Design and rationale of a pragmatic trial integrating routine screening for atrial fibrillation at primary care visits: The VITAL-AF trial
Publication date: Available online 22 June 2019Source: American Heart JournalAuthor(s): Jeffrey M. Ashburner, Steven J. Atlas, David D. McManus, Yuchiao Chang, Ana T. Trisini Lipsanopoulos, Leila H. Borowsky, Wyliena Guan, Wei He, Patrick T. Ellinor, Daniel E. Singer, Steven A. LubitzAbstractGiven the preventable morbidity and mortality associated with atrial fibrillation (AF), increased awareness of undiagnosed AF, and advances in mobile ECG technology, there is a critical need to assess the effectiveness of using such technology to routinely screen for AF in clinical practice. VITAL-AF is a pragmatic trial that will test...
Source: American Heart Journal - June 25, 2019 Category: Cardiology Source Type: research
Local opinion leaders: effects on professional practice and healthcare outcomes.
CONCLUSIONS: Local opinion leaders alone, or in combination with other interventions, can be effective in promoting evidence-based practice, but the effectiveness varies both within and between studies.The effect on patient outcomes is uncertain. The costs and the cost-effectiveness of the intervention(s) is unknown. These results are based on heterogeneous studies differing in types of intervention, setting, and outcomes. In most studies, the role and actions of the OL were not clearly described, and we cannot, therefore, comment on strategies to enhance their effectiveness. It is also not clear whether the methods used t...
Source: Cochrane Database of Systematic Reviews - June 24, 2019 Category: General Medicine Authors: Flodgren G, O'Brien MA, Parmelli E, Grimshaw JM Tags: Cochrane Database Syst Rev Source Type: research
Pilot Randomized Trial of a Self-Help Behavioral Activation Mobile App for Utilization in Primary Care.
Abstract Mobile technologies can be leveraged to meet the need for evidence-based psychological depression treatment via primary care. The purpose of the present study was to preliminarily examine the feasibility and efficacy of a self-help brief behavioral activation mobile application (app; "Moodivate") for depressive symptoms among adults treated via primary care. Participants (N = 52) were recruited from primary care practices between January and December 2017 and were randomized 2:2:1 to receive (a) Moodivate, (b) an active control cognitive-behavioral therapy-based mobile app ("MoodKit"),...
Source: Behavior Therapy - June 20, 2019 Category: Psychiatry & Psychology Authors: Dahne J, Lejuez CW, Diaz VA, Player MS, Kustanowitz J, Felton JW, Carpenter MJ Tags: Behav Ther Source Type: research
Transgender Adolescents' Experiences in Primary Care: A Qualitative Study
The objective of this study was to learn about the experiences in primary care of transgender and gender nonconforming (TGN) adolescents and their recommendations for primary care practices and clinicians. (Source: Journal of Adolescent Health)
Source: Journal of Adolescent Health - June 18, 2019 Category: Child Development Authors: Carly E. Guss, G. Alice Woolverton, Joshua Borus, S. Bryn Austin, Sari L. Reisner, Sabra L. Katz-Wise Tags: Original article Source Type: research
Saving bones without risking brain —bisphosphonates and risk of stroke: matched case-control study
ConclusionsWe found no association between bisphosphonate treatment and risk of stroke, after adjusting for other confounders. (Source: Osteoporosis International)
Source: Osteoporosis International - June 17, 2019 Category: Orthopaedics Source Type: research
Pharmacogenetic testing in primary care practice: opinions of physicians, pharmacists and patients
Pharmacogenomics,Volume 20, Issue 8, Page 589-598, June 2019. (Source: Future Medicine: Pharmacogenomics)
Source: Future Medicine: Pharmacogenomics - June 13, 2019 Category: Genetics & Stem Cells Authors: Marie-Pier Frigon Marie- Ève Blackburn Cam élia Dubois-Bouchard Ann-Lorie Gagnon Suzie Tardif Karine Tremblay Source Type: research
Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network
AbstractBackgroundPopulation-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters.ObjectiveTo determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters.Design3-arm pragmatic randomized controlled trial.ParticipantsCurrent smokers ≥ 18 years old with a primary care provider at one of five community health centers in Massachusetts were identified via the electronic health record (n = 5225) and recruited using automated phone calls.InterventionsOne int...
Source: Journal of General Internal Medicine - June 13, 2019 Category: Internal Medicine Source Type: research
[Panic disorder and agoraphobia in general practice: Advantages and pitfalls of a practice team-supported exposure training from the general practitioner's perspective - a qualitative study].
CONCLUSION: From the GP perspective, the treatment program for patients with panic disorder and/or agoraphobia seems to be a viable therapeutic option in primary care. PMID: 31176641 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen)
Source: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen - June 11, 2019 Category: Health Management Tags: Z Evid Fortbild Qual Gesundhwes Source Type: research
Variation in Physicians ’ Electronic Health Record Documentation and Potential Patient Harm from That Variation
AbstractBackgroundPhysician-to-physician variation in electronic health record (EHR) documentation not driven by patients ’ clinical status could be harmful.ObjectiveMeasure variation in completion of common clinical documentation domains. Identify perceived causes and effects of variation and strategies to mitigate negative effects.DesignSequential, explanatory, mixed methods using log data from a commercial EHR vendor and semi-structured interviews with outpatient primary care practices.ParticipantsQuantitative: 170,332 encounters led by 809 physicians in 237 practices. Qualitative: 40 interviewees in 10 practices....
Source: Journal of General Internal Medicine - June 10, 2019 Category: Internal Medicine Source Type: research
Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada
Elders living with polypharmacy may be taking medications that do not benefit them. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high care costs, and persistently... (Source: Implementation Science)
Source: Implementation Science - June 6, 2019 Category: Health Management Authors: M. Greiver, S. Dahrouge, P. O ’Brien, D. Manca, M. T. Lussier, J. Wang, F. Burge, M. Grandy, A. Singer, M. Twohig, R. Moineddin, S. Kalia, B. Aliarzadeh, N. Ivers, S. Garies, J. P. Turner & hellip; Tags: Study protocol Source Type: research
Characteristics of High-Performing Primary Care Pediatric Practices: A Qualitative Study
ConclusionsThis study suggested that elements of organizational culture may play as important a role in the quality of care delivered as specific quality improvement strategies. Interventions to further test this relationship may aid practices seeking to improve the care they deliver. (Source: Academic Pediatrics)
Source: Academic Pediatrics - June 4, 2019 Category: Pediatrics Source Type: research
Screening for reducing morbidity and mortality in malignant melanoma.
CONCLUSIONS: Adult general population screening for malignant melanoma is not supported or refuted by current evidence from RCTs. This review did not investigate the effects of screening people with a history of malignant melanoma or in people with a genetic disposition for malignant melanoma (e.g. familial atypical mole and melanoma syndrome). To determine the benefits and harms of screening for malignant melanoma, a rigorously conducted randomised trial is needed, which assesses overall mortality, overdiagnosis, psychosocial consequences, and resource use. PMID: 31157404 [PubMed - as supplied by publisher] (Source: ...
Source: Cochrane Database of Systematic Reviews - June 3, 2019 Category: General Medicine Authors: Johansson M, Brodersen J, Gøtzsche PC, Jørgensen KJ Tags: Cochrane Database Syst Rev Source Type: research
Quality of warfarin management in primary care: Determining the stability of international normalized ratios using a nationally representative prospective cohort.
CONCLUSION: Primary care warfarin management produces a TTR comparable to that in randomized trials, with out-of-range INR values 3 times more likely to predispose to thrombosis (INR of 3.5). A history of good INR control does predict future INR stability and meaningfully informs decisions to switch established warfarin users onto newer agents. PMID: 31189630 [PubMed - in process] (Source: Canadian Family Physician Medecin de Famille Canadien)
Source: Canadian Family Physician Medecin de Famille Canadien - June 1, 2019 Category: Primary Care Authors: Liu S, Singer A, McAlister FA, Peeler W, Heran BS, Drummond N, Manca DP, Allan GM, Korownyk C, Kolber MR, Greiver M, Garrison SR Tags: Can Fam Physician Source Type: research
Patient satisfaction and treatment outcomes of primary care practice in Ghana.
Authors: Ofei-Dodoo S Abstract Background: General evidence suggests a strong association between patient satisfaction and treatment outcomes, but data specific to the general Ghanaian population is lacking. Purpose: To use nationally representative data to examine the effects of primary care practices on patient satisfaction and how satisfaction influences treatment outcomes. Methods: The study utilized WAVE 1 data from a nationally representative survey (n = 2,967) of patients who received outpatient medical care in Ghana. The data were collected by the World Health Organization between 2007 and 2010 and ...
Source: Ghana Medical Journal - May 31, 2019 Category: African Health Tags: Ghana Med J Source Type: research
Effects of a Behavioral Health and Chronic Illness Care Intervention on Patient Outcomes in Primary Care Practices in the Dakotas.
Abstract From 2012 to 2015, Sanford Health, a large health care system, integrated behavioral health services and chronic condition care management in some of its primary care practices in the Dakotas and rural Minnesota. Using difference-in-differences analyses for fee-for-service Medicare beneficiaries attributed to 22 participating practices and 91 matched comparison practices, we found that the program increased the receipt of four recommended diabetes care processes by 8.6% (p=.048) and, by slowing the increase in emergency department (ED) visits, reduced them by 4.9% (p=.07) relative to the comparison group....
Source: Journal of Health Care for the Poor and Underserved - May 30, 2019 Category: International Medicine & Public Health Authors: Zurovac J, Peterson GG, Stewart KA, Kranker K, Wells K, Gilman B, Blue L, Day T, Hoag S, Moreno L Tags: J Health Care Poor Underserved Source Type: research
Primary Care in Cuba: Considerations for the U.S.
Abstract In 2017, we traveled to Cuba to learn about the nation's approach to health care. Despite being a developing nation, Cuba boasts health care indicators that are comparable to those of the United States and other developed nations. Emphasizing prevention and proactive care, the Cuban health care system provides lessons to inform future U.S. health care reform efforts in order to contain medical costs while providing quality care. Visiting with Cuban health care professionals over the course of eight days, and interviewing American physicians who were trained in Cuba but practice in the U.S., this paper pro...
Source: Journal of Health Care for the Poor and Underserved - May 30, 2019 Category: International Medicine & Public Health Authors: Bhardwaj N, Skinner D Tags: J Health Care Poor Underserved Source Type: research
Interactivity in a Decision Aid: Findings From a Decision Aid to Technologically Enhance Shared Decision Making RCT
Publication date: Available online 23 May 2019Source: American Journal of Preventive MedicineAuthor(s): Masahito Jimbo, Ananda Sen, Melissa A. Plegue, Sarah Hawley, Karen Kelly-Blake, Mary Rapai, Minling Zhang, Yuhong Zhang, Xiao Xie, Mack T. RuffinIntroductionColorectal cancer screening (CRCS) remains underutilized. Decision aids (DAs) can increase patient knowledge, intent, and CRCS rates compared with “usual care,” but whether interactivity further increases CRCS rate remains unknown.Study designA two-armed RCT compared the effect of a web-based DA that interactively assessed patient CRC risk and clarified p...
Source: American Journal of Preventive Medicine - May 24, 2019 Category: International Medicine & Public Health Source Type: research
Evaluation of the psychometric properties of the Greek version of the Active Life with Asthma (Gr-ALMA) review: a descriptive methodological study
Regular asthma reviews are recommended by international guidelines to improve the quality of life of asthma patients. To facilitate these reviews in primary care practice, there is a need for structured asthma... (Source: BMC Health Services Research)
Source: BMC Health Services Research - May 22, 2019 Category: General Medicine Authors: Chris Livadiotis, Ekaterini Lambrinou, Vasilios Raftopoulos and Nicos Middleton Tags: Research article Source Type: research
Telephone-Based Shared Decision-making for Lung Cancer Screening in Primary Care
AbstractThe national rate of lung cancer screening, approximately 3–5%, is too low and strategies which include shared decision-making and increase screening are needed. A feasibility study in one large primary care practice of telephone-based delivery of decision support via an online tool, the Decision Counseling Program © (DCP) was administered to patients eligible for lung cancer screening according to USPSTF screening guidelines. We collected data on demographics, decisional conflict, and conducted chart audits to ascertain screening. From electronic medical record data, we identified 829 age-eligibl...
Source: Journal of Cancer Education - May 9, 2019 Category: Cancer & Oncology Source Type: research
Practice Characteristics Associated with Better Implementation of Patient Self-Management Support
This study aimed to promote the translation of SMS into primary care practices and reported on key baseline practice characteristics that may impact SMS implementation. Methods: Thirty-six practices in Colorado and California participated in the study from December 2013 to March 2017. Practice administrators completed a Practice Information Form describing practice characteristics. Clinicians and staff (n = 716) completed the Practice Culture Assessment and the Patient-Centered Medical Home (PCMH) Monitor. Descriptive statistics were computed to determine practice characteristics related to culture, quality improvement, l...
Source: Journal of the American Board of Family Medicine - May 8, 2019 Category: Primary Care Authors: Jortberg, B. T., Fernald, D. H., Hessler, D. M., Dickinson, L. M., Wearner, R., Connelly, L., Holtrop, J. S., Fisher, L., Dickinson, W. P. Tags: Original Research Source Type: research
A Cluster Randomized Trial Comparing Strategies for Translating Self-Management Support into Primary Care Practices
Conclusion: An interactive behavior change technology tool such as CTH can increase primary care practice SMS activities and improve patient HbA1c levels. Even brief practice facilitation assists practices in implementing SMS. (Source: Journal of the American Board of Family Medicine)
Source: Journal of the American Board of Family Medicine - May 8, 2019 Category: Primary Care Authors: Dickinson, W. P., Dickinson, L. M., Jortberg, B. T., Hessler, D. M., Fernald, D. H., Cuffney, M., Fisher, L. Tags: Original Research Source Type: research
Does Ownership Make a Difference in Primary Care Practice?
Purpose: We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices. Methods: This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by using 15 survey-based...
Source: Journal of the American Board of Family Medicine - May 8, 2019 Category: Primary Care Authors: Lindner, S., Solberg, L. I., Miller, W. L., Balasubramanian, B. A., Marino, M., McConnell, K. J., Edwards, S. T., Stange, K. C., Springer, R. J., Cohen, D. J. Tags: Original Research Source Type: research
Using Public Cost Information During Low Back Pain Visits: A Qualitative Study.
Conclusion: This multicomponent intervention to introduce publicly reported cost information into LBP clinical discussions had low provider uptake. Whereas cost conversations and CompareMaine.org were perceived as useful by participating patients with LBP, providers were uncomfortable discussing cost variation at the point of care. Successful use of public cost information during clinical visits will require normalizing use to a broader group of patients and greater provider outreach and health system engagement. Primary Funding Source: Robert Wood Johnson Foundation. PMID: 31060060 [PubMed - in process] (Source:...
Source: Annals of Internal Medicine - May 7, 2019 Category: Internal Medicine Authors: Fox KS, Gray CE, Williamson ME, MacKenzie JA Tags: Ann Intern Med Source Type: research
Addressing Medication Costs During Primary Care Visits: A Before-After Study of Team-Based Training.
Conclusion: A single team training to screen and address patients' medication cost concerns improved COM discussions over the short term. Further research is needed to assess sustained effects and impact on patient costs and medication adherence and to determine whether more intensive, scalable interventions are needed. Primary Funding Source: Robert Wood Johnson Foundation. PMID: 31060055 [PubMed - in process] (Source: Annals of Internal Medicine)
Source: Annals of Internal Medicine - May 7, 2019 Category: Internal Medicine Authors: Carroll JK, Farah S, Fortuna RJ, Lanigan AM, Sanders M, Venci JV, Fiscella K Tags: Ann Intern Med Source Type: research
Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial.
Abstract BACKGROUND: The Health TAPESTRY (Health Teams Advancing Patient Experience: STRengthening QualitY) intervention was designed to improve primary care teamwork and promote optimal aging. We evaluated the effectiveness of Health TAPESTRY in attaining goals of older adults (e.g., physical activity, productivity, social connection, medical status) and other outcomes. METHODS: We conducted a pragmatic randomized controlled trial between January and October 2015 in a primary care practice in Hamilton, Ontario. Older adults were randomized (1:1) to Health TAPESTRY (n = 158) or control (n = 154). Trained comm...
Source: cmaj - May 6, 2019 Category: General Medicine Authors: Dolovich L, Oliver D, Lamarche L, Thabane L, Valaitis R, Agarwal G, Carr T, Foster G, Griffith L, Javadi D, Kastner M, Mangin D, Papaioannou A, Ploeg J, Raina P, Richardson J, Risdon C, Santaguida P, Straus S, Price D Tags: CMAJ Source Type: research
Job satisfaction and guideline adherence among physicians: Moderating effects of perceived autonomy support and job control
Publication date: Available online 2 May 2019Source: Social Science & MedicineAuthor(s): Anthony C. Waddimba, David C. Mohr, Howard B. Beckman, Thomas L. Mahoney, Gary J. YoungAbstractValue-based purchasing of physician services aims to incentivize greater adherence to clinical practice guidelines. By increasing job demands, new reimbursement models could adversely affect job satisfaction and, indirectly, clinical performance. Studies of satisfaction-performance associations among healthcare practitioners have yielded inconsistent findings. We investigated whether physicians' perceptions of autonomy support and job con...
Source: Social Science and Medicine - May 3, 2019 Category: Psychiatry & Psychology Source Type: research
Does Ownership Make a Difference in Primary Care Practice?
Abstract PURPOSE: We assessed differences in structural characteristics, quality improvement processes, and cardiovascular preventive care by ownership type among 989 small to medium primary care practices. METHODS: This cross-sectional analysis used electronic health record and survey data collected between September 2015 and April 2017 as part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by the Agency for Health Care Research and Quality. We compared physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHC) by...
Source: American Family Physician - May 1, 2019 Category: Primary Care Authors: Lindner S, Solberg LI, Miller WL, Balasubramanian BA, Marino M, McConnell KJ, Edwards ST, Stange KC, Springer RJ, Cohen DJ Tags: J Am Board Fam Med Source Type: research
Shifting Implementation Science Theory to Empower Primary Care Practices.
Abstract Observers of the past 10 to 15 years have witnessed the simultaneous growth of dramatic changes in the practice of primary care and the emergence of a new field of dissemination and implementation science (D&I). Most current implementation science research in primary care assumes practices are not meeting externally derived standards and need external support to meet these demands. After a decade of initiatives, many stakeholders now question the return on their investments. Overall improvements in quality metrics, utilization cost savings, and patient experience have been less than anticipated. While...
Source: Annals of Family Medicine - May 1, 2019 Category: Primary Care Authors: Miller WL, Rubinstein EB, Howard J, Crabtree BF Tags: Ann Fam Med Source Type: research
Opioid and Substance Use Disorder and Receipt of Treatment Among Parents Living With Children in the United States, 2015-2017.
CONCLUSION: Many parents in both groups have concurrent mental health issues, including suicidal thoughts and behavior. Primary care practices can play a critical role in screening and facilitating treatment initiation. PMID: 31085524 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - May 1, 2019 Category: Primary Care Authors: Clemans-Cope L, Lynch V, Epstein M, Kenney GM Tags: Ann Fam Med Source Type: research
Chronic Opioid Prescribing in Primary Care: Factors and Perspectives.
CONCLUSION: Although patients prescribed opioids in primary care have higher risks of opioid-related harms, clinicians report multiple barriers in deprescribing chronic opioids. Future studies should examine strategies to mitigate these harms and engage patients in shared decision making about their chronic opioid use. PMID: 31085523 [PubMed - in process] (Source: Annals of Family Medicine)
Source: Annals of Family Medicine - May 1, 2019 Category: Primary Care Authors: Tong ST, Hochheimer CJ, Brooks EM, Sabo RT, Jiang V, Day T, Rozman JS, Kashiri PL, Krist AH Tags: Ann Fam Med Source Type: research
Episodic and Chronic Migraine in Primary Care.
Abstract OBJECTIVE: To inform migraine care model development by assessing differences between patients with chronic migraine (CM) and episodic migraine (EM) in the current state of treatment, disability, patient satisfaction, and quality improvement opportunities. BACKGROUND: Efficient and focused use of scarce resources will be needed to address challenges within large populations of migraine patients. METHODS: We deployed a cross-sectional survey study of randomly selected migraine patients within a community primary care practice. RESULTS: There were 516 survey respondents (516/1804 [30%] respon...
Source: Headache - April 29, 2019 Category: Neurology Authors: Young NP, Philpot LM, Vierkant RA, Rosedahl JK, Upadhyaya SG, Harris A, Ebbert JO Tags: Headache Source Type: research
Psychiatric Comorbidity in Neurological Disorders: Towards a Multidisciplinary Approach to Illness Management in the United Arab Emirates
Conclusion: Our results indicate similar prevalence rates of comorbid psychiatric symptoms to studies carried out in the Middle East and North Africa (MENA) region and relatively high attendance and referral rates to psychiatric services.Implications: The results shed light on the clinical profile of patients in this region and support the need for integrated collaborative medical services. Moreover, findings have important implications for health care policies pertaining to resource distribution and funding.IntroductionMedical care has traditionally been dominated by a separation between disciplines catering to physiologi...
Source: Frontiers in Psychiatry - April 25, 2019 Category: Psychiatry Source Type: research
Panic Disorder in Primary Care.
Authors: Gensichen J, Hiller TS, Breitbart J, Brettschneider C, Teismann T, Schumacher U, Lukaschek K, Schelle M, Schneider N, Sommer M, Wensing M, König HH, Margraf J Abstract BACKGROUND: We evaluated a team-based program of exercises for patients with panic disorder with or without agoraphobia (PDA) in primary care. METHODS: 419 patients with PDA (mean age 46.2 years, standard deviation 14.4 years; 74% female) were included in this cluster-randomized, controlled intervention trial. The patients were blinded with respect to their group assignment at baseline. Patients in the intervention group (36 primary...
Source: Deutsches Arzteblatt International - April 20, 2019 Category: General Medicine Tags: Dtsch Arztebl Int Source Type: research
Characteristics of High Performing Primary Care Pediatric Practices: A Qualitative Study
ConclusionsThis study suggested that elements of organizational culture may play as important a role in the quality of care delivered as specific quality improvement strategies. Interventions to further test this relationship may aid practices seeking to improve the care they deliver. (Source: Academic Pediatrics)
Source: Academic Pediatrics - April 18, 2019 Category: Pediatrics Source Type: research
Implementing pharmacogenetic testing in rural primary care practices: a pilot feasibility study
Pharmacogenomics, Ahead of Print. (Source: Future Medicine: Pharmacogenomics)
Source: Future Medicine: Pharmacogenomics - April 15, 2019 Category: Genetics & Stem Cells Authors: Lynn G Dressler Gillian C Bell Pearl M Abernathy Karl Ruch Sheri Denslow Source Type: research
Comprehensive geriatric assessment in primary care: a systematic review.
DISCUSSION: The four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA. PMID: 30968287 [PubMed - as supplied by publisher] (Source: Aging Clinical and Experimental Research)
Source: Aging Clinical and Experimental Research - April 9, 2019 Category: Geriatrics Authors: Garrard JW, Cox NJ, Dodds RM, Roberts HC, Sayer AA Tags: Aging Clin Exp Res Source Type: research
Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?
ConclusionAfter controlling for differences in sociodemographic and clinical factors, resident patients were less likely to achieve chronic disease and preventive cancer screening outcomes compared to staff patients. Further efforts to address ambulatory trainee education and primary care quality along with novel approaches to the management of the disproportionately disadvantaged resident patient panels are needed. (Source: Journal of General Internal Medicine)
Source: Journal of General Internal Medicine - April 8, 2019 Category: Internal Medicine Source Type: research
Ranolazine: impact on quality of life in patients with stable angina pectoris, results from an observational study in Austria - the ARETHA AT study.
CONCLUSION: In this real-world study, ranolazine was shown to be effective, safe and well tolerable. Symptoms of AP were improved, as illustrated by the reduced number of angina attacks, reduced rate of nitrate use, reduced CCS scores and improved QoL. PMID: 30963332 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)
Source: Wiener Klinische Wochenschrift - April 8, 2019 Category: General Medicine Authors: Zweiker R, Aichinger J, Metzler B, Lang I, Wallner E, Delle-Karth G Tags: Wien Klin Wochenschr Source Type: research
The use of oximetry and a questionnaire in primary care enables exclusion of a subsequent obstructive sleep apnea diagnosis
AbstractPurposeThe study aims to prospectively validate the prognostic value of oximetry alone or combined in a two-step strategy with a questionnaire for the exclusion of obstructive sleep apnea (OSA) in primary care.MethodsA total of 140 subjects with suspected OSA were included from 54 participating primary care practices. All subjects completed the Philips questionnaire and underwent one night of oximetry prior to referral to a sleep center. The prognostic value of two strategies was evaluated against the diagnosis of the sleep center as the gold standard: (1) assume OSA and subsequently refer to a sleep center if the ...
Source: Sleep and Breathing - April 6, 2019 Category: Respiratory Medicine Source Type: research
The use of oximetry and a questionnaire in primary care enables exclusion of a subsequent obstructive sleep apnea diagnosis.
Abstract PURPOSE: The study aims to prospectively validate the prognostic value of oximetry alone or combined in a two-step strategy with a questionnaire for the exclusion of obstructive sleep apnea (OSA) in primary care. METHODS: A total of 140 subjects with suspected OSA were included from 54 participating primary care practices. All subjects completed the Philips questionnaire and underwent one night of oximetry prior to referral to a sleep center. The prognostic value of two strategies was evaluated against the diagnosis of the sleep center as the gold standard: (1) assume OSA and subsequently refer to a ...
Source: Sleep and Breathing - April 6, 2019 Category: Sleep Medicine Authors: Fabius TM, Benistant JR, Pleijhuis RG, van der Palen J, Eijsvogel MMM Tags: Sleep Breath Source Type: research
Measuring the Implementation of Lifestyle-Integrated Functional Exercise in Primary Care for Older Adults: Results of a Feasibility Study.
Abstract ABSTRACTOur pilot study evaluated the feasibility, effectiveness, and implementation of a group-based lifestyle-integrated functional exercise (Mi-LiFE) program for older adults in an interprofessional primary care practice. A physical therapist taught participants how to integrate strength and balance activities into daily routines during one individual and four group sessions, and two follow-up phone calls. Feasibility outcomes were recruitment, adherence, and retention over 6 months. Physical activity (PA) (accelerometer, International Physical Activity Questionnaire [IPAQ]), Short Physical Performance...
Source: Canadian Journal on Aging - April 5, 2019 Category: Geriatrics Authors: Gibbs JC, McArthur C, Milligan J, Clemson L, Lee L, Boscart VM, Heckman G, Stolee P, Giangregorio LM Tags: Can J Aging Source Type: research
Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Intraocular Pressure Measurements Found in a Population at High Risk for Glaucoma
Conclusions: In this telemedicine vision screening setting, having a higher IOP at the screening visit increased the likelihood of receiving a final diagnosis of glaucoma. Therefore, this study supports incorporating IOP measurements, using a portable tonometer, into vision screening programs in high-risk populations. (Source: Journal of Glaucoma)
Source: Journal of Glaucoma - April 1, 2019 Category: Opthalmology Tags: Original Studies Source Type: research
Incorporating the Patient Voice Into Practice Improvement: A Role for Medical Trainees.
CONCLUSIONS: Our study demonstrates two things: (1) there are areas of discordance between provider/staff perceptions and patient perspectives regarding practice improvement opportunities; and (2) medical students can participate meaningfully in the QI process. By harnessing patient perspectives with the help of medical trainees, clinics may better understand patient concerns and avoid potential QI blind spots. PMID: 30973624 [PubMed - in process] (Source: Famly Medicine)
Source: Famly Medicine - April 1, 2019 Category: Primary Care Authors: Hsu KY, Contreras VM, Vollrath K, Cuan N, Lin S Tags: Fam Med Source Type: research
Engaging primary care physicians in care coordination for patients with complex medical conditions.
CONCLUSION: The SCOPE project provided an opportunity for PCPs to build meaningful relationships, reconnect to the broader health care system, and redefine their roles. For many PCPs, reestablishing connections reaffirmed their role in the system and enabled a more collaborative care model. Strategies for connecting community-based PCPs to the broader system need to consider contextual factors and the effects of new linkages and coordination on the identities and relationships of PCPs. PMID: 30979773 [PubMed - in process] (Source: Canadian Family Physician Medecin de Famille Canadien)
Source: Canadian Family Physician Medecin de Famille Canadien - April 1, 2019 Category: Primary Care Authors: Lockhart E, Hawker GA, Ivers NM, O'Brien T, Mukerji G, Pariser P, Stanaitis I, Pus L, Baker GR Tags: Can Fam Physician Source Type: research
Top studies relevant to primary care from 2018: From PEER.
CONCLUSION: Research from 2018 produced several high-quality studies in CVD but also spanned the breadth of primary care including pediatrics, women's health, and pain management, among other areas. PMID: 30979756 [PubMed - in process] (Source: Canadian Family Physician Medecin de Famille Canadien)
Source: Canadian Family Physician Medecin de Famille Canadien - April 1, 2019 Category: Primary Care Authors: Perry D, Moe S, Korownyk C, Lindblad AJ, Kolber MR, Thomas B, Ton J, Garrison S, Allan GM Tags: Can Fam Physician Source Type: research
Practice-Based Research Networks: Strategic Opportunities to Advance Implementation Research for Health Equity.
This article will briefly outline the history of PBRNs, types of PBRNs, locations, topics, and patient outcomes over the past 25 years. Current PBRN efforts to address health disparities and improve health equity will be described. New PBRN opportunities to address health disparities and approaches to advance implementation research for health equity in the practice and community will be described. Readers will be challenged to consider ways to engage practice-based research networks in their health equity efforts. PMID: 30906158 [PubMed - in process] (Source: Ethnicity and Disease)
Source: Ethnicity and Disease - March 26, 2019 Category: International Medicine & Public Health Tags: Ethn Dis Source Type: research
Computer-Assisted Cognitive-Behavior Therapy for Depression: A Systematic Review and Meta-Analysis.
CONCLUSIONS: CCBT with a modest amount of support from a clinician or other helping person was found to be efficacious with relatively large mean effect sizes on measures of depressive symptoms. Self-guided CCBT for depression was considerably less effective. Future research should focus on enhancing the implementation of CCBT, including evaluating the amount and type of support needed for effective delivery, methods to improve engagement with computer-assisted therapies, and ways to improve treatment outcome in primary care settings. PMID: 30900849 [PubMed - in process] (Source: Journal of Clinical Psychiatry)
Source: Journal of Clinical Psychiatry - March 24, 2019 Category: Psychiatry Tags: J Clin Psychiatry Source Type: research
A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences
ConclusionsMulticomponent interventions that utilize professionals to provide parenting education, mental health counseling, social service referrals, or social support can reduce the impact of C-ACEs on child behavioral/mental health problems and improve the parent–child relationship for children aged 0–5years. (Source: American Journal of Preventive Medicine)
Source: American Journal of Preventive Medicine - March 21, 2019 Category: International Medicine & Public Health Source Type: research
EHR quality indicator tracking: A process improvement pilot project to meet MACRA requirements
This article outlines an information technology process improvement pilot project undertaken at a large primary care practice in western Florida to support readiness for Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 using new EHR quality indicator tracking features. (Source: The Nurse Practitioner)
Source: The Nurse Practitioner - March 20, 2019 Category: Nursing Tags: Feature: VALUE-BASED HEALTHCARE: DNP SPECIAL ISSUE Source Type: research
Primary care of asthma: new options for severe eosinophilic asthma.
CONCLUSIONS: A new class of agents is available for patients with moderate to severe eosinophilic asthma. Four biologic therapies - mepolizumab, reslizumab, benralizumab, and dupilumab - that interfere with the regulation and activity of eosinophils have been approved by the FDA for patients with moderate to severe asthma with an eosinophilic phenotype. Primary care physicians should be familiar with these medications to explain part of the rationale for referral to specialist care and manage patient expectations for treatment. PMID: 30880484 [PubMed - as supplied by publisher] (Source: Current Medical Research and Opinion)
Source: Current Medical Research and Opinion - March 20, 2019 Category: Research Tags: Curr Med Res Opin Source Type: research