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Primary Care Providers (primary + care_provider)
Selected AbstractsWeight Management Practices Among Primary Care ProvidersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2000Gayle M. Timmerman RN ABSTRACT This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared. [source] Evaluation of the Acceptability and Usability of a Decision Support System to Encourage Safe and Effective Use of Opioid Therapy for Chronic, Noncancer Pain by Primary Care ProvidersPAIN MEDICINE, Issue 4 2010Jodie Trafton PhD Abstract Objective., To develop and evaluate a clinical decision support system (CDSS) named Assessment and Treatment in Healthcare: Evidenced-Based Automation (ATHENA)-Opioid Therapy, which encourages safe and effective use of opioid therapy for chronic, noncancer pain. Design., CDSS development and iterative evaluation using the analysis, design, development, implementation, and evaluation process including simulation-based and in-clinic assessments of usability for providers followed by targeted system revisions. Results., Volunteers provided detailed feedback to guide improvements in the graphical user interface, and content and design changes to increase clinical usefulness, understandability, clinical workflow fit, and ease of completing guideline recommended practices. Revisions based on feedback increased CDSS usability ratings over time. Practice concerns outside the scope of the CDSS were also identified. Conclusions., Usability testing optimized the CDSS to better address barriers such as lack of provider education, confusion in dosing calculations and titration schedules, access to relevant patient information, provider discontinuity, documentation, and access to validated assessment tools. It also highlighted barriers to good clinical practice that are difficult to address with CDSS technology in its current conceptualization. For example, clinicians indicated that constraints on time and competing priorities in primary care, discomfort in patient-provider communications, and lack of evidence to guide opioid prescribing decisions impeded their ability to provide effective, guideline-adherent pain management. Iterative testing was essential for designing a highly usable and acceptable CDSS; however, identified barriers may limit the impact of the ATHENA-Opioid Therapy system and other CDSS on clinical practices and outcomes unless CDSS are paired with parallel initiatives to address these issues. [source] Shared Care in Geriatric Oncology: Primary Care Providers' and Medical/Oncologist's PerspectivesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Cynthia Owusu MD Existing literature lends support to the benefit of shared care in the management of chronic diseases, but there are limited data on the feasibility, cost-effectiveness, or benefits of shared care in oncology. A recent conference organized by the Aging and Cancer Program of the Case Comprehensive Cancer Center sought to explore the perceptions of physicians and other allied health professionals who attended the conference about shared care in the acute management of older patients with cancer using a case history presentation and an anonymous audience response system. Analyses of the audience response indicated that shared responsibility and enhanced information exchange in addition to the current level of communication between providers involved in the acute management of older patients with cancer is desirable. Studies exploring the feasibility and benefits of a shared care model in the management of older patients with cancer are needed. [source] Gender- and Age-Related Differences in Treatment and Control of Cardiovascular Risk Factors Among High-Risk Patients With AnginaJOURNAL OF CLINICAL HYPERTENSION, Issue 7 2005Katharine H. Hendrix PhD Dyslipidemic, hypertensive patients (N=48,863) were stratified by gender, age, and angina (n=2502) vs. nonangina (n=46,358) status. Comparing 95% confidence intervals yielded significant differences in treatment and cardiovascular risk factor control between subgroups. More men than women bad low-density lipoprotein cholesterol (LDL-C) <100 mg/dL (angina, 43.94-43.96 vs. 34.42-34.50; nonangina, 32.43-32.43 vs. 17.25-17.25) and 100-129 mg/dL (angina, 32.12-32.14 vs. 35.10-35.18; nonangina, 53.86-53.86 vs. 32.44-32.44). More women than men had LDL-C >130 mg/dL (angina, 27.68-27.72 vs. 23.91-23.93; nonangina, 38.70-38.70 vs. 35.38-35.39). Women were less likely than men to receive statins (angina, 69.95-69.99 vs. 82.11-82.13; nonangina, 59.80-59.80 vs. 63.72-63.72), any antilipidemic medication at all (angina, 25.93-25.97 vs. 13.48-13.48; nonangina, 36.73-36.73 vs. 30.73-30.73), or to have current cholesterol measurements (angina, 56.82-56.88 vs. 34.54-34.56; nonangina, 45.77-45.77 vs. 39.75-39.75). Primary care providers treat high-risk patients relatively aggressively; however, opportunities to forestall cardiovascular disease may be missed in hypertensive, dyslipidemic women whose LDL-C is often not measured and controlled. [source] Early childhood caries: Current evidence for aetiology and preventionJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2006Mark G Gussy Background: Despite the fact that it is largely preventable, dental caries (decay) remains one of the most common chronic diseases of early childhood. Dental decay in young children frequently leads to pain and infection necessitating hospitalization for dental extractions under general anaesthesia. Dental problems in early childhood have been shown to be predictive of not only future dental problems but also on growth and cognitive development by interfering with comfort nutrition, concentration and school participation. Objective: To review the current evidence base in relation to the aetiology and prevention of dental caries in preschool-aged children. Methods: A search of MEDLINE, CINALH and Cochrane electronic databases was conducted using a search strategy which restricted the search to randomized controlled trials, meta-analyses, clinical trials, systematic reviews and other quasi-experimental designs. The retrieved studies were then limited to articles including children aged 5 years and under and published in English. The evidence of effectiveness was then summarized by the authors. Conclusions: The review highlighted the complex aetiology of early childhood caries (ECC). Contemporary evidence suggests that potentially effective interventions should occur in the first 2 years of a child's life. Dental attendance before the age of 2 years is uncommon; however, contact with other health professionals is high. Primary care providers who have contact with children well before the age of the first dental visit may be well placed to offer anticipatory advice to reduce the incidence of ECC. [source] Clinical Practice Guideline: Screening and Diagnosing AutismJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2001APRN-C, Mary Jo Goolsby EdD The clinical practice guideline (CPG) reviewed in this month's column concerns the screening and diagnosis of autism. Autism is the third most common developmental disability and affects more than 1 in 500 children, or nearly 400,000 people in the United States, in some form. Primary care providers of children, including pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs), should reasonably expect to care for at least one child with autism (CWA). The American Academy of Neurology (AAN) has therefore developed guidelines to help healthcare providers facilitate the early identification of children with autism. [source] Communication of positive newborn screening results for sickle cell disease and sickle cell trait: Variation across states,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2008Patricia L. Kavanagh Abstract In the US, all states and the District of Columbia have universal newborn screening (NBS) programs for sickle cell disease (SCD), which also identify sickle cell trait (trait). In this project, we surveyed follow-up coordinators, including one in the District of Columbia and two in Georgia, about protocols for stakeholder notification for SCD and trait. The primary outcomes were total number and type of stakeholder informed of a positive screen. We received 52 completed surveys (100% response). Primary care providers (PCPs) (100%), hematologists (81%), hospitals (73%), and families (40%) were the most commonly notified stakeholders of positive SCD screens, while PCPs (88%), hospitals (63%), and families (37%) were most commonly notified for trait. On average, 3.4 stakeholders were notified for a positive screening for SCD, compared to 2.4 stakeholders for sickle cell trait (P,<,0.001). In multivariate analyses for SCD, we found a 2.9% increase in stakeholders notified for each additional year of universal screening mandated in a state (95% CI: 1.4,4.4%). For trait, we found an 8.5% increase in stakeholders notified for each additional follow-up staff (95% CI: 1.3,15.7%), and a 1.3% increase for each additional percent of black births in the state (95% CI: 0.1,2.5%). Wide variation exists in stakeholder notification by NBS programs of positive screenings for SCD and trait. This variation may alter the effectiveness of NBS programs by location of birth. © 2008 Wiley-Liss, Inc. [source] Patterns of care and referral in children with atopic dermatitis and concern for food allergyDERMATOLOGIC THERAPY, Issue 2 2006Michele M. Thompson ABSTRACT:, Although many providers believe that up to 30% of atopic dermatitis (AD) is food induced, food challenge studies show that food-induced eczematous reactions are rare. When food allergy is suggested to cause AD, it often leads to allergy testing with a high false-positivity rate, in turn further focusing parents on food allergy. Study subjects were children less than 11 years old with AD and food allergy suspicion. Prior diagnoses, provider, and testing patterns were assessed by questionnaire given to the parents. Thirty-eight patients with AD were enrolled. Most subject's parents suspected food allergy induced AD. Initial skin diagnoses were made by pediatricians (79%) and family practitioners (18%) as eczema. Allergy was suggested by providers as cause for AD in 63% of the present study's patients. Seventy-nine percent had allergy testing. Greater than 90% of parents claimed their children had food allergy and food-induced AD. Sixty-six percent had positive food allergy tests and 37% had definite history of immediate IgE reactions to food. The majority of this population had allergy suggested as causative for eczema by their primary care provider and were subsequently evaluated by allergist and allergy testing. Consensus about the role of food allergy between the different providers of AD in children would result in more effective, efficient, and less costly health care. [source] Lifetime depression and diabetes self-management in women with Type 2 diabetes: a case,control studyDIABETIC MEDICINE, Issue 6 2010J. A. Wagner Diabet. Med. 27, 713,717 (2010) Abstract Aims, Little is known about the association between lifetime history of major depressive disorder (L-MDD) and diabetes self-management, particularly when depression is remitted. We examined the association between L-MDD and diabetes self-management in women with Type 2 diabetes who were not depressed at the time of assessment. Methods, L-MDD was assessed with structured psychiatric interview. Participants completed paper-and-pencil measures of demographics, diabetes-related distress, self-care behaviours, healthcare utilization and diabetes self-efficacy. Results, One-hundred and fifty-three women participated; 41% had L-MDD. Compared with their never-depressed counterparts, women with L-MDD had more diabetes distress, reported lower overall rates of self-monitoring of blood glucose (SMBG) and greater tendency to skip SMBG, had lower diet adherence and were less likely to have seen a primary care provider in the past year. Diabetes self-efficacy mediated the relationship between L-MDD and self-management. Conclusions, Interventions to promote self-management for patients with L-MDD may be warranted. [source] Screening and outcomes in biliary atresia: Summary of a National Institutes of Health workshop,,HEPATOLOGY, Issue 2 2007Ronald J. Sokol Biliary atresia is the most common cause of end-stage liver disease in the infant and is the leading pediatric indication for liver transplantation in the United States. Earlier diagnosis (<30-45 days of life) is associated with improved outcomes following the Kasai portoenterostomy and longer survival with the native liver. However, establishing this diagnosis is problematic because of its rarity, the much more common indirect hyperbilirubinemia that occurs in the newborn period, and the schedule for routine infant health care visits in the United States. The pathogenesis of biliary atresia appears to involve immune-mediated fibro-obliteration of the extrahepatic and intrahepatic biliary tree in most patients and defective morphogenesis of the biliary system in the remainder. The determinants of the outcome of portoenterostomy include the age at surgery, the center's experience, the presence of associated congenital anomalies, and the postoperative occurrence of cholangitis. A number of screening strategies in infants have been studied. The most promising are early measurements of serum conjugated bilirubin and a stool color card given to new parents that alerts them and their primary care provider to acholic stools. This report summarizes a National Institutes of Health workshop held on September 12 and 13, 2006, in Bethesda, MD, that addressed the issues of outcomes, screening, and pathogenesis of biliary atresia. (HEPATOLOGY 2007;46:566,581.) [source] Transitioning the patient with acute coronary syndrome from inpatient to primary care,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2010FACPE, Tomás Villanueva DO Abstract Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS. Journal of Hospital Medicine 2010;5:S8,S14. © 2010 Society of Hospital Medicine. [source] CE ARTICLE: Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: A guide for primary care providersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2010Eva Quirion MSN Abstract Purpose: To provide an overview of the lymphatics, physiology of lymphedema (LE), incidence, risks, and costs as well as a guide for the primary care provider on how to recognize the symptoms of LE, a review of current published treatment recommendations, and advice about making a referral to appropriate LE specialists. Data sources: Selected studies on diagnosing and treating LE in breast cancer patients following mastectomy/lumpectomy and evidence-based treatment guidelines. Conclusions: LE is the most common complication related to breast cancer treatment with an occurrence estimated between 10% and 60% depending on the parameters used for measurement. Most commonly, LE occurs within the first 3 years after breast cancer treatment, but the remaining cases happen beyond this period of time and can occur after many years. This means that significant numbers of patients with LE can present to primary care clinicians. Implications for practice: A patient who is treated for breast cancer will be followed for a time by the oncology team, but eventually, that patient will be discharged from the oncology practice and will be seen in primary care. Risk factors for developing LE include treatment-related (number of nodes removed and radiation to axilla), disease-related (stage and location of tumor), and patient-related (younger age, obesity, and comorbid conditions) factors. A systematic evaluation of any patient presenting with LE will assure accurate diagnosis and prompt treatment. [source] Preventing Pediatric Obesity: Assessment and Management in the Primary Care SettingJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2002FAANP, Lorna Schumann PhD Purpose To review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese. Data Sources Selected research, national guidelines and recommendations, and the professional experience of the authors. Conclusions The focus of primary care involves early detectionand family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems. Implications For Practice Pediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender. [source] Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back painARTHRITIS & RHEUMATISM, Issue 10 2009Nicholas Henschke Objective To determine the prevalence of serious pathology in patients presenting to primary care settings with acute low back pain, and to evaluate the diagnostic accuracy of recommended "red flag" screening questions. Methods An inception cohort of 1,172 consecutive patients receiving primary care for acute low back pain was recruited from primary care clinics in Sydney, Australia. At the initial consultation, clinicians recorded responses to 25 red flag questions and then provided an initial diagnosis. The reference standard was a 12-month followup supplemented with a specialist review of a random subsample of participants. Results There were 11 cases (0.9%) of serious pathology, including 8 cases of fracture. Despite the low prevalence of serious pathology, most patients (80.4%) had at least 1 red flag (median 2, interquartile range 1,3). Only 3 of the red flags for fracture recommended for use in clinical guidelines were informative: prolonged use of corticosteroids, age >70 years, and significant trauma. Clinicians identified 5 of the 11 cases of serious pathology at the initial consultation and made 6 false-positive diagnoses. The status of a diagnostic prediction rule containing 4 features (female sex, age >70 years, significant trauma, and prolonged use of corticosteroids) was moderately associated with the presence of fracture (the area under the curve for the rule score was 0.834 [95% confidence interval 0.654,1.014]; P = 0.001). Conclusion In patients presenting to a primary care provider with back pain, previously undiagnosed serious pathology is rare. The most common serious pathology observed was vertebral fracture. Approximately half of the cases of serious pathology were identified at the initial consultation. Some red flags have very high false-positive rates, indicating that, when used in isolation, they have little diagnostic value in the primary care setting. [source] Racial and Ethnic Differences in Emergency Care for Acute Exacerbation of Chronic Obstructive Pulmonary DiseaseACADEMIC EMERGENCY MEDICINE, Issue 2 2009Chu-Lin Tsai MD ScD Abstract Objectives:, The objective was to investigate racial and ethnic differences in emergency care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods:, The authors performed a prospective multicenter cohort study involving 24 emergency departments (EDs) in 15 U.S. states. Using a standard protocol, consecutive ED patients with AECOPD were interviewed, their charts reviewed, and 2-week telephone follow-ups were completed. Results:, Among 330 patients, 218 (66%) were white, 84 (25%) were African American, and 28 (8%) were Hispanic. A quarter of the 24 EDs cared for 59% of all minority patients. Compared with white patients, African American and Hispanic patients were more likely to be uninsured or with Medicaid (19, 49, and 52%, respectively; p < 0.001), were less likely to have a primary care provider (93, 81, and 82%, respectively; p = 0.005), and had more frequent ED visits in the past year (medians = 1, 2, and 3, respectively; p = 0.002). In the unadjusted analyses, minority patients were less likely to receive diagnostic procedures, more likely to receive systemic corticosteroids in the ED, less likely to be admitted, and more likely to have a relapse. After adjustment for patient and ED characteristics, these many racial and ethnic differences in quality of care were nearly completely eliminated. Conclusions:, Despite pronounced racial and ethnic differences in stable COPD, all racial and ethnic groups received comparable quality of emergency care for AECOPD and had similar short-term outcomes. [source] Correlates of screening sigmoidoscopy use among men in a large nonprofit health planCANCER, Issue 2 2007Reina Haque PhD Abstract BACKGROUND. As the majority of patients diagnosed with colorectal cancer have no known risk factors, regular screening is strongly recommended. The authors examined factors associated with screening sigmoidoscopy use among participants in the California Men's Health Study (CMHS). METHODS. The authors conducted a cross-sectional study over a 5-year period nested within a prospective cohort study. The CMHS enrolled a large multiethnic cohort (n = 84,170) of men from 2 major California health plans. Because screening sigmoidoscopy was the preferred and most commonly used test for patients at average risk of colorectal cancer in the health plans, the authors excluded from the analysis men who completed a barium enema colonoscopy or a fecal occult blood test. RESULTS. Eligible subjects included 39,559 men at average risk for colorectal cancer. Prevalence of screening sigmoidoscopy use decreased with older age and increased with higher education and household income over the 5-year study period. Compared with whites, Asians (adjusted OR, 1.42; 95% CI, 1.30,1.56) and African Americans (adjusted OR, 1.18; 95% CI, 1.08,1.29) were more likely to undergo screening sigmoidoscopy. Screening increased with the number of outpatient visits and with having a primary care provider in internal medicine. Men who did not undergo prostate-specific antigen testing were also less likely to undergo sigmoidoscopy screening. Only 24.5% of current smokers had a screening sigmoidoscopy examination and were 25% less likely to undergo this procedure compared with nonsmokers (adjusted OR, 0.75; 95% CI, 0.69,0.82). CONCLUSIONS. In this insured population for whom financial barriers are minimized, screening sigmoidoscopy use was as low as reported in the general population. However, minority patients were not less likely to be screened. Cancer 2007. © 2007 American Cancer Society. [source] Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood: findings from a 10-year longitudinal studyADDICTION, Issue 9 2010Maria McKenzie ABSTRACT Aims To examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in young adulthood. Design A prospective cohort study of adolescent and young adult health (n = 1943). Teen assessments occurred at 6-monthly intervals, with two follow-up assessments in young adulthood (wave 7, 1998; wave 8, 2001,03). Setting Victoria, Australia. Participants Students who participated at least once during the first six (adolescent) waves of the cohort study. Measurements Adolescent depression and anxiety symptoms were assessed using the Revised Clinical Interview Schedule (CIS-R). Young adult tobacco use was defined as: daily use (6 or 7 days per week) and dependent use (,4 on the Fagerstrom Test for Nicotine Dependence). Findings Among adolescent ,less than daily' smokers, those with high levels of depression and anxiety symptoms had an increased risk of reporting nicotine dependence in young adulthood [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.2,9.1] compared to young adults who had low levels of adolescent depression and anxiety symptoms, after adjusting for potential confounding factors. Similarly, in the adjusted model (OR 1.9, 95% CI 1.0,3.4), among adolescent ,daily' smokers, those with high levels of depression and anxiety symptoms had an almost two-fold increase in the odds of reporting nicotine dependence in young adulthood compared to young adults with low levels of adolescent depression and anxiety symptoms. Conclusions Adolescent smokers with depression and anxiety symptoms are at increased risk for nicotine dependence into young adulthood. They warrant vigilance from primary care providers in relation to tobacco use well into adulthood. [source] Reports of information and support needs of daughters and sisters of women with breast cancerEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2003ASSOCIATE PROFESSOR , K. CHALMERS RN, MSC(A) The aim of this study was to describe the information and support needs of women who have primary relatives with breast cancer. The Information and Support Needs Questionnaire (ISNQ) was developed and revised from previous qualitative and pilot studies. The ISNQ addressed concepts of the importance of, and the degree to which, 29 information and support needs related to breast cancer had been met. The study sample consisted of 261 community-residing women who had mothers, sisters, or a mother and sister(s) with breast cancer. Data were collected using a mailed survey. In addition to the ISNQ, additional items addressed family and health history, breast self-care practices, perception of the impact of the relative's breast cancer and other variables. Also included were established and well-validated measures of anxiety and depression. The findings document women's priority information and support needs. The information need most frequently identified as very important was information about personal risk of breast cancer. Other highly rated needs addressed risk factors for breast cancer and early detection measures. Generally, the women perceived that their information and support needs were not well met. These findings illuminate needs of women for more information and support when they have close family relatives with breast cancer and opportunities for primary care providers to assist women in addressing their needs. [source] Primary mental health workers in child and adolescent mental health servicesJOURNAL OF ADVANCED NURSING, Issue 1 2004Wendy Macdonald BSc PhD Background., The interface between primary care and specialist services is increasingly seen as crucial in the effective management of child and adolescent mental health (CAMH) problems. In the United Kingdom, a new role of primary mental health worker (PMHW), has been established in order to achieve effective collaboration across the interface through the provision of clinical care in primary care settings and by improving the skills and confidence of primary care staff. However, little is known about the development of this innovative role in service contexts. Issues raised during the early stages of implementation may have important implications for the preparation and development of professionals who undertake the role. Aims., The aim of this paper is to report on a study that examined key issues in implementation of the PMHW role in six health authorities in England. Methods., Case study evaluation was conducted, using thematic analysis of 75 qualitative interviews with key stakeholders from different professions (e.g. PMHWs, general practitioners, health visitors, psychiatrists and service managers) and representing different sectors (primary care, specialist services and community child health services). Findings., The study identified three models of organization (outreach, primary care-based and teams). Each was associated with different advantages and disadvantages in its effects on referral rates to specialist services and the development of effective working relationships with primary care providers. Problems associated with accommodation and effective integration of PMHWs with specialist services, and tensions caused by the two different roles that PMHWs could undertake (direct clinical care vs. consultation-liaison) were common across all sites. Conclusions., The PMHW role is an important development that may go some way towards realizing the potential of primary care services in CAMH. The implementation of new roles and models of working in primary care is complex, but may be facilitated by effective planning with primary care providers, clear goals for staff, and a long-term perspective on service development. [source] A Multidisciplinary Program for Delivering Primary Care to the Underserved Urban Homebound: Looking Back, Moving ForwardJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2006Kristofer L. Smith BA The coming decades will see a dramatic rise in the number of homebound adults. These individuals will have multiple medical conditions requiring a team of caregivers to provide adequate care. Home-based primary care (HBPC) programs can coordinate and provide such multidisciplinary care. Traditionally, though, HBPC programs have been small because there has been little institutional support for growth. Three residents developed the Mount Sinai Visiting Doctors (MSVD) program in 1995 to provide multidisciplinary care to homebound patients in East Harlem, New York. Over the past 10 years, the program has grown substantially to 12 primary care providers serving more than 1,000 patients per year. The program has met many of its original goals, such as helping patients to live and die at home, decreasing caregiver burden, creating a home-based primary care training experience, and becoming a research leader. These successes and growth have been the result of careful attention to providing high-quality care, obtaining hospital support through the demonstration of an overall positive cost,benefit profile, and securing departmental and medical school support by shouldering significant teaching responsibilities. The following article will detail the development of the program and the current provision of services. The MSVD experience offers a model of growth for faculty and institutions interested in starting or expanding a HBPC program. [source] Effects of Provider Practice on Functional Independence in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2004Elizabeth A. Phelan MD Objectives: To examine provider determinants of new-onset disability in basic activities of daily living (ADLs) in community-dwelling elderly. Design: Observational study. Setting: King County, Washington. Participants: A random sample of 800 health maintenance organization (HMO) enrollees aged 65 and older participating in a prospective longitudinal cohort study of dementia and normal aging and their 56 primary care providers formed the study population. Measurements: Incident ADL disability, defined as any new onset of difficulty performing any of the basic ADLs at follow-up assessments, was examined in relation to provider characteristics and practice style using logistic regression and adjusting for case-mix, patient and provider factors associated with ADL disability, and clustering by provider. Results: Neither provider experience taking care of large numbers of elderly patients nor having a certificate of added qualifications in geriatrics was associated with patient ADL disability at 2 or 4 years of follow-up (adjusted odds ratio (AOR) for experience=1.29, 95% confidence interval (CI)=0.81,2.05; AOR for added qualifications=0.72, 95% CI=0.38,1.39; results at 4 years analogous). A practice style embodying traditional geriatric principles of care was not associated with a reduced likelihood of ADL disability over 4 years of follow-up (AOR for prescribing no high-risk medications=0.56, 95% CI=0.16,1.94; AOR for managing geriatric syndromes=0.94, 95% CI=0.40,2.19; AOR for a team care approach=1.35, 95% CI=0.66,2.75). Conclusion: Taking care of a large number of elderly patients, obtaining a certificate of added qualifications in geriatrics, and practicing with a traditional geriatric orientation do not appear to influence the development of ADL disability in elder, community dwelling HMO enrollees. [source] A systematic review of health-related quality of life instruments used for people with venous ulcers: an assessment of their suitability and psychometric propertiesJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Simon J Palfreyman Aims and objectives., To review the quality of life questionnaires used to measure the impact of venous ulceration and to evaluate their psychometric properties. Background., Venous leg ulcers have a negative impact on quality of life. Health-related quality of life can be measured using structured questionnaires. Nurses are the primary care providers for patients with venous ulceration and are ideally placed to assess and develop these types of questionnaires. There may also be an opportunity to use such quality of life instruments to measure the impact of nursing interventions in other areas where nurses are the key care providers. Design., Systematic review. Method., Studies were sought that used quality of life instruments to evaluate the impact of venous ulceration. Fourteen electronic bibliographical databases and 11 Internet-based health services research related resources were searched. In addition, grey literature was sought and the reference lists of relevant articles checked. Data were extracted regarding the type of instrument used, sample, number of items and domains and psychometric performance of the instrument. Results., The initial search identified a total of 338 potential citations. After review, a total of 31 studies were included: 17 used generic and 14 used disease-specific instruments. Five different types of generic and seven disease-specific instruments were identified. There was significant heterogeneity between the studies in terms of study design, aetiology of ulceration and times of assessment. The disease-specific instruments showed limitations in relation to their applicability to venous ulcer patients because of flaws in design or validation. Conclusions., The literature on quality of life related to venous ulceration failed to sufficiently distinguish between those with different causes of leg ulceration. There appeared to be problems with the ability of current quality of life instruments to detect changes in quality of life related to ulcer healing. Relevance to clinical practice., There appears to be an opportunity for nurses to develop a health-related quality of life health-related quality of life instruments to evaluate their impact on patient outcomes. Such instruments could potentially allow nursing interventions to be assessed more effectively than the recently proposed nursing metrics. [source] Primary care mental health: a new frontier for psychologyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2009William B. Gunn Abstract The medical system in this country is divided into primary care and specialty care. Mental health is for the most part a specialty service dependent on referrals, often from primary care providers. The authors propose a new model where psychologists work in collaboration with primary care medical teams. This integrated, coordinated model enables psychologists to help patients they would not otherwise see in a mental health system. Examples of patients in this category are seniors, those with somatizing disorders, and those experiencing the challenges of dealing with a chronic illness. This model also enables psychologists to provide consultation to the medical teams. In this article, the authors discuss the world of the primary care medical team and present the rationale for integration or collaboration. They describe the barriers to collaborative practices and ways to overcome these barriers. Finally, they present practical strategies that psychologists can use on a regular basis to increase their collaboration with primary care. These strategies can be used by those who work in colocated practices as well as those who work in separate locations. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1,18, 2009. [source] Integrative outpatient treatment for returning service membersJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2008Sonja V. Batten Abstract Veterans returning from Operations Enduring and Iraqi Freedom (OEF/OIF) frequently present with multiple psychological and physical symptoms. The authors propose an innovative approach in which primary care providers, polytrauma specialists, vocational rehabilitation specialists, and mental health clinicians work together to provide care that is not simply concurrent, but truly integrated. All members of this interdisciplinary team must provide a consistent message that supports treatment engagement and progress. The authors illustrate this approach with a case report of a soldier deployed to both OEF and OIF, requiring subsequent treatment for joint pain, headaches, mild traumatic brain injury, posttraumatic stress disorder, depression, and substance abuse. Despite the emphasis on early intervention, treatment engagement and retention remain challenges in this population. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1,12;, 2008. [source] Integration and coordination of pain management in primary careJOURNAL OF CLINICAL PSYCHOLOGY, Issue 11 2006John D. Otis Pain is one of the most common symptoms reported to primary care providers and has significant implications for health care costs. The primary aim of this article is to describe and illustrate how to integrate the treatment of chronic pain in the primary care setting. First, we address the integration and coordination of care between mental health and primary care. We then present a typical case and discuss the patient's treatment, outcome, and prognosis. The article concludes with a discussion of issues that frequently arise when integrating psychological treatment for pain in primary care settings. © 2006 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 1333,1343, 2006. [source] Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherenceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2004Gail M. Powell-Cope PhD ARNP Abstract Rationale, aims and objectives, Clinical practice guidelines have become a standard way of implementing evidence-based practice, yet research has shown that clinicians do not always follow guidelines. Method, As part of a larger study to test the effects of an intervention on provider adherence to ischaemic heart disease (IHD) guidelines, we conducted five focus groups at three Veterans Administration Medical Centers with 32 primary care providers, cardiologists, and internists to identify key barriers and facilitators to adherence of the guidelines. Using content analysis, responses were grouped into categories. Results, The main perceived advantages of using the IHD guidelines were improvements in quality and the cost of care. Perceived barriers were the lack of ability of guidelines to manage the care of any one individual patient, the difficulty of accessing guidelines, and high workloads with many complex patients. While providers agreed on the benefits of aspirin, beta-blockers and angiotensin converting enzyme inhibitors, barriers for use of these medications were lack of consensus about contraindications, difficulty in providing follow-up during medication titration, and lack of patient adherence. Sources of influence for guideline use were: professional cardiology organizations, colleagues, mainly cardiologists, and key cardiology journals. However, most providers acknowledged that following guidelines was a personal practice decision. Conclusions, While results validated the influences of using clinical practice guidelines, our results highlight the importance of ascertaining guideline-specific barriers for building effective interventions to improve provider adherence. An advisory panel reviewed results and, using a modified nominal group process, chose implementation strategies targeting key barriers. [source] CE ARTICLE: Recognizing and treating upper extremity lymphedema in postmastectomy/lumpectomy patients: A guide for primary care providersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2010Eva Quirion MSN Abstract Purpose: To provide an overview of the lymphatics, physiology of lymphedema (LE), incidence, risks, and costs as well as a guide for the primary care provider on how to recognize the symptoms of LE, a review of current published treatment recommendations, and advice about making a referral to appropriate LE specialists. Data sources: Selected studies on diagnosing and treating LE in breast cancer patients following mastectomy/lumpectomy and evidence-based treatment guidelines. Conclusions: LE is the most common complication related to breast cancer treatment with an occurrence estimated between 10% and 60% depending on the parameters used for measurement. Most commonly, LE occurs within the first 3 years after breast cancer treatment, but the remaining cases happen beyond this period of time and can occur after many years. This means that significant numbers of patients with LE can present to primary care clinicians. Implications for practice: A patient who is treated for breast cancer will be followed for a time by the oncology team, but eventually, that patient will be discharged from the oncology practice and will be seen in primary care. Risk factors for developing LE include treatment-related (number of nodes removed and radiation to axilla), disease-related (stage and location of tumor), and patient-related (younger age, obesity, and comorbid conditions) factors. A systematic evaluation of any patient presenting with LE will assure accurate diagnosis and prompt treatment. [source] Not just another case of nausea and vomiting: A review of postinfectious gastroparesisJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2010Allison R. Thorn MSN, FNP-BC (Family Nurse Practitioner) Purpose: To review the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of postinfectious gastroparesis (PIGP). Data sources: Review of literature using Medscape, the Internet, and PubMed. The following search terms were used: gastroparesis, postinfectious gastroparesis, postviral gastroparesis, and idiopathic gastroparesis. There was no limitation placed on publication year. Only articles in English were used. Conclusions: PIGP is a rare illness that can affect all ages and both genders, although more prominent in middle-aged women. It is defined as delayed gastric emptying after an acute self-limited viral infection in the absence of mechanical obstruction. Limited research is available on PIGP. It is a complicated disorder with an unclear pathogenesis and narrow treatment options, therefore affecting the patient's quality of life significantly. Fortunately, the prognosis of PIGP is good, although in some instances it can take years to recover completely. Implications for practice: There is a huge lack of awareness of PIGP among primary care providers (PCPs). The importance of this illness is greatly underestimated. Educating PCPs about PIGP leads to quicker referrals and therefore faster treatment for patients, which in turn improves their health and quality of life, and thereby decreases healthcare costs as well. [source] Assessing postprandial glucose using 1,5-anhydroglucitol: An integrative literature reviewJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2009Brian Lee Christensen MS, CDE CDE-certified Diabetes Educator, FNP-BC Abstract Purpose: Recent studies have determined postprandial blood glucose is an independent risk factor for macrovascular complications. This risk exists, despite having HbA1C results within acceptable ranges for diabetes. 1,5-Anhydroglucitol (1,5AG) has been proposed as an appropriate indicator to detect and screen for postprandial hyperglycemia (PPHG). This review discusses the efficacy of 1,5AG to predict PPHG in order to reveal those who may be at risk for macrovascular complications. Data Sources: An electronic search was conducted from 2003 to 2008 in the following databases: Medline, CINAHL, Health Source: Nursing/Academic Edition, and Pre-CINAHL. Any articles relating to 1,5AG as a marker for PPHG were used. The search was limited to any human research articles published in English. All articles were reviewed for additional relevant studies. Conclusions: 1,5AG was found to be a reliable indicator of PPHG, even when HbA1C levels were within target ranges. 1,5AG may be a simple and effective tool for primary care providers to identify those at risk for macrovascular complications, who would otherwise go unnoticed if assessed by HbA1C alone. [source] Sensory processing disorder: Any of a nurse practitioner's business?JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2009DrNPc, Elise D. Fish Professor of Clinical Health Care for the Underserved, FAAN Stone Foundation, Mary W. Byrne PhD Abstract Purpose: Children who exhibit the confusing symptom patterns associated with sensory processing deficits are often seen first by primary care providers, including family and pediatric nurse practitioners (NPs). The purpose of this article is to alert NPs to the state of the science for these disorders and to the roles NPs could play in filling the knowledge gaps in assessment, treatment, education, and research. Data sources: Literature searches using PubMed and MedLine databases and clinical practice observations. Conclusions: Sensory integration disorders have only begun to be defined during the past 35 years. They are not currently included in the DSM IV standard terminology, and are not yet substantively incorporated into most health disciplines' curricula or practice, including those of the NP. Implications for practice: NPs are in a unique position to test hypothesized terminology for Sensory Processing Disorder (SPD) by contributing precise clinical descriptions of children who match as well as deviate from the criteria for three proposed diagnostic groups: Sensory Modulation Disorder (SMD), Sensory Discrimination Disorder (SDD), and Sensory-Based Motor Disorder (SBMD). Beyond the SPD diagnostic debate, for children with sensory deficit patterns the NP role can incorporate participating in interdisciplinary treatment plans, refining differential diagnoses, providing frontline referral and support for affected children and their families, and making both secondary prevention and critical causal research possible through validation of consistently accepted diagnostic criteria. [source] | |||||||||||||||||||||||||