MedWorm: Primary Care Practices

Is Presence of a Student-Run Clinic During Medical School Associated with Future Primary Care Practice? (Sebastian Tong Mr.)

Family Medicine Digital Resources Library (FMDRL) Recently Uploaded — Tue, 07 Feb 2012 05:00:00 +0100

This powerpoint presentation addresses whether there is an association between presence of a student-run clinic at a medical school and future practice of medical school graduates in a primary care specialty. A 2005 survey of all student-run clinics associated with medical schools was supplemented by direct survey of schools missing from this dataset. We used multiple linear regression to test associations controlling for medical school confounders. In 2005, 72 of 115 responding medical schools had student-run clinics. No association was found between having a student-run clinic at a medical school and proportion of its graduates who currently practice primary care. We will discuss implications and future directions for student-run clinic research. Please contact me (Sebastian Tong) by em...

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Electronic Medical Record Availability and Primary Care Depression Treatment

Journal of General Internal Medicine — Mon, 06 Feb 2012 19:36:48 +0100

Conclusions EMRs appear to have an unintended negative association with depression care provided during visits made by primary care patients with multiple chronic conditions. Content Type Journal ArticleCategory Original ResearchPages 1-6DOI 10.1007/s11606-012-2001-0Authors Jeffrey S. Harman, Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USAKathryn M. Rost, Department of Mental Health Law and Policy, Florida Mental Health Institute, University of South Florida, Tampa, FL, USAChristopher A. Harle, Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USARobert L. Cook...

Improving rates of herpes zoster vaccination with a clinical decision support system in a primary care practice

Journal of Evaluation in Clinical Practice — Sun, 05 Feb 2012 05:00:00 +0100

Conclusion Herpes zoster vaccination rate significantly improved with implementation of a web‐based clinical decision support system. (Source: Journal of Evaluation in Clinical Practice)

A Rural Health Service Learning Elective (Rita Lahlou)

Family Medicine Digital Resources Library (FMDRL) Recently Uploaded — Wed, 01 Feb 2012 05:00:00 +0100

Although many curricula are designed to increase student interest in primary care, few have been evaluated with regard to participants' final specialty choice, controlling for characteristics known to predict primary care practice. This session will describe an elective designed to foster interest in primary care, in which second year medical students manage operations at a free clinic, establish a continuity relationship with patients, attend a class covering primary care topics, keep a reflective journal, and complete a community project. We evaluated the impact of this course by surveying a sample of 257 alumni who graduated between 2003 and 2007. After adjustment for characteristics known to be associated with specialty choice, course participants were 5.5 times more likely than contro...

The Effectiveness of Implementing an Electronic Health Record on Diabetes Care and Outcomes

ICMCC: The International Council on Medical and Care Compunetics — Wed, 25 Jan 2012 08:30:40 +0100

Source: Herrin J et al, Health Services Research, 2012 Content: Objective To assess the impact of electronic health record (EHR) implementation on primary care diabetes care. Data Sources Charts were abstracted semi-annually for 14,051 diabetes patients seen in 34 primary care practices in a large, fee-for-service network from January 1, 2005 to December 31, 2010. The study sample [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

[Use and acceptance of a basic geriatric assessment in primary care setting.]

Zeitschrift fur Gerontologie und Geriatrie — Wed, 25 Jan 2012 05:00:00 +0100

CONCLUSION: Hitherto BGA is not an established tool in German primary care practices. The question, which single instruments are most suitable for older general practice patients, still needs clarification. PMID: 22270893 [PubMed - as supplied by publisher] (Source: Zeitschrift fur Gerontologie und Geriatrie)

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Does general practice reduce health inequalities? Analysis of quality and outcomes framework data

The European Journal of Public Health — Tue, 24 Jan 2012 05:00:00 +0100

Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement. (Source: The European Journal of Public Health)

A Randomized Controlled Trial of Positive-Affect Intervention and Medication Adherence in Hypertensive African Americans [Original Investigation]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans. Future studies should assess the cost-effectiveness of integrating such interventions into primary care. Trial Registration clinicaltrials.gov Identifier: NCT00227175 (Source: Archives of Internal Medicine)

Myca Health focuses on improving efficiency of primary care with latest release of Hello Health®

Healthcare IT News Press Releases — Fri, 20 Jan 2012 14:33:12 +0100

Myca Health Inc. announced today the release of version 5.0 of its cloud-based Hello Health® Patient Management solution for primary care practices. The platform connects patients and their primary care physician through an integrated electronic health record, online patient portal and a suite of secure, web-based communication tools. Hello Health version 5.0 is Surescripts® certified for prescription routing among many new features designed to streamline workflow for primary care physicians and their staff. read more (Source: Healthcare IT News Press Releases)

A comparative analysis of the health and well-being of cancer survivors to the general population

Supportive Care in Cancer — Fri, 20 Jan 2012 07:05:17 +0100

Conclusions The majority of cancer survivors do not appear to require additional support services. There is, however, a subgroup of survivors who warrant specialist support, particularly survivors who are older, experience late effects and have had adjuvant treatments. Future research should focus on developing methods that could be used in routine clinical practice to identify ‘at risk’ or vulnerable patients and to provide appropriate and timely support. Content Type Journal ArticleCategory Original ArticlePages 1-8DOI 10.1007/s00520-011-1372-9Authors Olinda Santin, School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, Block 97, Health Sciences, Belfast, UKMoyra Mills, School of Nursing and Midwifery, Queen’s University Belf...

Mortality After Incident Cancer in People With and Without Type 2 Diabetes: Impact of metformin on survival.

Diabetes Care — Fri, 20 Jan 2012 05:00:00 +0100

CONCLUSIONSThis study confirmed that type 2 diabetes was associated with poorer prognosis after incident cancer, but that the association varied according to diabetes therapy and cancer site. Metformin was associated with survival benefit both in comparison with other treatments for diabetes and in comparison with a nondiabetic population. PMID: 22266734 [PubMed - as supplied by publisher] (Source: Diabetes Care)

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A qualitative study on patients' and physicians' visions for the future management of overweight or obesity

Family Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion. Options should be developed for closer cooperation between GPs and support facilities inside and outside practices. (Source: Family Practice)

Electronic health record-based surveillance of diagnostic errors in primary care

Quality and Safety in Health Care — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions While physician agreement on diagnostic error remains low, an EHR-facilitated surveillance methodology could be useful for gaining insight into the origin of these errors. (Source: Quality and Safety in Health Care)

Columbus medical homes move forward without state training grants

bizjournals.com Health Care:Biotechnology headlines — Wed, 18 Jan 2012 20:51:46 +0100

With its own privately coordinated medical home project in full swing, Central Ohio is not part of a growing state initiative to train primary care doctors as wellness quarterbacks. The state is investing $1 million in training for 50 primary care practices to convert to the patient-centered medical home model, which emphasizes coordination, prevention and follow-up in the hopes of keeping patients out of emergency rooms and hospitals. The initiative by the Ohio Department of Health and the state Office of Health Transformation is centered on Athens, Dayton, Toledo and the Akron/Canton region... (Source: bizjournals.com Health Care:Biotechnology headlines)

The Effectiveness of Implementing an Electronic Health Record on Diabetes Care and Outcomes

Health Services Research — Wed, 18 Jan 2012 15:46:45 +0100

ConclusionImplementation of a commercially available EHR in primary care practice may improve diabetes care and clinical outcomes. (Source: Health Services Research)

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Does GP training in depression care affect patient outcome? - A systematic review and meta-analysis.

BMC Health Services Research — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions: This is the first overview of randomized controlled trials introducing GP training for depression care. Provider training by itself does not seem to improve depression care; however, if combined with additional guidelines implementation, results are promising for new-onset depression patient samples. Additional organizational structure changes in form of collaborative care models are more likely to show effects on depression care. (Source: BMC Health Services Research)

Prevalence of Bipolar Disorder symptoms in Primary Care (ProBiD-PC): A Canadian study. - Chiu JF, Chokka PR.

SafetyLit: All (Unduplicated) — Fri, 06 Jan 2012 15:21:09 +0100

Objective To describe the prevalence of patients who screen positive for symptoms of bipolar disorder in primary care practice using the validated Mood Disorders Questionnaire (MDQ). Design Prevalence survey. Setting Fifty-four primary care practices acros... (Source: SafetyLit: All (Unduplicated))

Barriers and facilitators to routine distribution of patient decision support interventions: a preliminary study in community‐based primary care settings

Health Expectations — Mon, 02 Jan 2012 05:00:00 +0100

Conclusions This study confirmed the importance of physician engagement when implementing DESIs and found mixed effects for providing financial incentives. The relatively low rate of DESI viewing suggests further research on increasing patient uptake of these interventions in routine practice is necessary. (Source: Health Expectations)

Systematic review and meta-analysis of practice facilitation within primary care settings.

Annals of Family Medicine — Sun, 01 Jan 2012 05:00:00 +0100

CONCLUSION Practice facilitation has a moderately robust effect on evidence-based guideline adoption within primary care. Implementation fidelity factors, such as tailoring, the number of practices per facilitator, and the intensity of the intervention, have important resource implications. PMID: 22230833 [PubMed - in process] (Source: Annals of Family Medicine)

The SHARE Frailty Instrument for primary care predicts incident disability in a European population-based sample.

Quality in Primary Care — Mon, 26 Dec 2011 11:06:02 +0100

CONCLUSION: SHARE-FI may contribute to quality in primary care by offering a quick and reliable way to assess and monitor frailty in community dwelling individuals over the age of 50 and prioritise their access to resources, and it serves as a novel tool for audit and research. PMID: 22186172 [PubMed - in process] (Source: Quality in Primary Care)

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Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home.

Quality in Primary Care — Mon, 26 Dec 2011 11:06:02 +0100

CONCLUSIONS: Transforming practices to more patient-centred models of care will be a priority for primary care providers. Identifying opportunities and challenges associated with implementing change is critical for successful improvement programmes. Successful strategies for enhancing the adoption and uptake of PCMH elements should leverage areas of concordance between practice members' perceived needs and planned improvement efforts. PMID: 22186171 [PubMed - in process] (Source: Quality in Primary Care)

A practice-based trial of blood pressure control in African Americans (TLC-Clinic): study protocol for a randomized controlled trial

Trials — Thu, 22 Dec 2011 05:00:00 +0100

DiscussionThis vanguard trial will provide information on how to refine MINT-TLC and integrate it into a standard treatment protocol for hypertensive African Americans as a result of the data obtained; thus maximizing the likelihood of its translation into clinical practice.Trial Registration: Clinicaltrials.gov NCT01070056 (Source: Trials)

Failure to Follow-Up Test Results for Ambulatory Patients: A Systematic Review

Journal of General Internal Medicine — Tue, 20 Dec 2011 06:42:18 +0100

CONCLUSIONS Failure to follow-up test results is an important safety concern which requires urgent attention. Solutions should be multifaceted and include: policies relating to responsibility, timing and process of notification; integrated information and communication technologies facilitating communication; and consideration of the multidisciplinary nature of the process and the role of the patient. It is essential that evaluations of interventions are undertaken and solutions integrated into the work and context of ambulatory care delivery. Content Type Journal ArticleCategory ReviewsPages 1-15DOI 10.1007/s11606-011-1949-5Authors Joanne L. Callen, Centre for Health Systems and Safety Research, Faculty of Medicine, The University of New South Wales, Sydney, NSW ...

Inviting patients to read their doctors' notes: patients and doctors look ahead: patient and physician surveys.

Annals of Internal Medicine — Tue, 20 Dec 2011 05:00:00 +0100

Conclusion: Among PCPs, opinions about open visit notes varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care. Sharing visit notes has broad implications for quality of care, privacy, and shared accountability. Primary Funding Source: The Robert Wood Johnson Foundation's Pioneer Portfolio, Drane Family Fund, and Koplow Charitable Foundation. PMID: 22184688 [PubMed - in process] (Source: Annals of Internal Medicine)

Medical Center Characteristics Associated with PSA Screening in Elderly Veterans with Limited Life Expectancy

Journal of General Internal Medicine — Sat, 17 Dec 2011 06:45:07 +0100

CONCLUSIONS Substantial practice variation exists for PSA screening in older men with limited life expectancy across VAs. The high center-specific correlation of screening among men with limited and favorable life expectancies indicates that PSA screening is poorly targeted according to life expectancy. Content Type Journal ArticleCategory Original ResearchPages 1-8DOI 10.1007/s11606-011-1945-9Authors Cynthia So, School of Medicine, University of California, San Francisco, CA, USAKatharine A. Kirby, Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA, USAKala Mehta, Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA, USARichard M. Hoffman, New Mexico VA Health Ca...

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A cluster randomised trial of educational messages to improve the primary care of diabetes

Implementation Science — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions: Three out of four interventions improved intermediate outcomes or process of diabetes care. The diastolic BP reduction approximates to relative reductions in mortality of 3% to 5% in stroke and 3% to 4% in ischaemic heart disease over 10 years. The lack of effect for other outcomes may, in part, be explained by difficulties in bringing about further improvements beyond certain thresholds of clinical performance.Trial RegistrationCurrent Controlled Trials, ISRCTN2186314. (Source: Implementation Science)

Understanding ethnic and other socio-demographic differences in patient experience of primary care: evidence from the English General Practice Patient Survey

Quality and Safety in Health Care — Thu, 15 Dec 2011 05:00:00 +0100

Conclusion Substantial ethnic differences in patient experience exist in a national healthcare system providing universal coverage. Improving the experience of patients in low-scoring practices would not only improve the quality of care provided to their White patients but it would also substantially reduce ethnic group differences in patient experience. There were large variations in the experiences reported by ethnic minority patients in different practices: practices with high patient experience scores from ethnic minority patients could be studied as models for quality improvement. (Source: Quality and Safety in Health Care)

Exploring situational awareness in diagnostic errors in primary care

Quality and Safety in Health Care — Thu, 15 Dec 2011 05:00:00 +0100

Conclusions A framework of SA can help analyse and understand diagnostic errors in primary care settings that use EHRs. (Source: Quality and Safety in Health Care)

Diabetes care for older patients in America

International Journal of Clinical Practice — Mon, 12 Dec 2011 05:00:00 +0100

Conclusion: A designated primary care physician is crucial for providing recommended diabetes care services for older patients. Strengthening structural capabilities of primary care practices and implementing patient‐centred primary care initiatives in concert with health system reforms are necessary to deliver the co‐ordinated diabetes care with maximised health outcomes. (Source: International Journal of Clinical Practice)

Cued Recall and Other Cognitive Tasks to Facilitate Dementia Recognition in Primary Care

Journal of the American Geriatrics Society — Thu, 08 Dec 2011 05:00:00 +0100

ConclusionThe VAT (cued recall of pictorial material) is superior to other tasks for the recognition of dementia in terms of higher specificity and PPV. Age‐specific cutoff scores may improve the validity of all tests. (Source: Journal of the American Geriatrics Society)

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Preventive Care Delivery And Funding

Health News from Medical News Today — Tue, 06 Dec 2011 10:00:00 +0100

Female physicians, smaller patient loads and electronic reminders are associated with better delivery of preventive health care to patients, rather than the way in which primary care practices are funded, states an article in CMAJ (Canadian Medical Association Journal).. Although there is significant interest around the world in improving primary care delivery -- that is, first-line general health care -- and disease prevention, there is a lack of evidence about which payment model is associated with superior delivery of primary care... (Source: Health News from Medical News Today)

Funding models not associated with better preventive care delivery

EurekAlert! - Social and Behavioral Science — Mon, 05 Dec 2011 05:00:00 +0100

(Canadian Medical Association Journal) Female physicians, smaller patient loads and electronic reminders are associated with better delivery of preventive health care to patients, rather than the way in which primary care practices are funded, states an article in Canadian Medical Association Journal. (Source: EurekAlert! - Social and Behavioral Science)

Hip Fracture Risk Rose at Start of Loop Diuretics

Ob.Gyn. News — Thu, 01 Dec 2011 05:00:00 +0100

SAN DIEGO – The risk of hip fracture nearly doubles during the week following a new prescription for a loop diuretic. In contrast, there is no spike in the risk of hip fracture in the 7 days following a new prescription for other classes of diuretics or for ACE inhibitors, according to an analysis of the massive The Health Improvement Network (THIN) database involving more than 400 U.K. primary care practices. (Source: Ob.Gyn. News)

Deep vein thromboses in users of opioid drugs: incidence, prevalence, and risk factors.

The British Journal of General Practice — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION: Primary care providers should be aware of the considerably increased risk of DVT and its sequelae in users of intravenous drugs. Evidence for effective primary care prevention and the effective management of DVT complications is lacking; until this emerges, vigilance on the part of clinicians may help to minimise harm. PMID: 22137414 [PubMed - in process] (Source: The British Journal of General Practice)

Translating policy into practice: a case study in the secondary prevention of coronary heart disease

Health Expectations — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements – specifying tasks to be undertaken and methods for monitoring and reporting on activity – are required. (Source: Health Expectations)

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One-third of PCPs working with regional extension centers to implement EHRs

Modern Medicine — Wed, 30 Nov 2011 05:00:00 +0100

More than 100,000 primary care practices are using the services of a regional extension center to implement electronic health records. Consider joining them if your practice is closer to the beginning of the process than the end. (Source: Modern Medicine)

Designing a patient-centered personal health record to promote preventive care

BMC Medical Informatics and Decision Making - Latest articles — Thu, 24 Nov 2011 05:00:00 +0100

Conclusions The IPHR demonstrates that a patient-centered personal health record that interfaces with the electronic medical record can give patients a high level of individualized guidance and be successfully adopted by busy primary care practices. Further study and refinement are necessary to make information systems even more patient-centered and to demonstrate their impact on care.Trial Registration Clinicaltrials.gov identifier: NCT00589173 (Source: BMC Medical Informatics and Decision Making - Latest articles)

Identifying unintended consequences of quality indicators: a qualitative study

Quality and Safety in Health Care — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150 000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money. (Source: Quality and Safety in Health Care)

Multivariate modeling to identify patterns in clinical data: the example of chest pain

BMC Medical Research Methodology - Latest articles — Tue, 22 Nov 2011 05:00:00 +0100

Conclusions: Chest pain is a heterogeneous clinical category with no coherent associations between signs and symptoms on patient level. (Source: BMC Medical Research Methodology - Latest articles)

Passive immunization.

Primary Care — Mon, 21 Nov 2011 14:25:20 +0100

This article focuses on specific immunoglobulins for preventing or treating infectious diseases, as these are the most likely scenarios one might encounter in primary care practice. PMID: 22094139 [PubMed - in process] (Source: Primary Care)

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Automated blood pressure readings in primary care demonstrate better correlation to the gold standard of ambulatory monitoring than manual assessment

Evidence-Based Medicine — Sun, 20 Nov 2011 05:00:00 +0100

Context Despite the use of gold standard equipment such as mercury sphygmomanometers in primary care for the measurement of blood pressure, accuracy remains a problem. This is due to a combination of system (eg, lack of calibration of instruments), physician (eg, observer error) and patient (eg, sympathetic drive) factors. Programmable automatic and semiautomatic oscillometric devices are likely to replace such devices because of occupational health concerns with the use of mercury. Methods This is a cluster randomised controlled study of an automated oscillometric blood pressure device method of determining blood pressure (intervention) versus usual manual measurement (control) in primary care. Both arms ambulatory blood pressure (ABP) measurements were also taken. The study included 555 ...

Health Information Systems in Small Practices: Improving the Delivery of Clinical Preventive Services

American Journal of Preventive Medicine — Sun, 20 Nov 2011 00:39:41 +0100

Conclusions: Delivery of CPS can increase in small primary care practices that implement an EHR that includes comprehensive quality-improvement support. (Source: American Journal of Preventive Medicine)

Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement.

Translational Research : the journal of laboratory and clinical medicine — Fri, 18 Nov 2011 20:07:14 +0100

In conclusion, a primary care/Internet-based intervention model among adolescents demonstrated reductions in depressed mood over 6 months and may result in fewer depressive episodes. PMID: 22061038 [PubMed - in process] (Source: Translational Research : the journal of laboratory and clinical medicine)

Medical and Behavioral Evaluation of Patients with Obesity

The Psychiatric Clinics of North America — Fri, 18 Nov 2011 16:56:51 +0100

Overweight and obesity are the most common medical problems seen in primary care practice, together affecting over 68% of adults and 31.7% of children and adolescents in the United States. Obesity is known to affect at least nine organ systems and is linked to the most prevalent and costly medical problems seen in daily practice. Successful treatment and control of obesity has the potential to have a significant impact on several chronic diseases. Yet despite the importance of screening and evaluating for obesity—and the recommendation to do so from multiple organizations—detection and counseling rates among physicians remain low. On the other hand, several observational studies have shown that physician acknowledgment of patients' excess weight increases the likelihood of behavior cha...

Diagnostic Yield of Chromosomal Microarray Analysis in an Autism Primary Care Practice: Which Guidelines to Implement?

Journal of Autism and Developmental Disorders — Thu, 17 Nov 2011 05:00:00 +0100

Authors: McGrew SG, Peters BR, Crittendon JA, Veenstra-Vanderweele J Abstract Genetic testing is recommended for patients with ASD; however specific recommendations vary by specialty. American Academy of Pediatrics and American Academy of Neurology guidelines recommend G-banded karyotype and Fragile X DNA. The American College of Medical Genetics recommends Chromosomal Microarray Analysis (CMA). We determined the yield of CMA (N = 85), karyotype (N = 119), and fragile X (N = 174) testing in a primary pediatrics autism practice. We found twenty (24%) patients with abnormal CMA results (eight were clinically significant), three abnormal karyotypes and one Fragile X syndrome. There was no relationship between CMA result and cognitive level, seizures, dysmorphology, congenital ma...

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'Enhanced' Counseling May Help Some Obese Patients'Enhanced' Counseling May Help Some Obese Patients

Medscape Medical News Headlines — Tue, 15 Nov 2011 17:17:36 +0100

About a third of obese patients seen in primary-care practice who received an extra helping of weight-loss counseling plus either meal replacements or a diet drug achieved a modest but meaningful 5% weight loss at two years in a new study. Heartwire (Source: Medscape Medical News Headlines)

Some obese patients may shed pounds with "enhanced" counseling

theHeart.org — Tue, 15 Nov 2011 13:15:00 +0100

Project Better Care Aims to Improve Primary Care

RWJF News Digest - Quality/Equality — Tue, 15 Nov 2011 05:00:00 +0100

Healthy Memphis Common Table has launched a program to help support primary care practices in delivering the best patient care possible. (Source: RWJF News Digest - Quality/Equality)

A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice

New England Journal of Medicine — Mon, 14 Nov 2011 21:00:12 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print. (Source: New England Journal of Medicine)

Patient Care Improvements May Be Slow With Medical Homes

RWJF News Digest - Quality/Equality — Mon, 14 Nov 2011 05:00:00 +0100

The goal of transitioning existing primary care practices into patient-centered medical homes (PCMHs) is to improve quality of care and patient satisfaction. (Source: RWJF News Digest - Quality/Equality)

Sicker Adults With A Medical Home Fare Better

Health News from Medical News Today — Fri, 11 Nov 2011 08:00:00 +0100

Chronically and seriously ill US adults stand out for skipping needed care due to costs and struggling with medical debt Chronically and seriously ill adults who received care from a medical home - an accessible primary care practice that helps coordinate care - were less likely to report medical errors, test duplication, and other care coordination failures, according to a new Commonwealth Fund international survey of patients' experiences in the U.S. and 10 other high-income countries... (Source: Health News from Medical News Today)

Diabetes Care Among Somali Immigrants and Refugees

Journal of Community Health — Thu, 10 Nov 2011 16:54:50 +0100

This study demonstrates disparities in achievement of diabetes management quality goals among Somali patients compared with non-Somali patients, highlighting the need for additional system and practice changes to target this particularly vulnerable population. Content Type Journal ArticleCategory Original PaperPages 1-5DOI 10.1007/s10900-011-9499-7Authors Mark L. Wieland, Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55904, USAT. Ben Morrison, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USAStephen S. Cha, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USAAhmed S. Rahman, Division of Health Care Policy and Research, Mayo Clinic College of M...

Got PAD? Hidden dangers revealed with ABI

Journal of Vascular Nursing — Thu, 10 Nov 2011 15:58:05 +0100

Peripheral artery disease (PAD), a result of atherosclerotic vascular changes to the endothelial lining of blood vessels, affects 8-12 million Americans and increases the risk of mortality as much as 50% from heart attacks and strokes. Early diagnosis and treatment of PAD along with early risk-reduction strategies have the potential to decrease societal health costs, as well as morbidity and mortality. PAD through screening with ankle brachial index (ABI), versus relying on existing physical exam and screening questionnaires, can increase the number of participants correctly diagnosed with PAD and lead to earlier treatment options. ABI screening was implemented in a primary care practice setting; outcomes were compared with historical rates and outcomes for participants at risk who decline...

Medical homes prove worth, in U.S. and abroad

Healthcare IT News — Wed, 09 Nov 2011 15:04:13 +0100

A new Commonwealth Fund international survey finds that chronically and seriously ill adults who received care from a medical home were less likely to report medical errors, test duplication and other care coordination failures. The survey, which polled patient experiences in the U.S. and 10 other high-income countries, also found that patients connected with medical homes – accessible primary care practices that help coordinate care – had better relationships with their doctors and rated their care more highly. No read more (Source: Healthcare IT News)

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New international health survey of sicker adults: Those with a medical home fare better

EurekAlert! - Medicine and Health — Wed, 09 Nov 2011 05:00:00 +0100

(Commonwealth Fund) Chronically and seriously ill adults who received care from a medical home -- an accessible primary care practice that helps coordinate care -- were less likely to report medical errors, test duplication, and other care coordination failures, according to a new Commonwealth Fund international survey of patients' experiences in the US and 10 other high-income countries. The Health Affairs article found that patients connected with had better relationships with their doctors and rated their care more highly. (Source: EurekAlert! - Medicine and Health)

Payment models offer preview of future for primary care

Modern Medicine — Wed, 09 Nov 2011 05:00:00 +0100

What will the payment system for primary care look like in the future? A new government-sponsored program may offer a preview. Through the Comprehensive Primary Care Initiative announced by the Centers for Medicare and Medicaid Services, 75 high-performing primary care practices in each of five to seven markets will have the opportunity to earn additional revenue. Discover the payment models being tested under the program—and how they could innovate practice finance. (Source: Modern Medicine)

Predictors of Medication Adherence in an Urban Latino Community with Healthcare Disparities

Journal of Immigrant and Minority Health — Tue, 08 Nov 2011 16:50:05 +0100

Abstract Ethnic disparities exist when comparing glycemic control: Latino patients have suboptimal glycemic control as compared to non-Latino whites. A key factor to achieving optimal diabetes management and control is medication adherence. We conducted a nested, cross-sectional retrospective study of data (n = 61) collected from a larger parallel, randomized, longitudinal study conducted at an urban primary care practice examining a culturally tailored community-based peer counselor intervention. Baseline demographic and medication utilization covariates were evaluated for eligibility into the multivariate logistic regression to predict medication adherence. Significant correlates of medication adherence were physician or healthcare team support (OR 12.79, 95% CI...

Doctor-Office Collaborative Care for Pediatric Behavioral Problems: A Preliminary Clinical Trial [Article]

Archives of Pediatrics — Mon, 07 Nov 2011 05:00:00 +0100

Conclusion The feasibility and clinical benefits of DOCC for behavioral problems support the integration of collaborative mental health services for common mental disorders in primary care. (Source: Archives of Pediatrics)

Patients' evaluations of European general practice--revisited after 11 years

International Journal for Quality in Health Care — Mon, 07 Nov 2011 05:00:00 +0100

Conclusion Overall, the patients' evaluations of general practice were very positive in family practice care in the years 1998 and 2009. The trends over the years need to be carefully interpreted over time. (Source: International Journal for Quality in Health Care)

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One-Year Results of the Think Health! Study of Weight Management in Primary Care Practices.

Obesity — Thu, 03 Nov 2011 04:00:00 +0100

Authors: Kumanyika SK, Fassbender JE, Sarwer DB, Phipps E, Allison KC, Localio R, Morales KH, Wesby L, Harralson T, Kessler R, Tan-Torres S, Han X, Tsai AG, Wadden TA Abstract The Think Health! study evaluated a behavioral weight loss program adapted from the Diabetes Prevention Program (DPP) lifestyle intervention to assist primary care providers (PCPs) and auxiliary staff acting as lifestyle coaches (LCs) in offering weight loss counseling to their patients. In a randomized trial conducted at five clinical sites, study participants were randomly assigned in a 1:1 ratio within each site to either "Basic Plus" (n = 137), which offered PCP counseling every 4 months plus monthly LC visits during the first year of treatment, or "Basic" (n = 124), which offered only PCP counseling ever...

Patient-Centered Medical Home Services in 29 Rural Primary Care Practices: A Work in Progress

Rural publications via the Rural Assistance Center — Wed, 02 Nov 2011 16:49:19 +0100

Discusses survey responses from 29 rural physician practices from around the country. When asked about their use of specific policies and procedures that are included as criteria to certify patient-centered medical homes, fewer of them would qualify in each of five domains, including access to care, population-based, quality, care management, and clinical information management. -- RUPRI Center for Rural Health Policy Analysis (Source: Rural publications via the Rural Assistance Center)

Family physician attitudes in managing obesity: a cross-sectional survey study

BMC Research Notes — Tue, 01 Nov 2011 04:00:00 +0100

Conclusions: Our pilot survey suggests that differences in beliefs regarding the causes of obesity may exist between rural and non-rural physicians. Further research in larger, more diverse samples is necessary to further illuminate practice differences. More comprehensive approaches to obesity management, like the Chronic Care Model, are suggested by these results. (Source: BMC Research Notes)

Retainer medicine: an ethically legitimate form of practice that can improve primary care.

Annals of Internal Medicine — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Huddle TS, Centor RM Abstract Retainer medicine has become an important yet controversial form of primary care practice in the United States, coming under attack for its purported failure to measure up to professional ethics. Critics opine that retainer medicine obstructs professional commitments to health care access and social justice. Some ethicists urge that society should restrict or ban retainer medicine; professional organizations have yet to take a stand. The authors believe that retainer medicine is compatible with professional ethics and will more likely aid in solving the difficulties facing primary care rather than add to them. Although professional ethics should evolve to address new conditions, a condemnation of retainer medicine is warranted neither by tradi...

The Patient-Centered Medical Home and the Nephrologist

Advances in Chronic Kidney Disease — Tue, 01 Nov 2011 04:00:00 +0100

The patient-centered medical home (PCMH) is a model of practice that has been proposed to address the many ills of our current health care delivery and financing systems. At its heart is a primary care practice that provides comprehensive, coordinated, high-quality, personalized care. Integral to the success of the PCMH model is a “neighborhood” of specialists who subscribe to the principles of the PCMH. Nephrologists will have an opportunity to practice within this framework, either as the PCMH itself or, more likely, as “neighbors” to the “home.” The effective and enthusiastic participation of nephrologists and other specialists will depend on the details of the model, not the least important of which is the financial structure. Dozens of demonstration projects around the cou...

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Age equity in different models of primary care practice in Ontario.

Canadian Family Physician Medecin de Famille Canadien — Tue, 01 Nov 2011 04:00:00 +0100

Conclusion The salaried model might have an organizational structure that is more conducive to providing appropriate care across age groups. The thrust toward adopting capitation-based payment is unlikely to have an effect on age disparities. PMID: 22084464 [PubMed - in process] (Source: Canadian Family Physician Medecin de Famille Canadien)

Translating cholesterol guidelines into primary care practice: a multimodal cluster randomized trial.

Annals of Family Medicine — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSION This study showed null results with the intent-to-treat analysis regarding the benefits of a patient activation and a decision support tool in improving cholesterol management in primary care practices. Post hoc analysis showed a potential benefit in practices that used the e-health tools more frequently in screening and management of dyslipidemia. Further research on how to incorporate and increase adoption of user-friendly, patient-centered e-health tools to improve screening and management of chronic diseases and their risk factors is warranted. PMID: 22084264 [PubMed - in process] (Source: Annals of Family Medicine)

Medical Student Awareness of the Patient-centered Medical Home.

Famly Medicine — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSIONS: Medical students appear to have limited exposure and knowledge of the PCMH concept, suggesting the need to develop curricula about the PCMH in medical schools. PMID: 22076711 [PubMed - in process] (Source: Famly Medicine)

Effectiveness of a quality-improvement program in improving management of primary care practices.

cmaj — Mon, 31 Oct 2011 04:00:00 +0100

We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. METHODS:In a before-after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group's second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices,on a scale of 0 to 100. RESULTS:We found significant improvements in all domains between the first and second assessments in the intervention group. In t...

The appropriateness of prescribing antibiotics in the community in Europe: study design

BMC Infectious Diseases — Fri, 28 Oct 2011 04:00:00 +0100

This study will provide valuable and unique data concerning resistance patterns and prescription behaviours in primary care in nine European countries. It will provide evidence-based recommendations on antibiotic prescription guidelines that take resistance patterns into account which will be useful for both clinicians and policy makers. By improving antibiotic use we can move towards controlling the resistance problem globally. (Source: BMC Infectious Diseases)

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Implementing collaborative care for depression treatment in primary care: A cluster randomized evaluation of a quality improvement practice redesign

Implementation Science — Thu, 27 Oct 2011 04:00:00 +0100

Conclusions: Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed.Trial RegistrationNCT00105820 (Source: Implementation Science)

Shared Electronic Vascular Risk Decision Support in Primary Care: Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness (COMPETE III) Randomized Trial [Original Investigation]

Archives of Internal Medicine — Mon, 24 Oct 2011 04:00:00 +0100

Conclusion Despite favorable reviews and important improvements in the complex processes required to reduce vascular risk, clinical outcomes remain unchanged. Trial Registration clinicaltrials.gov Identifier: NCT00132145 (Source: Archives of Internal Medicine)

[Articles] Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial

LANCET — Sat, 22 Oct 2011 04:00:00 +0100

SummaryBackgroundThe increasing prevalence of overweight and obesity needs effective approaches for weight loss in primary care and community settings. We compared weight loss with standard treatment in primary care with that achieved after referral by the primary care team to a commercial provider in the community.MethodsIn this parallel group, non-blinded, randomised controlled trial, 772 overweight and obese adults were recruited by primary care practices in Australia, Germany, and the UK. Participants were randomly assigned with a computer-generated simple randomisation sequence to receive either 12 months of standard care as defined by national treatment guidelines, or 12 months of free membership to a commercial programme (Weight Watchers), and followed up for 12 months. (Source: LAN...

Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home

Implementation Science — Fri, 21 Oct 2011 04:00:00 +0100

Conclusions: This primary care practice tool based on an implementation science model has the potential to guide patients to more healthful behaviors and improved self-management of chronic conditions, while fostering effective and efficient communication between patients and their healthcare team. RE-AIM and similar models can help clinicians and media developers create practical products more likely to be widely adopted, feasible in busy medical practices, and able to produce public health impact. (Source: Implementation Science)

Half of Practices Lack What It Takes to Be Medical HomeHalf of Practices Lack What It Takes to Be Medical Home

Medscape Today Headlines — Thu, 20 Oct 2011 17:39:29 +0100

Primary care practices are more likely to qualify as medical homes, but 40% of them still do not make the grade, according to a new study. Medscape Medical News (Source: Medscape Today Headlines)

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Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

BMC Family Practice — Tue, 18 Oct 2011 04:00:00 +0100

Conclusions: This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice.Trial Registration: NCT00574808 (Source: BMC Family Practice)

Physician Practices and Readiness for Medical Home Reforms: Policy, Pitfalls, and Possibilities

Health Services Research — Tue, 18 Oct 2011 04:00:00 +0100

Conclusion.Almost half of all practices fail to meet NCQA standards for medical home recognition. (Source: Health Services Research)

Genetics in the Physician Assistant's Practice (Constance Goldgar PA-C, MS)

Family Medicine Digital Resources Library (FMDRL) Recently Uploaded — Tue, 18 Oct 2011 04:00:00 +0100

This is a case-based interactive website designed to help learners apply genetic family history information and work through genetic differential diagnoses in primary care practice. Three cases of increasing complexity are presented to work through with interactive exercises and feedback. Supplementary material, including a genetics primer,family history exercises, "Genetic Testing 101"are provided on the menu to help learners at different stages and with varying clinical genetic backgrounds. Additional tutorials and "learn more" links are also part of the cases to help learners make the correct diagnosis. (Source: Family Medicine Digital Resources Library (FMDRL) Recently Uploaded)

The role of leukotriene receptor antagonists in asthma

Thorax — Fri, 14 Oct 2011 04:00:00 +0100

This study assessed the effectiveness of a leukotriene receptor antagonist (LTRA) in two pragmatic randomised controlled trials over a 2-year period in primary care practices across the UK. The first trial compared LTRAs with inhaled glucocorticoids as the first-line treatment in asthma. The second trial compared the addition of LTRAs versus the addition of long-acting β2-agonists in patients already using inhaled glucocorticoids with asthma. All treatments led to significant improvements in the primary outcome measure: the mini Asthma Quality of Life Questionnaire. At 2 months, the LTRA was found to be equivalent in both studies. At 2 years, there was a trend towards equivalence between treatment groups although scores fell outside of their pretest definition of equivalence...

Prehypertension in Adolescents: How High is the Risk for Hypertension?

The Journal of Pediatrics — Mon, 10 Oct 2011 04:00:00 +0100

Measurement of blood pressure (BP) has become a routine part of pediatric care, and asymptomatic hypertension is now detected in primary care practices. To avoid over-diagnosing hypertension in children, the criterion for diagnosis of hypertension requires that the average of repeated BP levels are at or higher than the 95th percentile. With this criterion, the prevalence of pediatric hypertension had been expected to be between 1% and 2%. However, the prevalence of childhood hypertension is increasing, largely because of the childhood obesity epidemic and possibly other secular changes in lifestyles. Recent publications that apply the 95th percentile definition and repeat measurements on 3 separate visits report a pediatric hypertension prevalence of approximately 3.5%, and in obese adole...

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Practices' revenues increase faster than costs, despite weak economy

Medical Economics - Practice Management — Thu, 06 Oct 2011 04:00:00 +0100

It may not feel like good economic times for many primary care practices, but by at least one measure, they are doing OK. Revenues for independent practices increased nearly twice as fast as expenses, according to a recent survey. See how your practice's revenues compare with those of your peers. (Source: Medical Economics - Practice Management)

Choosing Brand-Name Over Generic Statins Can Cost BillionsChoosing Brand-Name Over Generic Statins Can Cost Billions

Medscape Today Headlines — Tue, 04 Oct 2011 15:33:11 +0100

That was the third most common of a dozen primary-care practices survey respondents said were overused, but it was far and away the most costly. Heartwire (Source: Medscape Today Headlines)

Passive Immunization

Primary Care: Clinics in Office Practice — Tue, 04 Oct 2011 04:00:00 +0100

Hip Fracture Risk Rose at Start of Loop Diuretic

Clinical Endocrinology News — Sat, 01 Oct 2011 04:00:00 +0100

SAN DIEGO – The risk of hip fracture nearly doubles in the week following a new prescription for a loop diuretic. In contrast, there is no spike in the risk of hip fracture in the 7 days after a new prescription for other classes of diuretics or for ACE inhibitors, according to an analysis of the Health Improvement Network (THIN) database involving more than 400 U.K. primary care practices. (Source: Clinical Endocrinology News)

A Retrospective Cohort Study of the Potency of Lipid-lowering Therapy and Race-gender Differences in LDL Cholesterol Control

BMC Cardiovascular Disorders — Fri, 30 Sep 2011 04:00:00 +0100

We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL. Methods: We studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency. Results: Time to LDL control decreased as lipid-lowering drug potency increased (P (Source: BMC Cardiovascular Disorders)

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HHS Launches New Affordable Care Act Initiative to Strengthen Primary Care

News stories via the Rural Assistance Center — Thu, 29 Sep 2011 06:00:00 +0100

The U.S. Department of Health and Human Services (HHS) has launched a new initiative made possible by the Affordable Care Act to help primary care practices deliver higher quality, more coordinated and patient-centered care by recruiting private payers to participate in a Medicare shared savings pilot oriented to primary care physicians. (Source: News stories via the Rural Assistance Center)

Initiative Will Use Blended Payment Model to Drive Health Care Transformation

AAFP Government and Medicine — Wed, 28 Sep 2011 23:35:00 +0100

The AAFP has long urged public and private payers to adopt a blended payment model that rewards primary care physicians for coordinating and managing patient care. Now, CMS and its Center for Medicare and Medicaid Innovation, or CMMI, have joined the movement with the launch of a new initiative -- the Comprehensive Primary Care Initiative. The initiative will allow CMS to work with commercial and state health insurance plans to support primary care practices that deliver coordinated and seamless care based on the tenets of the patient-centered medical home, or PCMH. (Source: AAFP Government and Medicine)

Medicare to Test Incentive Pay for Primary Care Docs

MedPage Today Public Health — Wed, 28 Sep 2011 19:10:32 +0100

WASHINGTON (MedPage Today) -- Starting next summer, a Medicare pilot project will pay primary care practices in select areas an extra $20 a month per patient for making themselves more available to patients and otherwise personalizing care. (Source: MedPage Today Public Health)

Physicians, Guidelines, and Cognitive Tasks

Evaluation — Wed, 28 Sep 2011 04:00:00 +0100

Using a case study analysis of the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Treatment of Asthma, this article compares the workflows and knowledge requirements of primary care practice to the structure and content of a well-respected set of clinical guidelines. The authors show that there are discrepancies between physician workflow and the structure of the EPR-3, as well as between physicians’ knowledge requirements and the content of the EPR-3. The analysis suggests that closing the gap between medical knowledge and practice will require alternative ways to represent guidelines’ knowledge and recommendations. (Source: Evaluation)

Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care

Implementation Science — Tue, 27 Sep 2011 04:00:00 +0100

DiscussionThis pragmatic, stepped-wedge randomized controlled trial with both quantitative and process evaluations demonstrates innovative methods of implementing large-scale quality improvement and evidence-based approaches to care delivery. This is the first Canadian study to examine the impact of a large-scale multifaceted cardiovascular quality-improvement program in primary care. It is anticipated that through the evaluation of IDOCC, we will demonstrate an effective, practical, and sustainable means of improving the cardiovascular health of patients across Canada.Trial Registration: NCT00574808 (Source: Implementation Science)

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Trinity Medical purchases O.P. medical building

bizjournals.com Health Care:Pharmaceuticals headlines — Thu, 22 Sep 2011 16:13:50 +0100

A medical group with physicians affiliated with Catholic Health System has acquired an Orchard Park building that neighbors the Mercy Ambulatory Care Center. Mercy Hospital of Buffalo, part of the Catholic Health System bought the 8,000-square-foot building at 3675 Southwestern Boulevard and leased it to Trinity Medical P.C., a primary care practice. Trinity’s doctors are all affiliated with Catholic Health System. Mercy Hospital paid $650,000 for the vacant building, according to documents filed with the Erie County Clerk’s office... (Source: bizjournals.com Health Care:Pharmaceuticals headlines)

Preferences for colorectal cancer screening tests and screening test use in a large multispecialty primary care practice

Cancer — Wed, 21 Sep 2011 17:11:29 +0100

CONCLUSIONS:Lack of concordance between patient preference and test completed suggests that patients' preferences are not well incorporated into screening discussions and test decisions, which could contribute to low screening uptake. Physicians should acknowledge patients' preferences when discussing test options and making recommendations, which may increase patients' receptivity to screening. Cancer 2011. © 2011 American Cancer Society. (Source: Cancer)

CIGNA launches accountable care programs minimizing risk to PCPs

Medical Economics - Practice Management — Tue, 20 Sep 2011 23:52:44 +0100

CIGNA’s recently launched initiative in Memphis, Tennessee, offers some variations on accountable care certain to increase the appeal to primary care practices—such as full payment as usual plus incentives for reaching quality and cost targets, all without sharing risk. How does that work? Read more to find out how RNs, paid by the insurer, stay in touch with “invisible” patients to make sure they don’t fall through the cracks. (Source: Medical Economics - Practice Management)

Vendor Notebook: McKesson releases new EHR for physician practices

Healthcare IT News — Fri, 16 Sep 2011 13:18:45 +0100

McKesson announced McKesson Practice Choice, a fully integrated electronic health record and practice management solution that puts advanced yet easy- to-use technology within reach of small independent primary care practices. Certified for Stage 1 meaningful use, the Web-based EHR offers clinical, financial and operational tools on a single database. Rhe solution enables physicians to deploy the system with minimal disruption, then care for patients from any location with an Internet connection. read more (Source: Healthcare IT News)

Industry’s Newest Web-Based EHR Combines Sophisticated Features With Affordability, Ease-Of-Use

ICMCC: The International Council on Medical and Care Compunetics — Thu, 15 Sep 2011 17:05:52 +0100

Source: EMR Daily News Content: “McKesson recently announced McKesson Practice Choice, a fully integrated electronic health record (EHR) and practice management solution that puts advanced yet easy-to-use technology within reach of small independent primary care practices. The industry’s newest Web-based EHR offers clinical, financial and operational tools on a single database. Certified for Stage 1 Meaningful [...] (Source: ICMCC: The International Council on Medical and Care Compunetics)

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The prevalence of multimorbidity in primary care and its effect on health care utilization and cost

Family Practice — Thu, 15 Sep 2011 04:00:00 +0100

Conclusions. Multimorbidity is very common in primary care and in a system with strong gatekeeping is associated with high health care utilization and cost across the health care system. Interventions to address quality and cost associated with multimorbidity must focus on primary as well as secondary care. (Source: Family Practice)

Bipolar Disorder is Common in Depressed Primary Care Patients

Postgraduate Medicine Online — Thu, 15 Sep 2011 04:00:00 +0100

Conclusions: The high prevalence of patients meeting full criteria for BD and the low rate of identification of BD in primary care patients are consistent with estimates using self-administered questionnaires, but the interview revealed a substantial additional population that could be considered to have subsyndromal BD. Because subsyndromal forms of BD are associated with significant impairment and comorbidity as well as progression to frank BD, recognition of both full and subthreshold BD in primary care practice should be improved. Keywords: depression, bipolar disorder, primary care, antidepressant, mood stabilizer, diagnosis read more (Source: Postgraduate Medicine Online)

Welcome back? Frequent attenders to a pediatric primary care center

Journal of Child Health Care — Wed, 14 Sep 2011 04:00:00 +0100

This study examines frequent attenders of a pediatric primary care clinic at a large urban children’s hospital — who they are and their reasons for frequent attendance to the clinic. The literature suggests that some visits by frequent attenders may not be medically necessary, and these additional appointments may impair others’ access to medical care within the same system. The key to eliminating excessive primary care visits is to determine if it is a problem in the primary care practice (quantify the problem), explore the reasons for the visits (from the patients’ perspective), and then provide educational interventions that address the various causes for the extra visits and encourage the use of available resources, either ancillary services in the practice itse...

Industry's Newest Web-based EHR Combines Sophisticated Features with Affordability, Ease-of-use

McKesson News — Tue, 13 Sep 2011 21:07:00 +0100

McKesson integrated solution is tailor-made for independent primary care practices (Source: McKesson News)

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Small Primary Care Practices Take Center Stage with New McKesson Service

McKesson News — Tue, 13 Sep 2011 21:03:00 +0100

McKesson to Leverage Expertise of TransforMED for Patient-Centered Medical Homes (Source: McKesson News)

Does pre-ordering tests enhance the value of the periodic examination?

BMC Health Services Research — Tue, 13 Sep 2011 04:00:00 +0100

Conclusions: A pre-order process was successfully implemented to improve the value of the PHE visit in an internal medicine primary care practice using a standardized approach that allowed for provider autonomy. The process was accepted by patients and providers and resulted in improved office efficiency through reduced message handling. Completion of routine tests before the PHE office visit can help facilitate face-to-face discussions about abnormal results and subsequent management that otherwise may only occur by telephone. (Source: BMC Health Services Research)

Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR

Journal of General Internal Medicine — Fri, 09 Sep 2011 05:59:50 +0100

CONCLUSIONS Providing patients with HM reminders via a PHR may be effective in improving some elements of preventive care. Content Type Journal ArticleCategory Original ResearchPages 1-8DOI 10.1007/s11606-011-1859-6Authors Adam Wright, Brigham & Women’s Hospital, 1620 Tremont St, Boston, MA 02115, USAEric G. Poon, Brigham & Women’s Hospital, 1620 Tremont St, Boston, MA 02115, USAJonathan Wald, Brigham & Women’s Hospital, 1620 Tremont St, Boston, MA 02115, USAJoshua Feblowitz, Brigham & Women’s Hospital, 1620 Tremont St, Boston, MA 02115, USAJustine E. Pang, Brigham & Women’s Hospital, 1620 Tremont St, Boston, MA 02115, USAJeffrey L. Schnipper, Brigham & Women’s Hospital, 1620 Tremont St, Boston, MA 02115, USARichard W. Grant, Harvard Medical School, Boston, ...

Portion Control for the Treatment of Obesity in the Primary Care Setting

BMC Research Notes — Fri, 09 Sep 2011 04:00:00 +0100

Conclusions: Our findings suggest that a portion control intervention incorporating dietary counseling and a portion control plate may be effective for enhancing weight loss among obese subjects. A portion control intervention deserves further evaluation as a weight control strategy in the primary care setting. (Source: BMC Research Notes)

Study tests slimming clubs

NHS News Feed — Thu, 08 Sep 2011 16:55:00 +0100

Conclusion This was a well-conducted study and its findings are likely to be reliable. Some points are worth noting: There were high drop-out rates in both groups (40%-50%), which may have affected the study’s results. Although the researchers say that they anticipated this possibility when calculating the sample sizes needed to obtain meaningful results, the difference in drop-out rates between groups could have affected the reliability of the results. The lack of blinding was unavoidable given the nature of the two interventions being tested. It is possible that participants knowing which treatment they were assigned could have had an influence on results. However, the objective measurement of weight makes this less important as it does quantify the effect of these interventions....

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Skin Autofluorescence and the Association with Renal and Cardiovascular Risk Factors in Chronic Kidney Disease Stage 3.

Clinical Journal of the American Society of Nephrology : CJASN — Thu, 01 Sep 2011 04:00:00 +0100

Conclusion Increased SAF is independently associated with multiple CV and renal risk factors in CKD 3. Long-term follow-up will assess the value of SAF as a predictor of CV and renal risk in this population. PMID: 21885790 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)

Original and REGICOR Framingham Functions in a Nondiabetic Population of a Spanish Health Care Center: A Validation Study.

Annals of Family Medicine — Thu, 01 Sep 2011 04:00:00 +0100

CONCLUSION The original Framingham equation overestimated coronary risk whereas the REGICOR Framingham function underestimated it. The original Framingham function selected a greater percentage of candidates for antihypertensive and lipid-lowering therapy. PMID: 21911762 [PubMed - in process] (Source: Annals of Family Medicine)

Coordination of health behavior counseling in primary care.

Annals of Family Medicine — Thu, 01 Sep 2011 04:00:00 +0100

CONCLUSIONS Easy-to-use system-level solutions that have point-of-delivery reminders and decision support facilitate coordination of health behavior counseling for primary care patients. Infrastructure is needed if broader integration of health behavior counseling is to be achieved in primary care. PMID: 21911759 [PubMed - in process] (Source: Annals of Family Medicine)

Meaningful use of electronic prescribing in 5 exemplar primary care practices.

Annals of Family Medicine — Thu, 01 Sep 2011 04:00:00 +0100

CONCLUSIONS More widespread implementation and effective use of e-prescribing in ambulatory care settings will require practice transformation efforts that focus on work process redesign while being attentive to effects on patient and pharmacy involvement in prescribing. Improved health information exchange is required to fully realize expected quality, safety, and efficiency gains of e-prescribing. PMID: 21911757 [PubMed - in process] (Source: Annals of Family Medicine)

Ten-year Trends in the Financing of Family Medicine Training Programs: Considerations for Planning and Policy.

Famly Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Conclusions: The mean cost per resident remained relatively stable over the 10-year period, with a 3.1% overall increase to $27,260 per resident per year. Programs that successfully obtained federally qualified health center (FQHC) status, increased their residency graduate medical education (GME) slots or received other new significant funding, such as state grants, were the most financially stable. Policy solutions would stabilize both federal GME and state Medicaid GME funding and increase reimbursement of primary care practice to maintain the viability of primary care training programs. PMID: 21918932 [PubMed - in process] (Source: Famly Medicine)

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Journey toward a Patient‐Centered Medical Home: Readiness for Change in Primary Care Practices

The Milbank Quarterly — Thu, 01 Sep 2011 04:00:00 +0100

Conclusions: The respondents from the higher and lower PCMH scoring practices commented on similar aspects of readiness—motivation and capability—but offered very different views of them. Our findings suggest the importance of understanding practice perceptions of the motivations for PCMH and the capability to undertake change. While this study identified some initial approaches that physician organizations and practices have used to prepare for practice redesign, we need much more information about their effectiveness. (Source: The Milbank Quarterly)

Building Capacity for Childhood Obesity Prevention and Treatment in the Medical Community: Call to Action

PEDIATRICS — Thu, 01 Sep 2011 04:00:00 +0100

Large gaps exist in the capacity of the US medical system to participate meaningfully in childhood obesity-prevention efforts and to meet the treatment needs of obese children. Current primary care practice for the prevention and treatment of childhood obesity often varies from evidence-based recommendations. Childhood obesity specialists have partnered successfully with schools of medicine, professional societies, and other organizations to collaboratively engage with primary care providers in quality improvement for obesity prevention and treatment. This review and commentary targets 2 audiences. For childhood obesity experts and their organizational partners, methods to support change in primary practice and the evidence supporting their use are outlined. For primary care providers and ...

The Counseling African Americans to Control Hypertension (CAATCH) trial: baseline demographic, clinical, psychosocial, and behavioral characteristics

Implementation Science — Wed, 31 Aug 2011 23:00:00 +0100

Conclusions: A majority of patients in the CAATCH trial exhibited adverse lifestyle behaviors, and had significant medical and psychosocial barriers to adequate BP control. Trial outcomes will shed light on the effectiveness of evidence-based interventions for BP control when implemented in real-world medical settings that serve high numbers of low-income hypertensive African-Americans with multiple co-morbidity and significant barriers to behavior change. (Source: Implementation Science)

Promoting cancer screening within the patient centered medical home

CA: A Cancer Journal for Clinicians — Wed, 31 Aug 2011 12:24:05 +0100

This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening. CA Cancer J Clin 2011. © 2011 American Cancer Society. (Source: CA: A Cancer Journal for Clinicians)

A pilot study of the use of near-patient C-Reactive Protein testing in the treatment of adult respiratory tract infections in one Irish general practice.

BMC Family Practice — Tue, 30 Aug 2011 23:00:00 +0100

Conclusion: This pilot study confirms the potential feasibility of a full trial in Irish general practice. Further consideration of possible increased re-attendance rates in a mixed payments health system is appropriate. We intend to pursue a larger trial in a newly established regional primary care research network. (Source: BMC Family Practice)

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Persistent microalbuminuria after treatment with renin-angiotensin axis blockers: causes and results of treatment intensification

Journal of the Renin-Angiotensin-Aldosterone System : JRAAS — Tue, 30 Aug 2011 23:00:00 +0100

Conclusions: Persistent microalbuminuria was associated with poor blood pressure control and inadequate drug dosage. Low frequency of administration of drugs at night and inappropriate once-daily pills intake were frequent. Strict control of blood pressure and intensive RAA blockade significantly reduced the prevalence of microalbuminuria. (Source: Journal of the Renin-Angiotensin-Aldosterone System : JRAAS)

Establishing an integrated care practice in a community health center.

Professional Psychology: Research and Practice — Mon, 29 Aug 2011 04:00:00 +0100

In a progressively complex and fragmented health care system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the United States have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe a working integrated primary care model, currently utilized in a large community health center system in Colorado, that encompasses universal screening, consultation, psychotherapy, and psychological testing. With appreciation for the way an organization's unique circumstances ...

AAFP Task Force Takes Steps to Better Value Primary Care

AAFP Government and Medicine — Tue, 23 Aug 2011 23:20:00 +0100

The newly formed AAFP Primary Care Valuation Task Force reached consensus on two key points during its first meeting here on Aug. 22: Medicare should pay more for primary care services, while also taking steps to better compensate high-functioning primary care practices. The task force, which comprises 22 members representing employer and patient groups, as well as the medical community and health plans, agreed that primary care continues to be undervalued. That fact creates an immediate need for "an across-the-board improved payment for primary care," said AAFP Board Chair Lori Heim of Vass, N.C., who chairs the task force. (Source: AAFP Government and Medicine)

Compensation up slightly but practice margins are ailing

Modern Medicine — Tue, 23 Aug 2011 23:00:00 +0100

Compensation in primary care practices edged up about 2.6% in 2010, a smaller increase than in the previous year but still slightly more than specialty practices, a recent survey found. Overall, however, the news was far from good?many practices were operating at a loss. (Source: Modern Medicine)

Randomized controlled trial of primary care physician motivational interviewing versus brief advice to engage adolescents with an Internet-based depression prevention intervention: 6-month outcomes and predictors of improvement

Translational Research — Mon, 22 Aug 2011 04:00:00 +0100

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Initiation of insulin glargine in patients with Type 2 diabetes in suboptimal glycaemic control positively impacts health-related quality of life. A prospective cohort study in primary care.

Molecular Medicine — Fri, 19 Aug 2011 18:14:15 +0100

Conclusions Results of this observational study demonstrate combined glycaemic and health-related quality of life benefits of initiating insulin glargine in patients with Type 2 diabetes in routine primary care. PMID: 21843305 [PubMed - in process] (Source: Molecular Medicine)

Initiation of insulin glargine in patients with Type 2 diabetes in suboptimal glycaemic control positively impacts health‐related quality of life. A prospective cohort study in primary care

Diabetic Medicine — Tue, 16 Aug 2011 21:43:36 +0100

Conclusions Results of this observational study demonstrate combined glycaemic and health‐related quality of life benefits of initiating insulin glargine in patients with Type 2 diabetes in routine primary care. (Source: Diabetic Medicine)

Intervention against Excessive Alcohol Consumption in Primary Health Care: A Survey of GPs' Attitudes and Practices in England 10 Years On

Alcohol and Alcoholism — Mon, 15 Aug 2011 23:00:00 +0100

Conclusion: Among GPs, there still appears to be a gap between actual practice and potential for preventive work relating to alcohol problems; they report little specific training and a lack of support. Translational work on understanding the evidence-base supporting screening and brief intervention could incentivize intervention against excessive drinking and embedding it into everyday primary care practice. (Source: Alcohol and Alcoholism)

Screening Young Children for Autism Spectrum Disorders in Primary Practice.

Journal of Autism and Developmental Disorders — Fri, 12 Aug 2011 23:00:00 +0100

Authors: Barton ML, Dumont-Mathieu T, Fein D Abstract The increasing prevalence of autism spectrum disorders as well as emerging evidence of the efficacy of early intervention has focused attention on the need for early identification of young children suspected of having an ASSD. Several studies have suggested that while parents report concerns early in development, it may be months before children can be evaluated and services provided, and these delays may be even more marked in under-served populations. The American Academy of Pediatrics recently recommended universal screening for autism spectrum disorders at the 18- and 24-month well-child pediatric visit. The authors review several early screening tools currently in use and offer recommendations for integrating autism specif...

The relationship between office system tools and evidence-based care in primary care physician practice

Health Services Management — Thu, 11 Aug 2011 23:00:00 +0100

A number of office system tools have been developed to improve the rates of preventive services and enhance the quality of medical care in practice settings. New approaches to measuring physician adherence to evidence-based standards of treatment, offer a unique opportunity to examine the link between the use of office system tools and evidence-based practices in primary care. Using episode-based profiling measures of adherence as the criterion, results from this investigation suggest that the application of simple physician reminders can be an effective technique for promoting evidence-based treatment. The data also reveal that the influence of health information technology (HIT) resources on adherence was not exclusively positive. Specifically, adherence to evidence-based standards was h...

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Engaging Pediatricians in Developmental Screening: The Effectiveness of Academic Detailing.

Journal of Autism and Developmental Disorders — Mon, 08 Aug 2011 23:00:00 +0100

Authors: Honigfeld L, Chandhok L, Spiegelman K Abstract Use of formal developmental screening tools in the pediatric medical home improves early identification of children with developmental delays and disorders, including Autism Spectrum Disorders. A pilot study evaluated the impact of an academic detailing module in which trainers visited 43 pediatric primary care practices to provide education about implementing developmental screening tools in well-child services. Attendees responded to a post presentation survey stating that they planned to implement screening in their practices. Medicaid billing data showed an increase in the state's overall rate of screening. An audit of medical charts in five practices that received the training and five that did not showed higher screening...

Parent-Led Activity and Nutrition (PLAN) for healthy living: Design and methods

Contemporary Clinical Trials — Mon, 08 Aug 2011 04:00:00 +0100

Abstract: Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5–11years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promo...

The "Top 5" Lists in Primary Care: Meeting the Responsibility of Professionalism [Special Article]

Archives of Internal Medicine — Sun, 07 Aug 2011 23:00:00 +0100

Conclusions Physician panels in the primary care specialties of family medicine, internal medicine, and pediatrics identified common clinical activities that could lead to higher quality care and better use of finite clinical resources. Field testing showed support among physicians for the evidence supporting the activities, the potential positive impact on medical care quality and cost, and the ease with which the activities could be performed. We recommend that these "Top 5" lists of activities be implemented in primary care practice across the United States. (Source: Archives of Internal Medicine)

UMd., Hopkins docs to advise on new medical home program

bizjournals.com Health Care:Hospitals headlines — Thu, 04 Aug 2011 18:52:08 +0100

A group of doctors and nurses from the University of Maryland and Johns Hopkins University has formed to advise participants in a statewide pilot program aiming to cut health care costs. They are joining with officials from the Maryland Health Care Commission and Community Health Resource Commission to form the Maryland Learning Collaborative. The collaborative will train and educate primary care practices taking part in the pilot Maryland Multi-Payer Patient-Centered Medical Home program. The idea is that primary care doctors act as home bases for patients and work with them and their specialists, hospitals and home care providers to make health care decisions... (Source: bizjournals.com Health Care:Hospitals headlines)

Hopkins, UMd. docs to advise on new medical home program

bizjournals.com Health Care:Hospitals headlines — Thu, 04 Aug 2011 18:43:12 +0100

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How Eight Primary Care Practices Initiated and Maintained Quality Monitoring and ReportingHow Eight Primary Care Practices Initiated and Maintained Quality Monitoring and Reporting

Medscape Today Headlines — Tue, 02 Aug 2011 11:04:21 +0100

Implementing and sustaining quality reporting requires a complex set of motivators, facilitators, and strategies to overcome inherent barriers. Read about how several practices attacked the problem. Journal of the American Board of Family Medicine (Source: Medscape Today Headlines)

Advanced Primary Care Practice Demo Project

Cardiology News — Sun, 31 Jul 2011 23:00:00 +0100

The patient-centered medical home, which has been promoted by primary care organizations for decades, is finally getting some attention under the Affordable Care Act. The concept, which calls for greater coordination of care and a team-based approach, is one of several care delivery improvement ideas being tested under the new health law. (Source: Cardiology News)

Patient self-management of warfarin therapy: Pragmatic feasibility study in Canadian primary care.

Canadian Family Physician Medecin de Famille Canadien — Sun, 31 Jul 2011 23:00:00 +0100

Conclusion Patient self-management was not demonstrated to be superior to standard care, but was easily implemented and was the method preferred by patients. Our feasibility outcomes justify a larger trial and suggest that subject recruitment and protocol adherence would not pose barriers for such a study. Trial registration number NCT00925028 (ClinicalTrials.gov). PMID: 21841092 [PubMed - in process] (Source: Canadian Family Physician Medecin de Famille Canadien)

Do immunisation procedures match provider perception? A study from the South Carolina Pediatric Practice Research Network (SCPPRN).

Quality in Primary Care — Sat, 30 Jul 2011 08:30:04 +0100

Authors: Roberts JR, Freeland KD, Kolasa MS, McElligott JT, Darden PM Immunisation coverage of children by 19 months of age in US primary care practices is below the desired goal of 80%. In order to improve this rate, primary care providers must first understand the specific processes of immunisation delivery within their office settings. This paper aims to identify key components in identifying strategies for quality improvement (QI) of immunisation delivery. PMID: 21781430 [PubMed - in process] (Source: Quality in Primary Care)

Hepatocellular Carcinoma Screening Rates Vary by Etiology of Cirrhosis and Involvement of Gastrointestinal Sub-specialists

Digestive Diseases and Sciences — Fri, 29 Jul 2011 16:07:16 +0100

Conclusions Patients with NASH cirrhosis and incidentally discovered cirrhosis have low rates of HCC screening and are referred less often to gastroenterologists. These data suggest a need for increased education about NASH cirrhosis and better systems of communication among general practitioners, surgeons, and gastroenterologists. Content Type Journal ArticlePages 1-7DOI 10.1007/s10620-011-1836-2Authors Vilas Patwardhan, Department of Medicine, Massachusetts General Hospital, Warren 1007, 55 Fruit Street, Boston, MA 02114, USASonali Paul, Department of Medicine, Massachusetts General Hospital, Warren 1007, 55 Fruit Street, Boston, MA 02114, USAKathleen E. Corey, Department of Medicine, Massachusetts General Hospital, Warren 1007, 55 Fruit Street, Boston, MA 02114, ...

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Houston healthcare system's HIE central to new PCMH program

Healthcare IT News — Thu, 28 Jul 2011 20:10:26 +0100

MHMD, the physician network of Houston-based Memorial Hermann Healthcare System, is implementing a new patient-centered medical program that will rely on IT, including its HIE, to keep providers up-to-date on patients' conditions. Officials said the program aims to provide major improvements in medical care at the level of the primary care physician practice. Called Advanced Primary Care Practices, or Advanced PCPs, the program is being developed in collaboration with Memorial Hermann. read more (Source: Healthcare IT News)

MHMD Launches Advanced Primary Care Practices, a Patient-Centered Medical Home Initiative

Medical News (via PRIMEZONE) — Thu, 28 Jul 2011 19:37:00 +0100

HOUSTON, July 28, 2011 (GLOBE NEWSWIRE) -- MHMD, the physician network of Memorial Hermann Healthcare System in Houston, is implementing a new program that will provide major improvements in medical care at the level of the primary care physician practice. Called Advanced Primary Care Practices or Advanced PCPs, the program is being developed in collaboration with Memorial Hermann. (Source: Medical News (via PRIMEZONE))

Epocrates launches EHR; iPhone app soon

mobihealthnews — Wed, 27 Jul 2011 14:58:32 +0100

By Brian Dolan and Neil Versel Epocrates announced this morning the first phase of availability for its EHR offering, which includes an iPhone app. The offering is targeting primary care practices with ten or fewer physicians. Epocrates’ EHR offering was first announced in March 2010. Epocrates built the EHR essentially from the ground up, taking a few, [...] (Source: mobihealthnews)

Management of chronic pain among older patients: Inside primary care in the US

European Journal of Pain — Mon, 25 Jul 2011 04:00:00 +0100

Abstract: Under-treatment of pain is a worldwide problem. We examine how often pain was addressed and the factors that influence how much time was spent on treating pain.We analyzed 385 videotapes of routine office visits in several primary care practices in the Southwest and Midwest regions of the United States. We coded the visit contents and the time spent on pain and other topics. Logistic regression and survival analyses examined the effects of time constraint, physician’s supportiveness, patient’s health, and demographic concordance. We found that discussion of pain occurred in 48% of visits. A median of 2.3min was spent on addressing pain. The level of pain, physician’s supportiveness, and gender concordance were significantly associated with the odds of having a pain discussi...

Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control.

Diabetes Care — Sun, 24 Jul 2011 23:00:00 +0100

CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data, lifestyle behaviors, and patient self-management data individually analyzed and presented with evidence-based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year. PMID: 21788632 [PubMed - as supplied by publisher] (Source: Diabetes Care)

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Prescription drug abuse creates liability, regulatory issues for practices

Modern Medicine — Wed, 20 Jul 2011 23:00:00 +0100

Prescription drug abuse is the nation?s fastest-growing drug problem, and, unless primary care practices take appropriate precautions, it also could become one of their fastest-growing regulatory and liability issues. With increased regulation on the horizon, a new study recommends ways that physicians can improve prescribing practices for opioids and other often-abused drugs. (Source: Modern Medicine)

Improving teamwork in healthcare: current approaches and the path forward

Quality and Safety in Health Care — Wed, 20 Jul 2011 23:00:00 +0100

My grandfather was a general practitioner in a small town in the USA in the mid-20th century. His medical team consisted of himself and a nurse (who was also my grandmother). He even served as his own pharmacist. In stark contrast, the team in my primary care practice consists of my physician partners, several trainees, nurses, medical assistants, referral coordinators, pharmacists, the subspecialists and their teams, home health nurses and therapists, and more. Such large and disconnected teams can provide comprehensive care for complex and chronic illnesses, but when they malfunction, they can harm patients.1 Teams are larger and more dispersed in time and space, and there are now many more types of teams. They vary from teams whose members repeatedly work together over many years (eg, h...

Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: An exploratory prospective study

Implementation Science — Thu, 14 Jul 2011 23:00:00 +0100

Conclusions: Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional behaviour. (Source: Implementation Science)

Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

BMC Geriatrics — Wed, 13 Jul 2011 23:00:00 +0100

Conclusions: Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life. (Source: BMC Geriatrics)

Electronic Medical Records Are Not Associated With Improved Documentation in Community Primary Care Practices

American Journal of Medical Quality — Wed, 13 Jul 2011 23:00:00 +0100

This study compares EMR versus paper medical record documentation of basic health history and preventive service indicators in 47 community-based practices. Differences in practice-level documentation rates between practices that did and did not use an EMR were examined using the Kruskal—Wallis nonparametric test and robust regression, adjusting for practice-level covariates. Frequency of documentation of health history and preventive service indicator items were similar in the 2 groups of practices. Although EMRs provide the capacity for more robust record keeping, the community-based practices here do not use EMRs to their full capacity. EMR usage does not guarantee more systematic record keeping and thus may not lead to improved quality in the community practice setting. (Source: ...

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Impact of an Electronic Health Record on Follow-up Time for Markedly Elevated Serum Potassium Results

American Journal of Medical Quality — Wed, 13 Jul 2011 23:00:00 +0100

Follow-up of abnormal ambulatory laboratory results is often suboptimal. The impact of an ambulatory electronic health record (EHR) on follow-up of markedly elevated blood potassium (K +) results was investigated via a retrospective medical record review—before and after EHR implementation—of patients at an adult primary care practice who had a nonhemolyzed K+ ≥ 6.0 mEq/L. In all, 188 patients in the pre-EHR group and 30 in the EHR group satisfied inclusion criteria. The mean K+ for the 2 groups was 6.3 mEq/L. The EHR group had 4.5 times the odds (95% confidence interval = 1.3-15.8) of having their episodes of hyperkalemia followed up within 4 days. Patients in the EHR group were also more likely to have their blood K+ rechecked within 4 days (63.3% vs 43.6%; P = .044). An a...

Putting research into primary care practice

BMJ Online First — Mon, 04 Jul 2011 23:00:00 +0100

The European Medical Research Council and European Science Foundation recently published a strategic report in its series of "Current Forward Looks" entitled Implementation of Medical Research in... (Source: BMJ Online First)

Patient care teams in treatment of diabetes and chronic heart failure in primary care: an observational networks study

Implementation Science — Sat, 02 Jul 2011 23:00:00 +0100

Conclusions: Our method can be used to measure connections between care providers of an individual patient, and to examine the association between specific network parameters and healthcare received. Further research is needed to refine the measurement method and to test the association of specific network parameters with quality and outcomes of healthcare. (Source: Implementation Science)

Design of a quality and performance improvement project for small primary care practices: reflections on the Center for Practice Innovation.

Quality in Primary Care — Thu, 30 Jun 2011 09:45:03 +0100

Authors: Marsteller JA, Woodward P, Underwood WS, Hsiao CJ, Barr MS Small practices often lack the human, financial and technical resources to make necessary practice improvements and infrastructure investments in order to achieve sustainable change that promotes quality and efficiency. PMID: 21703112 [PubMed - in process] (Source: Quality in Primary Care)