Journal for Quality in Health Care - March 22, 2017 Category: International Medicine & Public Health Source Type: research

Oral squamous cell carcinoma: Focusing on interprofessional collaboration
This article reviews oral squamous cell carcinoma relevant to primary care practice focusing on an interprofessional approach to care. (Source: The Nurse Practitioner)
Source: The Nurse Practitioner - March 18, 2017 Category: Nursing Tags: Feature: CANCER: DNP SPECIAL ISSUE Source Type: research

Addressing the crisis of GP recruitment and retention: a systematic review.
CONCLUSION: Although the published evidence relating to GP recruitment and retention is limited, and most focused on attracting GPs to rural areas, the authors found that there are clear overlaps between strategies to increase recruitment and retention. Indeed, the most influential factors are idiosyncratic and intrinsic to the individuals. PMID: 28289014 [PubMed - as supplied by publisher] (Source: The British Journal of General Practice)
Source: The British Journal of General Practice - March 13, 2017 Category: Primary Care Authors: Marchand C, Peckham S Tags: Br J Gen Pract Source Type: research

Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study.
CONCLUSION: The number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed. PMID: 28289013 [PubMed - as supplied by publisher] (Source: The British Journal of General Practice)
Source: The British Journal of General Practice - March 13, 2017 Category: Primary Care Authors: Diwakar L, Cummins C, Ryan R, Marshall T, Roberts T Tags: Br J Gen Pract Source Type: research

Opportunities for clinical research in primary-care practice
A HIGH proportion of published veterinary clinical research involves patients evaluated at specialist, multidiscipline university hospitals, in part because veterinarians in academia often have the time, expertise and support to engage in research involving their patients. In contrast, the commercial reality of private primary-care practice can limit opportunities for many practitioners to undertake clinical research. While specialist-led, university hospital-based clinical research has an advanced understanding of many diseases, this approach is not without its limitations. Clinicians in universities engaged in specialist...
Source: Veterinary Record - March 10, 2017 Category: Veterinary Research Authors: Mellanby, R. J. Tags: Research Source Type: research

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing
Conclusions Variation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the trial. Practices organised their delivery of changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation. Trial registration number NCT01425502. (Source: BMJ Open)
Source: BMJ Open - March 10, 2017 Category: Journals (General) Authors: Grant, A., Dreischulte, T., Guthrie, B. Tags: Open access, Evidence based practice, General practice / Family practice, Health informatics, Health services research, Qualitative research Source Type: research

Outcomes for High-Needs Patients: Practices with a Higher Proportion of These Patients Have an Edge
Patients with high health care needs enrolled in Michigan primary care practices that treat a large proportion of such patients had lower health care costs, fewer hospital admissions, and fewer emergency department visits than those enrolled in practices serving smaller proportions of these patients.         (Source: The Commonwealth Fund: Publications)
Source: The Commonwealth Fund: Publications - March 9, 2017 Category: Global & Universal Source Type: research

Clinical characteristics associated with diagnostic delay of pulmonary embolism in primary care: a retrospective observational study
Conclusions Diagnostic delay of more than 7 days in the diagnosis of PE is common in primary care, especially in the elderly, and if chest symptoms, like pain on inspiration, are absent. (Source: BMJ Open)
Source: BMJ Open - March 9, 2017 Category: Journals (General) Authors: Hendriksen, J. M. T., Koster-van Ree, M., Morgenstern, M. J., Oudega, R., Schutgens, R. E. G., Moons, K. G. M., Geersing, G.-J. Tags: Open access, Cardiovascular medicine, Diagnostics, Epidemiology, General practice / Family practice Research Source Type: research

Physician and Staff Acceptance of Care Managers in Primary Care Offices
Conclusion: The MiPCT demonstration confirms that following three years of implementation, embedded care managers are acceptable to both physicians and staff within primary care practices. Importantly, embeddedness, or the amount of time care managers are located within practices, is associated with increased acceptance. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - March 8, 2017 Category: Primary Care Authors: Malouin, J. M., Malouin, R. A., Sarinopoulos, I., Beisel, M., Bechel-Marriot, D., First, A., Gamble, G. M., Tanner, C. Tags: Original Research Source Type: research

Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement
(Source: Patient Preference and Adherence)
Source: Patient Preference and Adherence - March 7, 2017 Category: Global & Universal Tags: Patient Preference and Adherence Source Type: research

A tailored programme to implement recommendations for multimorbid patients with polypharmacy in primary care practices —process evaluation of a cluster randomized trial
We developed and evaluated a tailored programme to implement three evidence-based recommendations for multimorbid patients with polypharmacy into primary care practices: structured medication counselling inclu... (Source: Implementation Science)
Source: Implementation Science - March 6, 2017 Category: Health Management Authors: Cornelia J äger, Jost Steinhäuser, Tobias Freund, Sarah Kuse, Joachim Szecsenyi and Michel Wensing Source Type: research

Outcomes For High-Needs Patients: Practices With A Higher Proportion Of These Patients Have An Edge [Commercial Insurer Innovation]
We examined two scale-related characteristics that could predict how well physician practices delivered care to this population: the proportion of patients in the practice that were high-needs and practice size (number of physicians). Using four years of data on commercially insured, high-needs patients in Michigan primary care practices, we found lower spending and utilization among practices with a higher proportion of high-needs patients (more than 10 percent of the practice’s panel) compared to practices with smaller proportions. Small practices (those with one or two physicians) had lower overall spending, ...
Source: Health Affairs - March 6, 2017 Category: Global & Universal Authors: Cross, D. A., Cohen, G. R., Lemak, C. H., Adler-Milstein, J. Tags: Commercial Insurer Innovation Source Type: research

Evaluating a Residency Program Using Reflections of Recent Resident Graduates and their Pediatric Colleagues.
CONCLUSIONS: The ACGME Outcomes Project, which increases the emphasis on educational outcomes in the accreditation of residency education programs, requires programs to provide evidence of its effectiveness in preparing residents for practice. Direct assessment of the competency of our physician graduates in practice using structured interviews of graduates and their practice associates provide useful feedback information to a residency program as part of a comprehensive evaluation plan of our program's curriculum and can be used to direct future educational initiatives of our training program. PMID: 28253154 [PubMed] ...
Source: Medical Education Online - March 4, 2017 Category: Universities & Medical Training Tags: Med Educ Online Source Type: research

Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home
This study explores the implementation experience of nine primary care practices becoming patient-centered medical homes (PCMH) as part of the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot. Purpose: The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the PCMH model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. Methodology/Approach: Eighty-three interviews were conducted with a...
Source: Health Care Management Review - March 4, 2017 Category: American Health Tags: Features Source Type: research

The Reduction in ED and Hospital Admissions in Medical Home Practices Is Specific to Primary Care –Sensitive Chronic Conditions
ObjectiveTo determine whether the Patient‐Centered Medical Home (PCMH) transformation reduces hospital and ED utilization, and whether the effect is specific to chronic conditions targeted for management by the PCMH in our setting. Data Sources and Study SettingAll patients aged 18 years and older in 2,218 primary care practices participating in a statewide PCMH incentive program sponsored by Blue Cross Blue Shield of Michigan (BCBSM) in 2009–2012. Study DesignQuantitative observational study, jointly modeling PCMH‐targeted versus other hospital admissions and ED visits on PCMH score, patient, and practice c...
Source: Health Services Research - March 2, 2017 Category: Health Management Authors: Lee A. Green, Hsiu ‐Ching Chang, Amanda R. Markovitz, Michael L. Paustian Tags: Research Article Source Type: research

Prevalence of depression, anxiety, adjustment disorders, and somatoform disorders in patients with age-related macular degeneration in Germany.
Conclusion: Overall, a significant association was found between AMD and depression, anxiety, adjustment disorders, and somatoform disorders. PMID: 28243189 [PubMed - in process] (Source: GMS German Medical Science)
Source: GMS German Medical Science - March 1, 2017 Category: Journals (General) Tags: Ger Med Sci Source Type: research

Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three ‐part framework to guide efforts to improve hypertension control
This article describes the M.A.P. checklists: a framework to help practice teams summarize best practices for providing coordinated, evidence‐based care to patients with hypertension. Consisting of three domains—Measure Accurately; Act Rapidly; and Partner With Patients, Families, and Communities—the checklists were developed by a team of clinicians, hypertension experts, and quality improvement experts through a multistep process that combined literature review, iterative feedback from a panel of internationally recognized experts, and pilot testing among a convenience sample of primary care practices in two...
Source: The Journal of Clinical Hypertension - March 1, 2017 Category: Cardiology Authors: Romsai T. Boonyasai, Michael K. Rakotz, Lisa H. Lubomski, Donna M. Daniel, Jill A. Marsteller, Kathryn S. Taylor, Lisa A. Cooper, Omar Hasan, Matthew K. Wynia Tags: ORIGINAL PAPER Source Type: research

Patient experience midway through a large primary care practice transformation initiative.
CONCLUSIONS: During the first 2 years of CPC, CPC practices showed slightly better year-to-year patient experience ratings for selected items, indicating that transformation did not negatively affect patient experience and improved some aspects slightly. Patient ratings for the 2 groups were generally comparable, and both faced substantial room for improvement. PMID: 28385024 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2017 Category: Health Management Authors: Swankoski KE, Peikes DN, Dale SB, Clusen NA, Morrison N, Holland JJ, Day TJ, Brown RS Tags: Am J Manag Care Source Type: research

Leveraging National Reports to Transform Ambulatory Care Practice.
Abstract Multiple national reports identify actionable recommendations to transform education and practice to meet the needs of health care and healthcare delivery beyond the hospital walls. The Josiah Macy Jr. Conference (2016) focused on transforming primary care and changing healthcare culture to support expansion of roles for registered nurses (RNs). Partnerships between academia and clinical practice are critical to expanding learning opportunities beyond traditional acute care settings. Development of primary care expertise in nursing faculty and adjunct faculty, in collaboration with primary care and ambula...
Source: Nursing Economic$ - March 1, 2017 Category: Nursing Authors: Jessie AT, Swan BA Tags: Nurs Econ Source Type: research

Attitudes Toward Naloxone Prescribing in Clinical Settings: A Qualitative Study of Patients Prescribed High Dose Opioids for Chronic Non-Cancer Pain
ConclusionsWhile patients recognized the utility of naloxone prescribing, we identified important barriers to patient acceptance of naloxone prescribing. To improve the naloxone prescribing acceptability in primary care practice, medical providers and health systems may need to enhance patient education, employ empowering, non-judgmental communication styles and adequately frame discussions about naloxone to address patients ’ fears. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - March 1, 2017 Category: Internal Medicine Source Type: research

Decision Support and Navigation to Increase Colorectal Cancer Screening among Hispanic Primary Care Patients
The study compared the impact of a novel decision support and navigation intervention (DSNI) to a mailed standard intervention (SI) on colorectal cancer (CRC) screening among Hispanic patients from 5 primary care practices in the Lehigh Valley Health Network (LVHN). Methods. We randomized surveyed and consented patients who were 50 to 75 years of age and were eligible for CRC screening either to an SI Group (n = 200) or a DSNI Group (n = 200). Following randomization, SI Group participants were mailed a set of standard materials (i.e., a letter from the participant's primary care practice encouraging selection and performa...
Source: Cancer Epidemiology Biomarkers and Prevention - March 1, 2017 Category: Cancer & Oncology Authors: Myers, R., Stello, B., Daskalakis, C., Sifri, R., DiCarlo, M., Johnson, M., Gonzalez, E., Hegarty, S., Rivera, A., Gordis-Molina, L., Shaak, K., Quinn, A., Careyva, B., Anderson-Ortiz, R. Tags: ASPO 41st Annual Meeting Abstracts Source Type: research

Implementing Diabetic Foot Care in the  Primary Care Setting
Patients with diabetes mellitus are at risk for foot ulcers and subsequent amputations. The outpatient diabetic population could benefit from services to prevent factors that lead to the development of foot ulcers and further complications. The purpose of this project was to evaluate the effectiveness and feasibility of implementing a foot care program in the primary care setting. An evaluation of the outcomes supported these foot care services. Future studies showing the effectiveness of foot care services in the primary care setting would further substantiate the benefits of providing diabetic foot care in primary care p...
Source: The Journal for Nurse Practitioners - March 1, 2017 Category: Nursing Authors: Tabitha Hunt Cousart, Marilyn Handley Tags: Brief Report Source Type: research

Factors determining uptake of diabetic retinopathy screening in Oxfordshire
Abstract AimsTo investigate variables at the demographic and primary care practice levels that influence the uptake of diabetic retinopathy screening. MethodsData were extracted from the management software of one screening programme for 21 797 people registered with 79 general practices. Uptake was examined by gender, age group, modality of screening (mobile unit at general practice versus high‐street optometrist), and by general practice. A telephone survey of high‐street optometrists provided information on the availability of screening appointments. ResultsUptake was 82.4% during the study period, and was high...
Source: Diabetic Medicine - March 1, 2017 Category: Endocrinology Authors: R. B. R. Moreton, I. M. Stratton, S. J. Chave, H. Lipinski, P. H. Scanlon Tags: Research Article Source Type: research

The Challenges of Measuring, Improving, and Reporting Quality in Primary Care.
Abstract We propose a new set of priorities for quality management in primary care, acknowledging that payers and regulators likely will continue to insist on reporting numerical quality metrics. Primary care practices have been described as complex adaptive systems. Traditional quality improvement processes applied to linear mechanical systems, such as isolated single-disease care, are inappropriate for nonlinear, complex adaptive systems, such as primary care, because of differences in care processes, outcome goals, and the validity of summative quality scorecards. Our priorities for primary care quality managem...
Source: Annals of Family Medicine - March 1, 2017 Category: Primary Care Authors: Young RA, Roberts RG, Holden RJ Tags: Ann Fam Med Source Type: research

Access to Primary Care Appointments Following 2014 Insurance Expansions.
CONCLUSIONS: Contrary to widespread concern, we find no evidence that the millions of individuals newly insured through the ACA decreased new-patient appointment availability across 10 states as shown by stable wait times and appointment rates for private insurance as of mid-2014. PMID: 28289108 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - March 1, 2017 Category: Primary Care Authors: Rhodes KV, Basseyn S, Friedman AB, Kenney GM, Wissoker D, Polsky D Tags: Ann Fam Med Source Type: research

Transforming Primary Care Practice and Education: Lessons From 6 Academic Learning Collaboratives
We describe a common framework that academic learning collaboratives are using to transform primary care practice based on our analysis of 6 collaboratives nationally. We show that the work of the collaboratives could be divided into 3 phases and provide detail on the phases of work and a road map for those who seek to emulate this work. We found that learning collaboratives foster transformation, even in complex academic practices, but need specific support adapted to their unique challenges. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 28, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Using self-reported data on the social determinants of health in primary care to identify cancer screening disparities: opportunities and challenges
Data on the social determinants of health can help primary care practices target improvement efforts, yet relevant data are rarely available. Our family practice located in Toronto, Ontario routinely collects ... (Source: BMC Family Practice)
Source: BMC Family Practice - February 28, 2017 Category: Primary Care Authors: A.K. Lofters, A. Schuler, M. Slater, N.N. Baxter, N. Persaud, A.D. Pinto, E. Kucharski, S. Davie, R. Nisenbaum and T. Kiran Source Type: research

Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands.
CONCLUSION: The suggestion that OOH antibiotic prescribing quality is worse than in daily practice does not seem founded. The higher OOH prescribing rates can be explained by a different population of presenting patients. The appropriateness of prescribing rather than prescribing rates, therefore, should be used to determine quality. PMID: 28232364 [PubMed - in process] (Source: The British Journal of General Practice)
Source: The British Journal of General Practice - February 28, 2017 Category: Primary Care Authors: Debets VE, Verheij TJ, van der Velden AW, SWAB’s Working Group on Surveillance of Antimicrobial Use Tags: Br J Gen Pract Source Type: research

Pediatricians ’ Comfort Level in Caring for Children with Special Health Care Needs
Conclusions Most pediatricians endorse that the medical home for CSHCN be in the primary care setting. Improving access to subspecialty care and providing resources, such as case management, to address family social complexity may raise pediatrician comfort in providing primary care to children with medical and developmental conditions. (Source: Academic Pediatrics)
Source: Academic Pediatrics - February 28, 2017 Category: Pediatrics Source Type: research

The EUROPEP questionnaire for patient's evaluation of general practice care: Bulgarian experience.
CONCLUSION: Two scales with satisfactory psychometric properties were established in the Bulgarian version of the EUROPEP-questionnaire. The study identified areas requiring improvement in general practice, such as reduction in waiting times and obtaining patient's convenience appointment. PMID: 28252877 [PubMed - in process] (Source: Croatian Medical Journal)
Source: Croatian Medical Journal - February 28, 2017 Category: Journals (General) Authors: Dimova R, Stoyanova R, Keskinova D Tags: Croat Med J Source Type: research

Changes in Primary Care Access for New Patients With Medicaid and Private Coverage
This study examines changes in appointment availability in primary care practices for new patients with Medicaid and private insurance after the implementation of major Affordable Care Act provisions. (Source: JAMA Internal Medicine)
Source: JAMA Internal Medicine - February 27, 2017 Category: Internal Medicine Source Type: research

Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations
AbstractStarfield and colleagues have suggested four overarching attributes of good primary care: “first-contact access for each need; long-term person- (not disease) focused care; comprehensive care for most health needs; and coordinated care when it must be sought elsewhere.” As this series on reinventing primary care highlights, there is a compelling need for new care delivery models that would advance these objectives. This need is particularly urgent for high-needs, high-cost (HNHC) populations. By definition, HNHC patients require extensive attention and consume a disproportionate share of resources, and ...
Source: Journal of General Internal Medicine - February 27, 2017 Category: Internal Medicine Source Type: research

Primary Care Practice Transformation and the Rise of Consumerism
AbstractAmericans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care. For each, the intersection of consumer-driven care and the goals of value-ba...
Source: Journal of General Internal Medicine - February 27, 2017 Category: Internal Medicine Source Type: research

Modifying the Primary Care Exception Rule to Require Competency-Based Assessment
Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training. However, CMS does not mandate that programs assess or attest to re...
Source: Academic Medicine - February 23, 2017 Category: Universities & Medical Training Tags: Perspectives Source Type: research

What's the Right Referral Rate? Specialty Referral Patterns and Curricula Across I3 Collaborative Primary Care Residencies.
We present data describing the referral process and specialty referral curriculum within the I3 collaborative. METHODS: Residency directors were surveyed about residency characteristics related to referrals. Specialty physician referral rates were obtained from each program and then correlated to program characteristics referral rates in four domains: presence and type of referral curriculum, process of referral review, faculty preceptor characteristics, and use of referral data for administrative processes. RESULTS: The survey response rate was 87%; 10 programs submitted complete referral data. Three programs (23%...
Source: Family Medicine - February 22, 2017 Category: Primary Care Tags: Fam Med Source Type: research