Integrating Personalized Care Planning into Primary Care: a Multiple-Case Study of Early Adopting Patient-Centered Medical Homes
ConclusionsPersonalized care planning is a novel patient-centered practice, but complicated to implement. We found variation in effective implementation and identified critical components to structuring this practice in a manner that engages patients in treatment aligned with personal priorities. Primary care practices seeking to implement personalized care planning must go beyond simply asking patients a series of questions to establish a plan. They must also engage team members in plan development, communication, and dissemination. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - October 24, 2019 Category: Internal Medicine Source Type: research

Patient Activation as a Pathway to Shared Decision-making for Adults with Diabetes or Cardiovascular Disease
AbstractBackgroundShared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed.ObjectiveWe examine the temporal association of patient activation and patients ’ experience with the SDM process to assess the dominant directionality of this relationship.DesignPatient activation, or a patients ’ knowledge, skills, and confidence in self-management, was assessed using the 13-item Patient Activation Measure (PAM). Patient-reported assessment of the SDM process was assessed using th...
Source: Journal of General Internal Medicine - October 23, 2019 Category: Internal Medicine Source Type: research

Genetic counseling perspective of engagement with urology and primary care.
Authors: Hyatt C, Russo J, McDougall C Abstract Germline genetic testing for prostate cancer is helping to inform risk stratification and staging of prostate cancer and also screening for men with family history of prostate cancer. Genetic counseling is an important piece of germline genetic testing; however there can be limitations of access to genetic counselors and other genetic professionals. It is important to integrate genetic counseling with urology and primary care practices. PMID: 31629434 [PubMed - in process] (Source: Canadian Journal of Urology)
Source: Canadian Journal of Urology - October 21, 2019 Category: Urology & Nephrology Tags: Can J Urol Source Type: research

Prescribing Technology to Increase Uptake of Depression Treatment in Primary Care: A Pre-implementation Focus Group Study of SOVA (Supporting Our Valued Adolescents)
AbstractSupporting Our Valued Adolescents (SOVA) is a web-based technology intervention designed to increase depression and anxiety treatment uptake by adolescents in the context of an anonymous peer community with an accompanying website for parents. With a goal of informing the design of a hybrid effectiveness-implementation randomized controlled trial, we conducted a pre-implementation study in two primary care practices to guide implementation strategy development. We conducted focus groups with primary care providers (PCPs) at three different timepoints with PCPs (14 total) from two community practices. A baseline sur...
Source: Journal of Clinical Psychology in Medical Settings - October 19, 2019 Category: Psychiatry & Psychology Source Type: research

Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study
Conclusions and RelevancePhysicians report that nonclinical factors frequently influence their decision to prescribe antibiotics for URTI. Physician concerns regarding antibiotic side effects and patient satisfaction are important factors in the decision-making process. Changes in the health system addressing both physicians and patients may be necessary to attain desired prescribing levels. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - October 19, 2019 Category: Internal Medicine Source Type: research

Use of Medicare Data to Identify Team-based Primary Care: Is it Possible?
Conclusions: Medicare data can be used to identify shared care with low sensitivity and high PPV. Community discovery from Medicare data provided good agreement in identifying members of practices. Adapting network analyses in different contexts needs more validation studies. (Source: Medical Care)
Source: Medical Care - October 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Primary Care: the New Frontier for Reducing Readmissions
AbstractTo date, efforts to reduce hospital readmissions have centered largely on hospitals. In a recently published environmental scan, we examined the literature focusing on primary care –based efforts to reduce readmissions. While rigorous studies on interventions arising from primary care are limited, we found that multi-component care transitions programs that are initiated early in the hospitalization and are part of broader primary care practice transformation appear most pro mising. However, policy changes are necessary to spur innovation and support effective primary care–led transitions interventions....
Source: Journal of General Internal Medicine - October 16, 2019 Category: Internal Medicine Source Type: research

Reducing Healthcare Costs for Mental Health Hospitalizations With the Evidence-based COPE Program for Child and Adolescent Depression and Anxiety: A Cost Analysis
Although depression and anxiety affect approximately 20% of children and adolescents, many of those affected do not receive treatment because, in large part to the shortage of mental health providers across the United States. As an alternative to traditional mental health counseling, the Creating Opportunities for Personal Empowerment (COPE) program is an evidence-based manualized 7-session cognitive behavioral therapy –based program that is being effectively delivered to children and teens with depression and anxiety by pediatric and family healthcare providers in primary care practices with reimbursement from insur...
Source: Journal of Pediatric Health Care - October 12, 2019 Category: Pediatrics Authors: Bernadette Mazurek Melnyk Tags: Article Source Type: research

The complementary nature of query-based and directed health information exchange in primary care practice
ConclusionsQuantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings. (Source: Journal of the American Medical Informatics Association)
Source: Journal of the American Medical Informatics Association - October 8, 2019 Category: Information Technology Source Type: research

Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis
by Martin B. Whyte, William Hinton, Andrew McGovern, Jeremy van Vlymen, Filipa Ferreira, Silvio Calderara, Julie Mount, Neil Munro, Simon de Lusignan BackgroundDisparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people with T2D. Methods and findingsA T2D cohort was identified from the Royal College of General Practitioners Research and Surveillance ...
Source: PLoS Medicine - October 7, 2019 Category: Internal Medicine Authors: Martin B. Whyte Source Type: research

Measuring attributes of team functioning in primary care settings: development of the TEAMS tool.
This study examines attributes of a high-functioning primary care team by creating a survey measuring staff perceptions of team culture in primary care practices with innovative team-based workforce models. Survey data from a national study of 30 exemplar primary care practices with innovative team-based workforce models was used. Staff and clinicians (n = 943) at the 30 primary care sites completed a 31-item survey online. Survey items came from previous surveys of adaptive reserve and team culture. Factor analysis, reliability and validity were examined for the survey. Case summaries from site visits and survey...
Source: Journal of Interprofessional Care - October 3, 2019 Category: Health Management Tags: J Interprof Care Source Type: research

Quality Improvement Principles and Practice
This article outlines some key principles for how to implement quality improvement effectively in primary care practice, drawing from the authors ’ collective experience in leading such efforts. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - October 3, 2019 Category: Primary Care Authors: Shana Ratner, Michael Pignone Source Type: research

1.67 implementing suicide risk screening in pediatric primary care: from research to practice
Approximately 70 percent of US adolescents who died by suicide visited a primary care provider (PCP) in the year before their deaths (45% within weeks). However, very few PCPs screen for suicide risk. Concerns about disrupting office workflow and managing the patients who screen positive, prevent the integration of screening into routine care. The aim of this Quality Improvement Project is to describe a real-world implementation of suicide-risk screening in a pediatric primary care practice, with additional aims to assess the feasibility and acceptability of screening. (Source: Journal of the American Academy of Child and ...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Mary V. Tipton, Ted Abernathy, Elizabeth C. Lanzillo, Daniel Powell, Deborah Snyder, Jeff Bridge, Michael Schoenbaum, Maryland Pao, Lisa M. Horowitz Source Type: research

37.1 making family-driven collaborative practice work in primary care: challenges and rewards
This presentation will introduce integrated care within multiple busy pediatric primary care practices serving high-need youth. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Gregory N. Hagan Tags: Clinical Perspectives 37 Source Type: research

23.4 a registered nurse-centered collaborative care model for adolescents with depression in primary care achieves the “quadruple aim”
We describe a collaborative care intervention for adolescent depression embedded in a busy primary care practice. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Sandra Rackley Tags: Clinical Perspectives 23 Source Type: research

Updated concepts in the diagnosis and management of community-acquired pneumonia
This article reviews recent updates in best practices for diagnosing and managing pneumonia in the ED or primary care practice. Despite developments in the diagnosis of pneumonia, vital signs and chest examination findings can and should guide clinical management. Chest radiography is routinely used to diagnose pneumonia. However, a negative chest radiograph should not replace clinical impression. In immunocompetent patients with community-acquired pneumonia, the CURB-65 decision rule has a role in identifying high-risk patients, including those who will require ICU admission and a critical care intervention. (Source: Jour...
Source: Journal of the American Academy of Physician Assistants - September 27, 2019 Category: Primary Care Tags: CME: Pulmonology Source Type: research

Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study
Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The... (Source: BMC Family Practice)
Source: BMC Family Practice - September 14, 2019 Category: Primary Care Authors: Cesar I. Fernandez-Lazaro, Juan M. Garc ía-González, David P. Adams, Diego Fernandez-Lazaro, Juan Mielgo-Ayuso, Alberto Caballero-Garcia, Francisca Moreno Racionero, Alfredo Córdova and Jose A. Miron-Canelo Tags: Research article Source Type: research

Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices
ConclusionsIn primary care, appointment time of day is associated with patient-reported experience. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 13, 2019 Category: Internal Medicine Source Type: research

A Qualitative Analysis of Implementing EvidenceNOW to Improve Cardiovascular Care
Conclusions: Study findings provide insights for future dissemination research and implementation of evidence-based practices in primary care. Challenges experienced in project development can result in a domino effect that could change the project timeline, type of practices recruited for study participation, resource allocation, and planned activities for quality improvement. Effectiveness of external quality improvement support may depend on practice engagement, preexisting organizational structures and processes, availability of resources, and length and continuity of practice facilitation. (Source: Journal of the Amer...
Source: Journal of the American Board of Family Medicine - September 10, 2019 Category: Primary Care Authors: Goetz Goldberg, D., Haghighat, S., Kavalloor, S., Nichols, L. M. Tags: Original Research Source Type: research

Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis.
CONCLUSION: Following devolution, primary care practices in Greater Manchester are still reliant on funding from national funding schemes, which poorly reflect its deprivation. The devolved administration's ability to address health inequities at the primary care level seems uncertain. PMID: 31501163 [PubMed - as supplied by publisher] (Source: The British Journal of General Practice)
Source: The British Journal of General Practice - September 9, 2019 Category: Primary Care Authors: Lee JA, Meacock R, Kontopantelis E, Matheson J, Gittins M Tags: Br J Gen Pract Source Type: research

Depression, anxiety and acute pain: links and management challenges.
Authors: Michaelides A, Zis P Abstract Pain is a subjective experience that is influenced by genetics, gender, social, cultural and personal parameters. Opposed to chronic pain, which by definition has to last for at least 3 months, acute pain is mostly because of trauma, acute medical conditions or treatment. The link between mood disorders and acute pain has proven to be increasingly significant since the link is bi-directional, and both act as risk factors for each other. Depression and anxiety are associated with increased perception of pain severity, whereas prolonged duration of acute pain leads to increased ...
Source: Postgraduate Medicine - September 6, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Primary Care –Based Staff Ideas for Implementing a Mammography Decision Aid for Women 75+: a Qualitative Study
ConclusionsParticipants felt that as long as use of the mammography DA for women ≥ 75 years was supported by clinicians, it would be feasible to implement with minimal refinements to existing healthcare system processes. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - September 4, 2019 Category: Internal Medicine Source Type: research

Transitions, Suicidality, and Underappreciated Autism Spectrum Disorder in a High School Student
CASE: Alex is a 14-year-old Portuguese-American boy with a psychiatric history starting at age 5 who presents to your primary care practice after an insurance change. He was delivered prematurely at 32 weeks and diagnosed with congenital hypothyroidism at the age of 6 weeks and growth hormone deficiency at the age of 2 years; he is in active treatment for both. He otherwise met developmental milestones on time yet continues to have significant fatigue despite adequate sleep and vitamin D supplementation. His family history is remarkable for maternal anxiety, depression, suicidal thoughts, and previous attempted suicide...
Source: Journal of Developmental and Behavioral Pediatrics - September 1, 2019 Category: Child Development Tags: Challenging Case Source Type: research

Primary Care Occupational Therapy: How Can We Get There? Remaining Challenges in Patient-Centered Medical Homes.
Abstract Passage of the Patient Protection and Affordable Care Act in 2010 mandated reform of the United States' existing primary care system. As part of this reform, advanced practice models, including the Patient-Centered Medical Home model, expanded, with the goal of increasing the use of interprofessional teams. Integrating occupational therapy was promoted as an opportunity to enhance the value of care provided in these redesigned primary care practices. However, occupational therapy's presence in primary care is still extremely limited. PMID: 31484018 [PubMed - in process] (Source: The American Journal ...
Source: The American Journal of Occupational Therapy - September 1, 2019 Category: Occupational Health Authors: Pape SB, Muir S Tags: Am J Occup Ther Source Type: research

Multi-Payer Advanced Primary Care Practice Demonstration on quality of care.
CONCLUSIONS: Our analyses showed few statistically significant, favorable impacts on quality metrics among Medicare or Medicaid beneficiaries receiving care from MAPCP practices. PMID: 31518094 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Leung M, Beadles C, Romaire M, Gulledge M, MAPCP Evaluation Team Tags: Am J Manag Care Source Type: research

Prevalence and Characteristics of Asthma –Chronic Obstructive Pulmonary Disease Overlap in Routine Primary Care Practices
Annals of the American Thoracic Society,Volume 16, Issue 9, Page 1143-1150, September 2019. (Source: Annals of the American Thoracic Society)
Source: Annals of the American Thoracic Society - August 30, 2019 Category: Respiratory Medicine Authors: Jerry A. Krishnan Anjan Nibber Alison Chisholm David Price Eric D. Bateman Leif Bjermer Job F. M. van Boven Guy Brusselle Richard W. Costello Ronald J. Dandurand Zuzana Diamant Eric Van Ganse Caroline Gouder Sanne C. van Kampen Alan Kaplan Janwillem Kocks Source Type: research

Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial
Publication date: Available online 23 August 2019Source: The LancetAuthor(s): Jo Hardy, Christina Baggott, James Fingleton, Helen K Reddel, Robert J Hancox, Matire Harwood, Andrew Corin, Jenny Sparks, Daniela Hall, Doñah Sabbagh, Saras Mane, Alexandra Vohlidkova, John Martindale, Mathew Williams, Philippa Shirtcliffe, Mark Holliday, Mark Weatherall, Richard Beasley, Andrew Corin, Liz DronfieldSummaryBackgroundIn adults with mild asthma, a combination of an inhaled corticosteroid with a fast-onset long-acting β-agonist (LABA) used as reliever monotherapy reduces severe exacerbations compared with short-acting &b...
Source: The Lancet - August 24, 2019 Category: General Medicine Source Type: research

The association between type 2 diabetes mellitus, hip fracture, and post-hip fracture mortality: a multi-state cohort analysis
ConclusionT2DM individuals are at increased risk of hip fracture, post-hip fracture mortality, and hip fracture –free death. After adjustment, T2DM men were at a 28% higher risk of dying after suffering a hip fracture and women had 57% excess risk of post-hip fracture mortality. (Source: Osteoporosis International)
Source: Osteoporosis International - August 23, 2019 Category: Orthopaedics Source Type: research

What Care Models Have Generalists Implemented to Address Transition from Pediatric to Adult Care?: a Qualitative Study
ConclusionsParticipants used disparate care models. Common features and strategies among interviews highlight key functions and attributes of transitional care across settings, suggest important elements of care post-transfer, and clarify the role of generalists. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 13, 2019 Category: Internal Medicine Source Type: research

Coaching Small Primary Care Practices to Use Patient Portals.
PMID: 31405883 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - August 12, 2019 Category: Primary Care Authors: Gritzer L, Davenport M, Dark M, Khanna N Tags: Ann Fam Med Source Type: research

The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies.
Abstract Passage of the Patient Protection and Affordable Care Act triggered 2 successive grant initiatives from the Agency for Healthcare Research and Quality, allowing for the evolution of health extension models among 20 states, not limited to support for in-clinic primary care practice transformation, but also including a broader concept incorporating technical assistance for practices and their communities to address social determinants of health. Five states stand out in stretching the boundaries of health extension: New Mexico, Oklahoma, Oregon, Colorado, and Washington. Their stories reveal lessons learned...
Source: Annals of Family Medicine - August 12, 2019 Category: Primary Care Authors: Kaufman A, Dickinson WP, Fagnan LJ, Duffy FD, Parchman ML, Rhyne RL Tags: Ann Fam Med Source Type: research

A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care.
CONCLUSIONS: Although we found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation. PMID: 31405875 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - August 12, 2019 Category: Primary Care Authors: Parchman ML, Anderson ML, Dorr DA, Fagnan LJ, O'Meara ES, Tuzzio L, Penfold RB, Cook AJ, Hummel J, Conway C, Cholan R, Baldwin LM Tags: Ann Fam Med Source Type: research

Clinician Perspectives on the Benefits of Practice Facilitation for Small Primary Care Practices.
CONCLUSIONS: SIP clinicians perceived practice facilitation to be an important resource for connecting their practice to the external health care environment and resources, and helping their practice build QI capacity through teaching, hands-on support, and EHR-driven solutions. PMID: 31405872 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - August 12, 2019 Category: Primary Care Authors: Rogers ES, Cuthel AM, Berry CA, Kaplan SA, Shelley DR Tags: Ann Fam Med Source Type: research

De-implementing Inhaled Corticosteroids to Improve Care and Safety in COPD Treatment: Primary Care Providers ’ Perspectives
ConclusionsInhaled corticosteroid prescribing in this patient population is partly due to primary care providers ’ lack of knowledge about the potential harms and availability of alternative therapies. Our findings suggest that efforts to expand access by increasing the number of prescribing providers a patient potentially sees could make it more difficult to de-implement harmful prescriptions. Our findings also corroborate prior findings that awareness of current evidence-based guidelines is likely an important part of medical overuse. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - August 8, 2019 Category: Internal Medicine Source Type: research

Association Between Behavioral Risk Factors And Presence Of Cardiovascular Disease In Primary Healthcare Patients In Crete, Greece.
Background and Aims: A large increase in cardiovascular disease (CVD) incidence has been recently documented in Crete, Greece. The presence of certain behavioural risk factors (BRF) may increase CVD risk. We aimed to explore associations between BRFs and CVD prevalence among adults aged 40 years or older identified in primary care practices in Crete. (Source: Atherosclerosis)
Source: Atherosclerosis - August 5, 2019 Category: Cardiology Authors: M. Anastasaki, M. Linardakis, N. Katsiki, S. Papadakis, E. Vasilaki Anastasaki, G. Duijker, D. Anyfantakis, E. Symvoulakis, C. Lionis Tags: Posters 26 - 29 May, 2019 Source Type: research

25. keystones of development online residency curriculum: weaving attachment, autonomy, and executive function into well-child visits, birth to 5.
Publication date: August 2019Source: Academic Pediatrics, Volume 19, Issue 6Author(s): Blair S. Hammond, Carrie A. Quinn, Joel Forman, Mariel Benjamin, Aliza W. PressmanBackgroundResearch has identified specific parenting behaviors that promote children's cognitive, social and emotional health. Per the AAP, pediatricians should counsel on these behaviors, but they may not do so without formal training during residency. An e-learning curriculum allows dissemination to multiple programs with little demand on faculty while providing a flexible learning experience for residents.ObjectivesTo assess the likability and efficacy o...
Source: Academic Pediatrics - August 1, 2019 Category: Pediatrics Source Type: research

Patient perceptions of treatment with medication treatment for opioid use disorder (MOUD) in the Vermont hub-and-spoke system
This report describes the qualitative component of an evaluation of the H&S system, conducted in 2016. The qualitative data collection assessed patient perspectives about the positive and negative aspects of treatment in the H & S system. The data collected included 80 responses to five open ended questions and 24 in-depth interviews. Five open-ended questions were completed with hub (n = 40) and spoke (n = 40) participants. In-depth qualitative interviews were conducted with different hub (n = 12) and spoke (n = 12) participants. Findings from both data collection approaches suggest positive percep...
Source: Preventive Medicine - July 28, 2019 Category: International Medicine & Public Health Source Type: research

Decline in primary care providers' prescribing of Schedule II opioids following the implementation of federal and state guidelines.
CONCLUSIONS: This study reports the benefit of incorporating federal and state regulations and institutional evidence-based guidelines into primary care practice to decrease the number of Schedule II opioids prescribed. Further preventive measures include selecting alternative treatments to opioids and reducing the rates of opioid nonmedical use and overdose while maintaining access to prescription opioids when indicated. PMID: 31343712 [PubMed - in process] (Source: Journal of Opioid Management)
Source: Journal of Opioid Management - July 27, 2019 Category: Addiction Tags: J Opioid Manag Source Type: research

Assessing quality improvement capacity in primary care practices
Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood p... (Source: BMC Family Practice)
Source: BMC Family Practice - July 25, 2019 Category: Primary Care Authors: Michael L. Parchman, Melissa L. Anderson, Katie Coleman, Le Ann Michaels, Linnaea Schuttner, Cullen Conway, Clarissa Hsu and Lyle J. Fagnan Tags: Research article Source Type: research

Implementing Practice Changes in Family Medicine to Enhance Care and Prevent Disease Progression
This issue epitomizes family medicine with a heavy emphasis on research to prevent illness and illness progression. Which patients will experience significant symptomatic knee osteoarthritis? Do the elderly use retail clinics, and what is the impact on care for chronic conditions? Does capitation payment enhance or decrease same-day access? How do primary care practices risk stratify to provide integrated care? Can risk screening and on-site providers enhance psychiatric care? What screening questions should we ask adolescents, to identify problematic drug use? A report on a practice intervention to improve opioid prescrib...
Source: Journal of the American Board of Family Medicine - July 12, 2019 Category: Primary Care Authors: Bowman, M. A., Seehusen, D. A., Neale, A. V. Tags: Editors ' Note Source Type: research

Primary Care Practices' Implementation of Patient-Team Partnership: Findings from EvidenceNOW Southwest
Conclusion: Practices can improve efforts to partner with patients to assess social needs, gather meaningful input on practice improvement and patient experience, and offer resource connections. Our findings supplement recent evidence that patient registries and evidence-based guidelines may effectively prevent and manage cardiovascular disease. These strategies may also promote primary care patient-team partnership. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - July 12, 2019 Category: Primary Care Authors: Hall, T. L., Knierim, K. E., Nease, D. E., Staton, E. W., Nkouaga, C., Miriam Dickinson, L., Rhyne, R. L., Perry Dickinson, W. Tags: Original Research Source Type: research

Implementing Risk Stratification in Primary Care: Challenges and Strategies
This study aims to understand key considerations practices faced and practice experiences as they began to implement RS models. Methods: We conducted semistructured interviews about experiences in RS with 34 stakeholders from 15 primary care practices in Oregon and Colorado and qualitatively analyzed the data. Results: Three decisions were important in shaping practices' experiences with RS: choosing established versus self-created algorithms or heuristics, clinical intuition, or a combination; selecting mechanisms for assigning risk scores; determining how to integrate RS approaches into care delivery. Practices using c...
Source: Journal of the American Board of Family Medicine - July 12, 2019 Category: Primary Care Authors: Wagner, J., Hall, J. D., Ross, R. L., Cameron, D., Sachdeva, B., Kansagara, D., Cohen, D. J., Dorr, D. A. Tags: Original Research Source Type: research

Excessive substance use screening to encourage behaviour change among young people in primary care: Pilot study in preparation for a randomized trial.
CONCLUSION: The study procedures proved to be feasible in primary care practices and acceptable to young people who were readily available to participate. The main challenge for the future full-sized trial will be to ensure that recruitment targets can be met. PMID: 31330465 [PubMed - as supplied by publisher] (Source: Addictive Behaviors)
Source: Addictive Behaviors - July 12, 2019 Category: Addiction Authors: Pfarrwaller E, Meynard A, Reyre A, Sommer J, Haller DM Tags: Addict Behav Source Type: research

Human Immunodeficiency Virus Preexposure Prophylaxis: A Quick Guide for Primary Care Practice
Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is when HIV-negative persons use antiretroviral medication to prevent HIV acquisition. It is up to 96% efficacious. Patients at risk for HIV warrant PrEP, and contraindications include being HIV positive and an estimated glomerular filtration rate (eGFR) (Source: The Journal for Nurse Practitioners)
Source: The Journal for Nurse Practitioners - July 8, 2019 Category: Nursing Authors: Patrick O ’Byrne Tags: Featured Article Source Type: research

Building Powerful Primary Care Teams
Primary care practices face chronic problems: their panels/calendars are full, making it difficult to add new patients; their capacity is insufficient to meet patient demand for appointments, resulting in poor access to care; and clinicians (physicians and advanced practice providers) are working too hard and spending too much time on electronic medical records and desk work, thereby creating dissatisfaction and burnout. Teams are offered as a solution to these problems. However, to add value, teams need to increase the capacity of the practice to see more patients promptly while reducing the workload and nonclinical respo...
Source: Mayo Clinic Proceedings - July 1, 2019 Category: Internal Medicine Authors: Thomas Bodenheimer Tags: Editorial Source Type: research

A pilot study on the Spanish version of the Psychosocial Adjustment to Illness Scale (PAIS ‐SR) with carers of people with Parkinson's disease
AbstractAimTo report the cross ‐cultural adaptation and pilot study of the ongoing validation of the Spanish version of the Psychosocial Adjustment to Illness Scale with carers of people with Parkinson's disease.DesignCross ‐cultural adaptation and pilot study with a cross‐sectional validation design of the Spanish version of the Psychosocial Adjustment to Illness Scale – Carers.MethodsTwenty ‐one carers of people with Parkinson's disease from a Primary Care practice in Spain were recruited and completed the PAIS‐Carers, the SF‐36 Health Survey, the Brief COPE Inventory and an assessment form. SPSS 23.0 w...
Source: Nursing Open - July 1, 2019 Category: Nursing Authors: Mari Carmen Portillo, Leire Ambrosio, Raquel Lanas Mart ín, Maria Victoria Navarta, MEugenia Ursua Sesma, Mario Riverol Fernández Tags: RESEARCH ARTICLE Source Type: research

Primary Care Appointments for Medicaid Beneficiaries With Advanced Practitioners.
Abstract Primary care access in Medicaid improved after the Patient Protection and Affordable Care Act despite millions of new beneficiaries. One possible explanation is that practices are scheduling more appointments with advanced practitioners. To test this theory, we used data from a secret shopper study in which callers simulated new Medicaid patients and requested appointments with 3,742 randomly selected primary care practices in 10 states. Conditional on scheduling an appointment, simulated patients asked whether the practitioner was a physician or advanced practitioner. From 2012 through 2016, the proporti...
Source: Annals of Family Medicine - July 1, 2019 Category: Primary Care Authors: Leszinsky L, Candon M Tags: Ann Fam Med Source Type: research

Herbal Nephropathy.
Abstract This column is supplied by Amita Jain, MD, and Juan Jose Olivero, MD. Dr. Jain completed an internal medicine residency at Houston Methodist Hospital in Houston, Texas, and recently joined a primary care practice in Delaware. She earned a Bachelor of Medicine and Surgery (MBBS) degree, with a distinction in microbiology, from Terna Medical College at the Maharashtra University of Health Sciences in Navi Mumbai, India. Before coming to Houston, Dr. Jain completed residency training in internal medicine and allied subspecialties at the Dr. Babasaheb Ambedkar Memorial Hospital in Byculla, Mumbai. Dr. Olivero...
Source: Methodist DeBakey Cardiovascular Journal - July 1, 2019 Category: Cardiology Authors: Jain A, Olivero JJ Tags: Methodist Debakey Cardiovasc J Source Type: research

What Can the Giant Do? Defining the Path to Unsupervised Primary Care Practice by Competence, Not Time
In this issue of Academic Medicine, Dewan and Norcini examine the significant variability of time-in-training between patient care “giants”—the physicians, nurse practitioners, and physician assistants who practice primary care—and they call for further studies to determine optimal training duration and eventual scope of practice. They ask, what is the minimum education and training required to practice primary care, or “how tall is the shortest giant?” In this Invited Commentary, the authors reframe the question from identifying the minimum length of training required, to identifying de...
Source: Academic Medicine - June 27, 2019 Category: Universities & Medical Training Tags: Invited Commentaries Source Type: research

One Size Does Not Fit All: Balancing Individual and System Needs in Primary Care and Beyond
In this issue, Dewan and Norcini invite readers to reconsider the basic minimum standards for independent primary care practice. Their willingness to push boundaries, question turf wars, and suggest innovative ways forward is laudable. Although their piece is timely and provocative, it does not fully consider the interplay between individual and system factors that influence people to pursue different kinds of degrees and practice in this context. In this Invited Commentary, the authors discuss imperatives that are underacknowledged by Dewan and Norcini: the importance of diversity in health system planning; status, power,...
Source: Academic Medicine - June 27, 2019 Category: Universities & Medical Training Tags: Invited Commentaries Source Type: research