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Garpenhag L, Halling A, Calling S, Rosell L, Larsson AM. "Being ill was the easy part": exploring cancer survivors' reactions to perceived challenges in engaging with primary healthcare. Int J Qual Stud Health Well-being 2024; 19:2361492. [PMID: 38824662 PMCID: PMC11146241 DOI: 10.1080/17482631.2024.2361492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/24/2024] [Indexed: 06/04/2024] Open
Abstract
PURPOSE Cancer survivors experience barriers to primary healthcare (PHC) services. The aim was to explore reactions to and opinions about perceived challenges associated with PHC access and quality among cancer survivors in Sweden, including how they have acted to adapt to challenges. METHODS Five semi-structured focus group interviews were conducted with cancer survivors (n = 20) from Skåne, Sweden, diagnosed with breast, prostate, lung, or colorectal cancer or malignant melanoma. Focus groups were mixed in regard to diagnosis. Data were analysed using a descriptive template analysis approach. RESULTS In light of perceived challenges associated with access to adequate PHC, participants experienced that they had been forced to work hard to achieve functioning PHC contacts. The demands for self-sufficiency were associated with negative feelings such as loneliness and worry. Participants believed that cancer survivors who lack the ability to express themselves, or sufficient drive, risk missing out on necessary care due to the necessity of being an active patient. CONCLUSIONS The findings highlight negative patient experiences. They have implications for the organization of care for cancer survivors as they indicate a need for more efficient post-treatment coordination between cancer specialist care and PHC providers, as well as increased support for patients leaving primary cancer treatment.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Lund, Sweden
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Halling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Lund, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Lund, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Linn Rosell
- Regional Cancer Center South, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anna-Maria Larsson
- Regional Cancer Center South, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Schmutz W, Hejazi A, Brixner D, Arnwine C, Magness J. The Utah Pharmacy Summit: Collaborating to Optimize Patient Care. J Pharm Pract 2024; 37:1039-1041. [PMID: 38262928 DOI: 10.1177/08971900241228806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Pharmacy has evolved significantly over the past 20 years, despite advances in pharmacotherapy and the expanding scope of pharmacy practice, pharmacists have struggled to collaborate across disciplines to create improved processes that enable the best outcomes from these innovations. A lack of innovation at any part of the healthcare system could inhibit the progress of practice innovations thereby leading to suboptimal patient medication and health outcomes. The Utah Pharmacy Summit was held in late 2022 with the goal of promoting pharmacist collaboration and a unified pharmacist voice within the state. The success of the Summit leads us to encourage collaborative forums across the Globe.
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Affiliation(s)
- Weston Schmutz
- Academy of Managed Care, Salt Lake City, UT, United States
- Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT, United States
| | - Andre Hejazi
- Academy of Managed Care, Salt Lake City, UT, United States
- Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT, United States
| | - Diana Brixner
- Academy of Managed Care, Salt Lake City, UT, United States
- Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT, United States
| | - Caitlin Arnwine
- Academy of Managed Care, Salt Lake City, UT, United States
- Amgen, Thousand Oaks, CA, United States
| | - Jonathan Magness
- Academy of Managed Care, Salt Lake City, UT, United States
- Magellan Rx Management, Scottsdale, AZ, United States
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Last BS, Beidas RS, Hoskins K, Waller CR, Khazanov GK. A critical review of clinician-directed nudges. Curr Opin Psychol 2024; 59:101856. [PMID: 39137509 DOI: 10.1016/j.copsyc.2024.101856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/15/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
As nudges-subtle changes to the way options are presented to guide choice-have gained popularity across policy domains in the past 15 years, healthcare systems and researchers have eagerly deployed these light-touch interventions to improve clinical decision-making. However, recent research has identified the limitations of nudges. Although nudges may modestly improve clinical decisions in some contexts, these interventions (particularly nudges implemented as electronic health record alerts) can also backfire and have unintended consequences. Further, emerging research on crowd-out effects suggests that healthcare nudges may direct attention and resources toward the clinical encounter and away from the main structural drivers of poor health outcomes. It is time to move beyond nudges and toward the development of multi-level, structurally focused interventions.
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Affiliation(s)
- Briana S Last
- Department of Psychology, Psychology Building B, Room 358, Stony Brook University, Stony Brook, NY, 11794, USA.
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue, 21st Floor, Chicago, IL, 60611, USA
| | - Katelin Hoskins
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, USA
| | - Claire R Waller
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue, 21st Floor, Chicago, IL, 60611, USA
| | - Gabriela Kattan Khazanov
- Center of Excellence for Substance Addiction and Treatment, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
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Waite S, Davenport MS, Graber ML, Banja JD, Sheppard B, Bruno M. Opportunity and Opportunism in Artificial-Intelligence-Powered Data Extraction: A Value-Centered Approach. AJR Am J Roentgenol 2024. [PMID: 39291941 DOI: 10.2214/ajr.24.31686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Radiologists' traditional role in the diagnostic process is to respond to specific clinical questions and reduce uncertainty enough to permit treatment decisions. This charge is rapidly evolving due to forces such as artificial intelligence [AI], big data [opportunistic imaging, imaging prognostication], and advanced diagnostic technologies. A new "modernistic" paradigm is emerging whereby radiologists, in conjunction with computer algorithms, will be tasked with extracting as much information from imaging data as possible, often without a specific clinical question being posed and independent of any stated clinical need. In addition, AI algorithms are increasingly able to predict long-term outcomes using data from seemingly normal examinations, enabling AI-assisted prognostication. As these algorithms become a standard component of radiology practice, the sheer amount of information they demand will increase the need for streamlined workflows, communication, and data management techniques. In addition, the provision of such information raises reimbursement, liability, and access issues. Guidelines will be needed to ensure all patients have access to the benefits of this new technology and guarantee mined data do not inadvertently create harm. In this article, we discuss challenges and opportunities relevant to radiologists in this changing landscape, with an emphasis on ensuring that radiologists provide high-value care.
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Affiliation(s)
- Stephen Waite
- Clinical Associate Professor of Radiology and Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203
| | - Matthew S Davenport
- William Martel Collegiate Professor of Radiology and Professor of Urology, Co-Director, Ronald Weiser Center for Prostate Cancer, Service Chief for Radiology, Vice Chair (Research, Academic Affairs, Faculty Development) Michigan Medicine, Michigan Medicine, 1500 E Medical Center Dr, B2A209P, Ann Arbor, MI 48109-5030
| | - Mark L Graber
- Professor Emeritus, Stony Brook University, NY; Founder and President Emeritus, Society to Improve Diagnosis in Medicine (SIDM)
| | - John D Banja
- Professor: Department of Rehabilitation Medicine; Medical Ethicist: Center for Ethics; Associate Editor: Radiology: Artificial Intelligence; Principal Investigator: Radiology, Ethics and Artificial Intelligence Project, Emory University, 1531 Dickey Drive, Room 184
| | - Brian Sheppard
- Professor of Law, Seton Hall University, One Newark Center, Newark, NJ 07102
| | - Michael Bruno
- Professor of Radiology and Medicine, Vice-Chair for Radiology Quality and Safety, Chief Section Emergency Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033
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Dumont DM, Levy JS, Gargano LM, White JC. Closing the gaps in adolescent vaccinations: Rhode Island's Vaccinate Before You Graduate program as a model for other jurisdictions. Prev Med Rep 2024; 45:102837. [PMID: 39175591 PMCID: PMC11338944 DOI: 10.1016/j.pmedr.2024.102837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Objective The northeastern state of Rhode Island (RI) has a Vaccinate Before You Graduate (VBYG) program that supplements the traditional primary care infrastructure by providing vaccines to adolescents while they are in school, with no out-of-pocket expenses. We analyzed data from RI's immunization registry to evaluate whether VBYG also reduces disparities in adolescent immunization rates. Methods We identified adolescent and catch-up vaccines administered in RI to people who were aged 11-18 at any point during the 5-year study period of 2019-2023, and conducted bivariate and multivariate analyses of vaccine administration data by setting (VBYG clinics, community health centers [CHCs], all other primary care practices [oPCPs], other school-based clinics, and other sites) and adolescent demographics (racial and ethnic identity, insurance status, sex, and age at time of vaccine). Results Of over 387,000 routine vaccines administered during the study period, 3.3 % were administered by a VBYG clinic despite significant declines during school closures associated with the early COVID-19 pandemic. VBYG-administered doses went to slightly older youth, and a higher proportion were catch-up doses (25.7 % versus 14.1 % for CHC doses and 6.5 % for oPCP). Youths received an average of 2.71 vaccines in VBYG clinics compared to 1.77 from oPCPs and 2.08 from CHCs. A higher proportion of vaccines administered by VBYG went to adolescents of color and those without private insurance than those administered by oPCPs. Conclusions VBYG provides a model to other jurisdictions of a vaccine safety net for adolescents who may not otherwise receive recommended vaccines before exiting the school system.
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Affiliation(s)
- Dora M. Dumont
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, United States
| | - Jennifer S. Levy
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, United States
| | - Lisa M. Gargano
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, United States
| | - Jordan C. White
- Rhode Island Department of Health, 3 Capitol Hill, Providence, RI 02908, United States
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Wyse JJ, Eckhardt A, Newell S, Gordon AJ, Morasco BJ, Carlson K, Korthuis PT, Ono SS, Lovejoy TI. Integrating Buprenorphine for Opioid Use Disorder into Rural, Primary Care Settings. J Gen Intern Med 2024; 39:2142-2149. [PMID: 38955895 PMCID: PMC11347530 DOI: 10.1007/s11606-024-08898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) including buprenorphine are effective, but underutilized. Rural patients experience pronounced disparities in access. To reach rural patients, the US Department of Veterans Affairs (VA) has sought to expand buprenorphine prescribing beyond specialty settings and into primary care. OBJECTIVE Although challenges remain, some rural VA health care systems have begun offering opioid use disorder (OUD) treatment with buprenorphine in primary care. We conducted interviews with clinicians, leaders, and staff within these systems to understand how this outcome had been achieved. DESIGN Using administrative data from the VA Corporate Data Warehouse (CDW), we identified rural VA health care systems that had improved their rate of primary care-based buprenorphine prescribing over the period 2015-2020. We conducted qualitative interviews (n = 30) with staff involved in implementing or prescribing buprenorphine in these systems to understand the processes that had facilitated implementation. PARTICIPANTS Clinicians, staff, and leaders embedded within rural VA health care systems located in the Northwest, West, Midwest (2), South, and Northeast. APPROACH Qualitative interviews were analyzed using a mixed inductive/deductive approach. KEY RESULTS Interviews revealed the processes through which buprenorphine was integrated into primary care, as well as processes insufficient to enact change. Implementation was often initially catalyzed through a targeted hire. Champions then engaged clinicians and leaders one-on-one to "pitch" the case, describe concordance between buprenorphine prescribing and existing goals, and delineate the supportive role that they could provide. Sites were prepared for implementation by developing new clinical teams and redesigning clinical processes. Each of these processes was made possible with the active, instrumental support of leadership. CONCLUSIONS Results suggest that rural systems seeking to improve buprenorphine accessibility in primary care may need to alter primary care structures to accommodate buprenorphine prescribing, whether through new hires, team development, or clinical redesign.
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA.
- School of Public Health, OHSU-PSU, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA.
| | - Alison Eckhardt
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
| | - Summer Newell
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
- Division of Epidemiology & Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Kathleen Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
- School of Public Health, OHSU-PSU, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA
| | - P Todd Korthuis
- School of Public Health, OHSU-PSU, 1810 SW 5th Avenue, Suite 510, Portland, OR, 97201, USA
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- VA Office of Rural Health, Veterans Rural Health Resource Center-Portland, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- VA Office of Rural Health, Veterans Rural Health Resource Center-Portland, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. Clin Exp Nephrol 2024; 28:835-846. [PMID: 38970648 PMCID: PMC11341759 DOI: 10.1007/s10157-024-02518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 07/08/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, 105 W 8th Avenue, Suite 250 E, Spokane, WA, 99204, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Cranford, USA
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Cranford, USA
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Harbin, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kaplan A, Babineau A, Hauptman R, Levitz S, Lin P, Yang M. Breaking down barriers to COPD management in primary care: applying the updated 2023 Canadian Thoracic Society guideline for pharmacotherapy. Front Med (Lausanne) 2024; 11:1416163. [PMID: 39165372 PMCID: PMC11333456 DOI: 10.3389/fmed.2024.1416163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/21/2024] [Indexed: 08/22/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent yet under-recognized and sub-optimally managed disease that is associated with substantial morbidity and mortality. Primary care providers (PCPs) are at the frontlines of COPD management, and they play a critical role across the full spectrum of the COPD patient journey from initial recognition and diagnosis to treatment optimization and referral to specialty care. The Canadian Thoracic Society (CTS) recently updated their guideline on pharmacotherapy in patients with stable COPD, and there are several key changes that have a direct impact on COPD management in the primary care setting. Notably, it is the first guideline to formally make recommendations on mortality reduction in COPD, which elevates this disease to the same league as other chronic diseases that are commonly managed in primary care and where optimized pharmacotherapy can reduce all-cause mortality. It also recommends earlier and more aggressive initial maintenance inhaler therapy across all severities of COPD, and preferentially favors the use of single inhaler therapies over multiple inhaler regimens. This review summarizes some of the key guideline changes and offers practical tips on how to implement the new recommendations in primary care. It also addresses other barriers to optimal COPD management in the primary care setting that are not addressed by the guideline update and suggests strategies on how they could be overcome.
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Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
| | - Amanda Babineau
- Respiratory Health Clinic, Vitalité Health Network, Moncton, NB, Canada
| | - Robert Hauptman
- Family Physician Airways Group of Canada, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Suzanne Levitz
- Medical Director Inpatient Pulmonary Rehabilitation Program, Mount Sinai Hospital, Montreal, QC, Canada
| | - Peter Lin
- Director Primary Care Initiatives, Canadian Heart Research Centre, Toronto, ON, Canada
| | - Molly Yang
- Wholehealth Pharmacy Partners, Markham, ON, Canada
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Porterfield L, Yu X, Warren V, Bowen ME, Smith-Morris C, Vaughan EM. A community health worker led diabetes self-management education program: Reducing patient and system burden. J Diabetes Complications 2024; 38:108794. [PMID: 38878424 DOI: 10.1016/j.jdiacomp.2024.108794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 06/09/2024] [Indexed: 07/12/2024]
Abstract
AIMS Conduct a secondary analysis of the TIME (Telehealth-supported, Integrated Community Health Workers (CHWs), Medication access, diabetes Education) made simple trial (SIMPLE) to evaluate healthcare utilization and explore variables that may have influenced HbA1c. METHODS Participants (N = 134 [67/group]) were low-income, uninsured Hispanics with or at risk for type 2 diabetes mellitus. We included in-person and telehealth clinician visits, other visits, missed visits, orders placed, and guideline-adherence (e.g., vaccinations, quarterly HbA1c for uncontrolled diabetes). Using multivariable models, we explored for associations between HbA1c changes and these measures. RESULTS The control arm had higher missed visits rates (intervention: 45 %; control: 56 %; p = 0.007) and missed telehealth appointments (intervention: 10 %; control: 27.4 %; p = 0.04). The intervention group received more COVID vaccinations than the control (p = 0.005). Other health measures were non-significant between groups. Intervention individuals' HbA1c improved with more missed visits (-0.60 %; p < 0.01) and worsened with improved guideline-adherent HbA1c measurements (HbA1c: 1.2 %; p = 0.057). The control group had non-significant HbA1c associations. CONCLUSIONS Findings suggest that the SIMPLE trial's improved HbA1c levels stemmed from a CHW-driven intervention and not additional healthcare contact. Exploratory outcomes resulted in seemingly counterintuitive HbA1c associations with missed visits and guideline-adherent measurements; these may suggest that an intervention that enhances communication provides support to reduce the amount of follow-up needed by participants without sacrificing clinical improvements.
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Affiliation(s)
- Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, United States; Sealy Institute for Vaccine Scienes, University of Texas Medical Branch, Galveston, TX, United States
| | - Xiaoying Yu
- Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, United States
| | - Victoria Warren
- Department of Health and Human Services; University of Houston, Houston, TX, United States
| | - Michael E Bowen
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, United States; Peter O'Donnell Jr. School of Public Health, Univeristy of Texas Southwestern, Dallas, TX, United States
| | - Carolyn Smith-Morris
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Elizabeth M Vaughan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States; Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
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Burgess J, Kim HM, Porath BR, Van T, Osatuke K, Boden M, Sripada RK, Wong ES, Zivin K. The Importance of Autonomy and Performance Goals in Perceived Workload Among Behavioral Health Providers. Psychiatr Serv 2024; 75:748-755. [PMID: 38532686 PMCID: PMC11406112 DOI: 10.1176/appi.ps.20230406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The authors sought to assess workplace characteristics associated with perceived reasonable workload among behavioral health care providers in the Veterans Health Administration. METHODS The authors evaluated perceived reasonable workload and workplace characteristics from the 2019 All Employee Survey (AES; N=14,824) and 2019 Mental Health Provider Survey (MHPS; N=10,490) and facility-level staffing ratios from Mental Health Onboard Clinical Dashboard data. Nine AES and 15 MHPS workplace predictors of perceived reasonable workload, 11 AES and six MHPS demographic predictors, and facility-level staffing ratios were included in mixed-effects logistic regression models. RESULTS In total, 8,874 (59.9%) AES respondents and 5,915 (56.4%) MHPS respondents reported having a reasonable workload. The characteristics most strongly associated with perceived reasonable workload were having attainable performance goals (average marginal effect [AME]=0.10) in the AES and ability to schedule patients as frequently as indicated (AME=0.09) in the MHPS. Other AES characteristics significantly associated with reasonable workload included having appropriate resources, support for personal life, skill building, performance recognition, concerns being addressed, and no supervisor favoritism. MHPS characteristics included not having collateral duties that reduce care time, staffing levels not affecting care, support staff taking over some responsibilities, having spirit of teamwork, primary care-mental health integration, participation in performance discussions, well-coordinated mental health care, effective veteran programs, working at the top of licensure, and feeling involved in improving access. Facility-level staffing ratios were not significantly associated with perceived reasonable workload. CONCLUSIONS Leadership may consider focusing resources on initiatives that support behavioral health providers' autonomy to schedule patients as clinically indicated and develop attainable performance goals.
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Affiliation(s)
- Jennifer Burgess
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Hyungjin Myra Kim
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Brittany R Porath
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Tony Van
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Katerine Osatuke
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Matthew Boden
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Rebecca K Sripada
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Edwin S Wong
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
| | - Kara Zivin
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Health Care System, Ann Arbor (Burgess, Kim, Porath, Van, Sripada, Zivin); Departments of Biostatistics (Kim) and Psychiatry (Sripada, Zivin), University of Michigan, Ann Arbor; Veterans Health Administration, National Center for Organization Development, Cincinnati (Osatuke); Program Evaluation and Resource Center and VA Office of Mental Health Operations, VA Palo Alto Health Care System, Palo Alto, California (Boden); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, and Department of Health Systems and Population Health, Magnuson Health Sciences Center, University of Washington School of Public Health, Seattle (Wong)
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11
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Hoffer EP. Primary Care in the United States: Past, Present and Future. Am J Med 2024; 137:702-705. [PMID: 38499134 DOI: 10.1016/j.amjmed.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
Even though a well-functioning primary care system is widely acknowledged as critical to population health, the number of primary care physicians (PCPs) practicing in the United States has steadily declined, and PCPs are in short supply. The reasons are multiple and include inadequate income relative to other specialties, excessive administrative demands on PCPs and the lack of respect given to primary care specialties during medical school and residency. Advanced practice nurses can augment the services of primary care physicians but cannot substitute for them. To change this situation, we need action on several fronts. Medical schools should give preference to students who are more likely to enter the primary care specialties. The income gap between primary care and other specialties should be narrowed. The administrative load placed on PCPs, including cumbersome electronic medical records, must be lessened. Insurers, including Medicare and Medicaid, must provide the resources to allow primary care physicians to act as leaders of multidisciplinary teams.
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12
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Bobo JFG, Keith BA, Marsden J, Zhang J, Schreiner AD. Patterns of gastroenterology specialty referral for primary care patients with metabolic dysfunction-associated steatotic liver disease. Am J Med Sci 2024:S0002-9629(24)01385-5. [PMID: 39074780 DOI: 10.1016/j.amjms.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND As metabolic dysfunction-associated steatotic liver disease (MASLD) management extends into primary care, little is known about patterns of specialty referral for affected patients. We determined the proportion of primary care patients with MASLD that received a gastroenterology (GI) consultation and compared advanced fibrosis risk between patients with and without a referral. METHODS This retrospective study of electronic health record data from a primary care clinic included patients with MASLD, no competing chronic liver disease diagnoses, and no history of cirrhosis. Referral to GI for evaluation and management (E/M) any time after MASLD ascertainment was the outcome. Fibrosis-4 Index (FIB-4) scores were calculated, categorized by advanced fibrosis risk, and compared by receipt of a GI E/M referral. Logistic regression models were developed to determine the association of FIB-4 risk with receipt of a GI referral. RESULTS The cohort included 652 patients of which 12% had FIB-4 scores (≥2.67) at high-risk for advanced fibrosis. Overall, 31% of cohort patients received a GI referral for E/M. There was no difference in the proportion of patients with high (12% vs. 12%, p=0.952) risk FIB-4 scores by receipt of a GI E/M referral. In adjusted logistic regression models, high-risk FIB-4 scores (OR 1.01; 95% CI 0.59 - 1.71) were not associated with receipt of a referral. CONCLUSIONS Only 30% of patients in this primary care MASLD cohort received a GI E/M referral during the study period, and those patients with a referral did not differ by FIB-4 advanced fibrosis risk.
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Affiliation(s)
- John F G Bobo
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Brad A Keith
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Justin Marsden
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jingwen Zhang
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Andrew D Schreiner
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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13
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Press VG. Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2024; 11:331-340. [PMID: 39054287 PMCID: PMC11363969 DOI: 10.15326/jcopdf.2024.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2024] [Indexed: 07/27/2024]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) rely primarily on inhaled medications to control and treat symptoms. Although the medications delivered by inhaler devices are often quite efficacious when delivered to the lung, the real-world effectiveness of these inhaler devices often falls short. Barriers to effective inhaler use include inhaler misuse and cost-related nonadherence. Inhaler misuse can be reduced with appropriate education which leads to improved outcomes. Education can be provided in multiple settings by a wide array of clinicians and clinical team members including pharmacists, respiratory therapists, nurses, physicians, advanced practice nurses, physician assistants, and community health workers, among others. However, despite decades of research and existing effective strategies across settings and types of educators, overall not much progress has been made with respect to effective inhaler technique among populations of patients with COPD in nearly half a century. Similarly, cost-related nonadherence is a long-standing and critical barrier to effective control of COPD, with limited improvements, especially until very recently. This perspective reviews the current promising directions for inhaler-based therapies, ongoing challenges, and critical issues requiring urgent attention.
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Affiliation(s)
- Valerie G. Press
- Department of Medicine, University of Chicago, Chicago, Illinois, United States
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14
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Kordon A, Carroll AJ, Fu E, Rosenthal LJ, Rado JT, Jordan N, Brown CH, Smith JD. Multilevel perspectives on the implementation of the collaborative care model for depression and anxiety in primary care. BMC Psychiatry 2024; 24:519. [PMID: 39039458 PMCID: PMC11265029 DOI: 10.1186/s12888-024-05930-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Collaborative Care Model (CoCM) is an evidence-based mental health treatment in primary care. A greater understanding of the determinants of successful CoCM implementation, particularly the characteristics of multi-level implementers, is needed. METHODS This study was a process evaluation of the Collaborative Behavioral Health Program (CBHP) study (NCT04321876) in which CoCM was implemented in 11 primary care practices. CBHP implementation included screening for depression and anxiety, referral to CBHP, and treatment with behavioral care managers (BCMs). Interviews were conducted 4- and 15-months post-implementation with BCMs, practice managers, and practice champions (primary care clinicians). We used framework-guided rapid qualitative analysis with the Consolidated Framework for Implementation Research, Version 2.0, focused on the Individuals domain, to analyze response data. These data represented the roles of Mid-Level Leaders (practice managers), Implementation Team Members (clinicians, support staff), Innovation Deliverers (BCMs), and Innovation Recipients (primary care/CBHP patients) and their characteristics (i.e., Need, Capability, Opportunity, Motivation). RESULTS Mid-level leaders (practice managers) were enthusiastic about CBHP (Motivation), appreciated integrating mental health services into primary care (Need), and had time to assist clinicians (Opportunity). Although CBHP lessened the burden for implementation team members (clinicians, staff; Need), some were hesitant to reallocate patient care (Motivation). Innovation deliverers (BCMs) were eager to deliver CBHP (Motivation) and confident in assisting patients (Capability); their opportunity to deliver CBHP could be limited by clinician referrals (Opportunity). Although CBHP alleviated barriers for innovation recipients (patients; Need), it was difficult to secure services for those with severe conditions (Capability) and certain insurance types (Opportunity). CONCLUSIONS Overall, respondents favored sustaining CoCM and highlighted the positive impacts on the practice, health care team, and patients. Participants emphasized the benefits of integrating mental health services into primary care and how CBHP lessened the burden on clinicians while providing patients with comprehensive care. Barriers to CBHP implementation included ensuring appropriate patient referrals, providing treatment for patients with higher-level needs, and incentivizing clinician engagement. Future CoCM implementation should include strategies focused on education and training, encouraging clinician buy-in, and preparing referral paths for patients with more severe conditions or diverse needs. TRIAL REGISTRATION ClinicalTrials.gov(NCT04321876). Registered: March 25,2020. Retrospectively registered.
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Affiliation(s)
- Avram Kordon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa J Rosenthal
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey T Rado
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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15
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We Do. Am J Hypertens 2024; 37:640-649. [PMID: 39004933 PMCID: PMC11247168 DOI: 10.1093/ajh/hpae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Koven S. A matter of time. Lancet 2024; 404:114-115. [PMID: 39002983 DOI: 10.1016/s0140-6736(24)01407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Affiliation(s)
- Suzanne Koven
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. http://www.suzannekoven.com
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17
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Mehta LS, Churchwell K, Coleman D, Davidson J, Furie K, Ijioma NN, Katz JN, Moutier C, Rove JY, Summers R, Vela A, Shanafelt T. Fostering Psychological Safety and Supporting Mental Health Among Cardiovascular Health Care Workers: A Science Advisory From the American Heart Association. Circulation 2024; 150:e51-e61. [PMID: 38813685 DOI: 10.1161/cir.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The psychological safety of health care workers is an important but often overlooked aspect of the rising rates of burnout and workforce shortages. In addition, mental health conditions are prevalent among health care workers, but the associated stigma is a significant barrier to accessing adequate care. More efforts are therefore needed to foster health care work environments that are safe and supportive of self-care. The purpose of this brief document is to promote a culture of psychological safety in health care organizations. We review ways in which organizations can create a psychologically safe workplace, the benefits of a psychologically safe workplace, and strategies to promote mental health and reduce suicide risk.
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18
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. J Bras Nefrol 2024; 46:e2024E007. [PMID: 38991207 PMCID: PMC11239182 DOI: 10.1590/2175-8239-jbn-2024-e007en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 07/13/2024] Open
Abstract
Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Zurich, Switzerland
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
- University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Inland Northwest Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington, Department of Medicine, Nephrology Division, Seattle, Washington, USA
| | - Dina Abdellatif
- Cairo University Hospital, Department of Nephrology, Cairo, Egypt
| | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubiran, Department of Nephrology and Mineral Metabolism, Mexico City, Mexico
| | - Winston W.S. Fung
- University of Hong Kong, Prince of Wales Hospital, Department of Medicine and Therapeutics, The Chinese Shatin, Hong Kong, China
| | - Agnès Haris
- Péterfy Hospital, Nephrology Department, Budapest, Hungary
| | - Li-Li Hsiao
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | | | - Stefanos Roumeliotis
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- University of Nigeria, College of Medicine, Department of Medicine, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | - Siu-Fai Lui
- The Chinese University of Hong Kong, Jockey Club School of Public Health and Primary Care, Division of Health System, Policy and Management, Hong Kong, China
| | - Vassilios Liakopoulos
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
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19
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Huntwork MP, Myint MT, Simon E, Desselle B, Creel AM. Perceptions of Communities of Practice and Sense of Belonging: Focus Groups of Academic Pediatric Faculty. Cureus 2024; 16:e63605. [PMID: 39087158 PMCID: PMC11290700 DOI: 10.7759/cureus.63605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Providing the opportunity for collaboration around a central purpose to improve skills and exchange knowledge, the Community of Practice model can be useful for faculty development. A sense of belonging enhances the engagement in communities. Yet, the barriers and contributors to academic medicine faculty's sense of belonging in communities are not as well explored. METHODS Through focus groups with 21 academic pediatric faculty conducted between January and March 2023, this qualitative study examined knowledge of Communities of Practice and the factors that affect sense of belonging and engagement. The authors iteratively coded transcripts to generate themes. RESULTS Community accessibility; opportunities for active engagement; working under a clear, shared purpose; and personal interactions enhanced faculty sense of belonging. Barriers to engagement included competing demands, process challenges, and uncertainty. DISCUSSION Study results suggest strategies for the promotion of faculty sense of belonging and engagement in Communities of Practice. Consideration of contributors to a sense of belonging may enhance efforts to design and improve engaging faculty development programs.
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Affiliation(s)
- Margaret P Huntwork
- Clinical Immunology, Allergy, and Rheumatology, Tulane University School of Medicine, New Orleans, USA
| | - Myo T Myint
- Child and Adolescent Psychiatry, Tulane University School of Medicine, New Orleans, USA
| | - Emma Simon
- Office of Medical Education, Children's Hospital New Orleans, New Orleans, USA
| | - Bonnie Desselle
- Pediatric Critical Care Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, USA
| | - Amy M Creel
- Pediatric Critical Care Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, USA
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20
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Hand RK, Schofield MK. Expanding Time Covered for Medical Nutrition Therapy: A Need for Clear Reporting on the Intensity of Nutrition Interventions. J Acad Nutr Diet 2024; 124:797-803. [PMID: 38286250 DOI: 10.1016/j.jand.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Rosa K Hand
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio.
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21
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Jhamb M, Weltman MR, Devaraj SM, Lavenburg LMU, Han Z, Alghwiri AA, Fischer GS, Rollman BL, Nolin TD, Yabes JG. Electronic Health Record Population Health Management for Chronic Kidney Disease Care: A Cluster Randomized Clinical Trial. JAMA Intern Med 2024; 184:737-747. [PMID: 38619824 PMCID: PMC11019443 DOI: 10.1001/jamainternmed.2024.0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/12/2024] [Indexed: 04/16/2024]
Abstract
Importance Large gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes. Objective To compare the effectiveness of an electronic health record-based population health management intervention vs usual care for reducing CKD progression and improving evidence-based care in high-risk CKD. Design, Setting, and Participants The Kidney Coordinated Health Management Partnership (Kidney CHAMP) was a pragmatic cluster randomized clinical trial conducted between May 2019 and July 2022 in 101 primary care practices in Western Pennsylvania. It included patients aged 18 to 85 years with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2 with high risk of CKD progression and no outpatient nephrology encounter within the previous 12 months. Interventions Multifaceted intervention for CKD comanagement with primary care clinicians included a nephrology electronic consultation, pharmacist-led medication management, and CKD education for patients. The usual care group received CKD care from primary care clinicians as usual. Main Outcomes and Measures The primary outcome was time to 40% or greater reduction in eGFR or end-stage kidney disease. Results Among 1596 patients (754 intervention [47.2%]; 842 control [52.8%]) with a mean (SD) age of 74 (9) years, 928 (58%) were female, 127 (8%) were Black, 9 (0.6%) were Hispanic, and the mean (SD) estimated glomerular filtration rate was 36.8 (7.9) mL/min/1.73m2. Over a median follow-up of 17.0 months, there was no significant difference in rate of primary outcome between the 2 arms (adjusted hazard ratio, 0.96; 95% CI, 0.67-1.38; P = .82). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker exposure was more frequent in intervention arm compared with the control group (rate ratio, 1.21; 95% CI, 1.02-1.43). There was no difference in the secondary outcomes of hypertension control and exposure to unsafe medications or adverse events between the arms. Several COVID-19-related issues contributed to null findings in the study. Conclusion and Relevance In this study, among patients with moderate-risk to high-risk CKD, a multifaceted electronic health record-based population health management intervention resulted in more exposure days to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers but did not reduce risk of CKD progression or hypertension control vs usual care. Trial Registration ClinicalTrials.gov Identifier: NCT03832595.
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Affiliation(s)
- Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Melanie R. Weltman
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Susan M. Devaraj
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Linda-Marie Ustaris Lavenburg
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zhuoheng Han
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alaa A. Alghwiri
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gary S. Fischer
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce L. Rollman
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas D. Nolin
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Jonathan G. Yabes
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Research on Heath Care, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Kernan WN. The Primary Care Workforce Training Pipeline Has Two Ends. J Gen Intern Med 2024; 39:1539-1540. [PMID: 38429483 PMCID: PMC11254885 DOI: 10.1007/s11606-024-08682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
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Satterwhite S, Nguyen MLT, Honcharov V, McDermott AM, Sarkar U. "Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety. J Gen Intern Med 2024; 39:1575-1582. [PMID: 38360962 PMCID: PMC11255151 DOI: 10.1007/s11606-024-08658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. OBJECTIVE To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. DESIGN Qualitative study based on semi-structured interviews. PARTICIPANTS Twenty-five primary care physicians practicing in the USA. APPROACH Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. KEY RESULTS Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. CONCLUSIONS Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.
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Affiliation(s)
- Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, CA, USA
| | - Michelle-Linh T Nguyen
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Vlad Honcharov
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Aoife M McDermott
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
- UCSF Pride Hall, San Francisco, CA, USA.
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24
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris Á, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Fai Lui S, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Indian J Nephrol 2024; 34:281-290. [PMID: 39156847 PMCID: PMC11328056 DOI: 10.25259/ijn_145_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 08/20/2024] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston WS Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ágnes Haris
- Department of Nephrology, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | - Siu Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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25
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Kukhareva PV, Weir CR, Cedillo M, Taft T, Butler JM, Rudd EA, Zepeda J, Zheutlin E, Kiraly B, Flynn M, Conroy MB, Kawamoto K. Design and implementation of electronic health record-based tools to support a weight management program in primary care. JAMIA Open 2024; 7:ooae038. [PMID: 38745592 PMCID: PMC11091423 DOI: 10.1093/jamiaopen/ooae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/17/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives This paper reports on a mixed methods formative evaluation to support the design and implementation of information technology (IT) tools for a primary care weight management intervention delivered through the patient portal using primary care staff as coaches. Methods We performed a qualitative needs assessment, designed the IT tools to support the weight management program, and developed implementation tracking metrics. Implementation tracking metrics were designed to use real world electronic health record (EHR) data. Results The needs assessment revealed IT requirements as well as barriers and facilitators to implementation of EHR-based weight management interventions in primary care. We developed implementation metrics for the IT tools. These metrics were used in weekly project team calls to make sure that project resources were allocated to areas of need. Conclusion This study identifies the important role of IT in supporting weight management through patient identification, weight and activity tracking in the patient portal, and the use of the EHR as a population management tool. An intensive multi-level implementation approach is required for successful primary care-based weight management interventions including well-designed IT tools, comprehensive involvement of clinic leadership, and implementation tracking metrics to guide the process of workflow integration. This study helps to bridge the gap between informatics and implementation by using socio-technical formative evaluation methods early in order to support the implementation of IT tools. Trial registration clinicaltrials.gov, NCT04420936. Registered June 9, 2020.
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Affiliation(s)
- Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Maribel Cedillo
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Jorie M Butler
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
- George E. Wahlen Department of Veterans Affairs Medical Center, Geriatrics Research and Education Center (GRECC), Salt Lake City, UT 84148, United States
| | - Elizabeth A Rudd
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Jesell Zepeda
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Emily Zheutlin
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Bernadette Kiraly
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Michael Flynn
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, United States
- Community Physicians Group, University of Utah Health, Salt Lake City, UT 84102, United States
| | - Molly B Conroy
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
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Alanaeme CJ, Ghazi L, Akinyelure OP, Wen Y, Christenson A, Poudel B, Dooley EE, Chen L, Hardy ST, Foti K, Bowling CB, Long MT, Colantonio LD, Muntner P. Trends in the Prevalence of Multiple Chronic Conditions Among US Adults With Hypertension From 1999-2000 Through 2017-2020. Am J Hypertens 2024; 37:493-502. [PMID: 38576398 DOI: 10.1093/ajh/hpae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The prevalence of many chronic conditions has increased among US adults. Many adults with hypertension have other chronic conditions. METHODS We estimated changes in the age-adjusted prevalence of multiple (≥3) chronic conditions, not including hypertension, using data from the National Health and Nutrition Examination Survey, from 1999-2000 to 2017-2020, among US adults with (n = 24,851) and without (n = 24,337 hypertension. Hypertension included systolic blood pressure (BP) ≥130 mm Hg, diastolic BP ≥80 mm Hg, or antihypertensive medication use. We studied 14 chronic conditions: arthritis, asthma, cancer, coronary heart disease, chronic kidney disease, depression, diabetes, dyslipidemia, hepatitis B, hepatitis C, heart failure, lung disease, obesity, and stroke. RESULTS From 1999-2000 to 2017-2020, the age-adjusted mean number of chronic conditions increased more among US adults with vs. without hypertension (2.2 to 2.8 vs. 1.7 to 2.0; P-interaction <0.001). Also, the age-adjusted prevalence of multiple chronic conditions increased from 39.0% to 52.0% among US adults with hypertension and from 26.0% to 30.0% among US adults without hypertension (P-interaction = 0.022). In 2017-2020, after age, gender, and race/ethnicity adjustment, US adults with hypertension were 1.94 (95% confidence interval: 1.72-2.18) times as likely to have multiple chronic conditions compared to those without hypertension. In 2017-2020, dyslipidemia, obesity, and arthritis were the most common 3 co-occurring chronic conditions among US adults with and without hypertension (age-adjusted prevalence 16.5% and 3.1%, respectively). CONCLUSIONS In 2017-2020, more than half of US adults with hypertension had ≥3 additional chronic conditions, a substantial increase from 20 years ago.
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Affiliation(s)
- Chibuike J Alanaeme
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lama Ghazi
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Oluwasegun P Akinyelure
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ying Wen
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashley Christenson
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bharat Poudel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin E Dooley
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ligong Chen
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shakia T Hardy
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn Foti
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - C Barrett Bowling
- Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Veterans Affairs, Durham Geriatric Research Education and Clinical Center, Durham, North Carolina, USA
| | - Michelle T Long
- Section of Gastroenterology, Department of Medicine, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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27
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Callahan CM, Carter A, Carty HS, Clark DO, Grain T, Grant SL, McElroy-Jones K, Reinoso D, Harris LE. Building the Infrastructure to Integrate Social Care in a Safety Net Health System. Am J Public Health 2024; 114:619-625. [PMID: 38574317 PMCID: PMC11079822 DOI: 10.2105/ajph.2024.307602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
A recent National Academies report recommended that health systems invest in new infrastructure to integrate social and medical care. Although many health systems routinely screen patients for social concerns, few health systems achieve the recommended model of integration. In this critical case study in an urban safety net health system, we describe the human capital, operational redesign, and financial investment needed to implement the National Academy recommendations. Using data from this case study, we estimate that other health systems seeking to build and maintain this infrastructure would need to invest $1 million to $3 million per year. While health systems with robust existing resources may be able to bootstrap short-term funding to initiate this work, we conclude that long-term investments by insurers and other payers will be necessary for most health systems to achieve the recommended integration of medical and social care. Researchers seeking to test whether integrating social and medical care leads to better patient and population outcomes require access to health systems and communities who have already invested in this model infrastructure. (Am J Public Health. 2024;114(6):619-625. https://doi.org/10.2105/AJPH.2024.307602).
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Affiliation(s)
- Christopher M Callahan
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Amy Carter
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Hannah S Carty
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Daniel O Clark
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Tedd Grain
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Seth L Grant
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Kimberly McElroy-Jones
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Deanna Reinoso
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
| | - Lisa E Harris
- Christopher M. Callahan, Amy Carter, Hannah S. Carty, Tedd Grain, Seth L. Grant, Kimberly McElroy-Jones, Deanna Reinoso, and Lisa E. Harris are with Eskenazi Health, Indianapolis, IN. Daniel O. Clark is with the Department of Medicine, Indiana University School of Medicine, Indianapolis
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Kidney Int Rep 2024; 9:1541-1552. [PMID: 38899169 PMCID: PMC11184315 DOI: 10.1016/j.ekir.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 06/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W.S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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29
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Goldberg DG, Soylu T, Hoffman CF, Kishton RE, Cronholm PF. "Anxiety, COVID, Burnout and Now Depression": a Qualitative Study of Primary Care Clinicians' Perceptions of Burnout. J Gen Intern Med 2024; 39:1317-1323. [PMID: 38010463 PMCID: PMC11169157 DOI: 10.1007/s11606-023-08536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Clinician burnout has become a major issue in the USA, contributing to increased mental health challenges and problems with quality of care, productivity, and retention. OBJECTIVE The objective of this study was to understand primary care clinicians' perspectives on burnout during the COVID-19 pandemic as well as their perspectives on the causes of burnout and strategies to improve clinician well-being. APPROACH This qualitative research involved in-depth interviews with 27 primary care clinicians practicing in a range of settings across the USA. Semi-structured interviews lasted between 60 and 90 min and were conducted using Zoom video conferencing software between July 2021 and February 2023. Transcripts were analyzed in NVivo software using multiple cycles of coding. KEY RESULTS Clinicians shared their experiences with burnout and mental health challenges during the COVID-19 pandemic. Contributors to burnout included high levels of documentation, inefficiencies of electronic health record (EHR) systems, high patient volume, staffing shortages, and expectations for responding to patient emails and telephone calls. The majority of participants described the need to work after clinic hours to complete documentation. Many clinicians also discussed the need for health system leaders to make sincere efforts to enhance work-life balance and create a culture of health and well-being for health professionals. Suggested strategies to address these issues included supportive leadership, accessible mental health services, and additional administrative time to complete documentation. CONCLUSIONS The results of this study provide an in-depth view of participating primary care clinicians' experiences and perceptions of burnout and other mental health challenges. These viewpoints can improve awareness of the issues and strategies to improve the health and well-being of our clinician workforce. Strategies include aligning payment models with the best approaches for delivering quality patient care, reducing administrative burden related to documentation, and redesigning EHR systems with a human factors approach.
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Affiliation(s)
- Debora Goetz Goldberg
- Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Drive MS IJ3, Fairfax, VA, 22030, USA.
- Center for Evidence-Based Behavioral Health, George Mason University, Fairfax County, USA.
| | - Tulay Soylu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, USA
| | - Carolyn Faith Hoffman
- Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Drive MS IJ3, Fairfax, VA, 22030, USA
| | - Rachel E Kishton
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, USA
- Center for Public Health, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
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30
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Darby M, Smith L, Waldron B, Fiandt K. Intensive Primary Care Nursing: Exploring the Impact of a Nurse-Led Model for Medically and Social Complex Patients. Clin Nurs Res 2024; 33:384-394. [PMID: 38757758 DOI: 10.1177/10547738241253654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Lack of access to primary care contributes to health inequities. Treatment settings that utilize the full experience and training of nurses, both registered nurses (RNs) and advanced practice registered nurses (APRNs), can expand in primary care and successfully address health inequities. This small study describes the implementation of a model of primary care called intensive primary care (IPC), which has eight elements that support the full utilization of a nurse's experience and training. This is a mixed method qualitative study, which reports the observations of the implementation and pre- and post-intervention measures. The IPC model was implemented at a free clinic, which targeted underserved population between 2020 and 2023. Participants were selected as a convenience sample. Participants were to have two or more chronic health problems The participants received primary care using the IPC model, which included setting self-management goals, and meeting with RN or APRN on a monthly basis (face to face, via phone or zoom) to monitor progress toward goals. Twenty-two people were approached, and 19 completed the intervention. Pre- and Post-intervention measures (Patient Assessment of Chronic Illness Care [PACIC]-20); Functional, Communicative, Critical Thinking Health Literacy; Perceived Stress; Patient Activation; Perceived Self Efficacy for Chronic Disease; EuroQo- 5 Dimension (EQ-5D); Trust in Provider; Emotional Support-Patient Reported Outcome Measure Information System (PROMIS); and Patient Health Questionnaire-9) were obtained and analyzed with paired T test (α < .05). Nurses involved meet weekly to share observations recorded in free form notes. These observations were summarized by two of the authors (MD and KF) at the end of the study. All patients had improved physical health outcomes, but more importantly, there were significant improvements in measures known to impact health and health outcomes, specifically, patient activation, self-efficacy for chronic illness, PACIC, and trust in provider. Time spent with patients, both duration and frequency of contact, was observed to have significant impacts.
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Affiliation(s)
- Mark Darby
- University of Nebraska Medical Center College of Nursing, Omaha, USA
| | - Linda Smith
- University of Nebraska Medical Center College of Nursing, Omaha, USA
| | - Bailey Waldron
- University of Nebraska Medical Center College of Nursing, Omaha, USA
| | - Kathryn Fiandt
- University of Nebraska Medical Center College of Nursing, Omaha, USA
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Ren Care 2024; 50:79-91. [PMID: 38770802 DOI: 10.1111/jorc.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Department of Medicine, Nephrology Division, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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32
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Chan CA, Binder M, Levander XA, Morford KL. To the Editor: Let This Be the Last Call to Action to Train Residents in Addiction. J Grad Med Educ 2024; 16:369-370. [PMID: 38882438 PMCID: PMC11173032 DOI: 10.4300/jgme-d-24-00147.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Affiliation(s)
- Carolyn A. Chan
- Carolyn A. Chan, MD, MHS, is Assistant Professor of Clinical Medicine, Division of Psychiatry and Behavioral Neuroscience, and Assistant Professor of Clinical Medicine, Division of General Internal Medicine, Department Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael Binder
- Michael Binder, MD, MPH, is Adjunct Associate Professor of Clinical Medicine, Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ximena A. Levander
- Ximena A. Levander, MD, MCR, is Assistant Professor of Medicine, Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Oregon Health & Science University, Portland, Oregon, USA; and
| | - Kenneth L. Morford
- Kenneth L. Morford, MD, is Assistant Professor of Medicine, Program in Addiction Medicine, Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Kiran T, Daneshvarfard M, Wang R, Beyer A, Kay J, Breton M, Brown-Shreves D, Condon A, Green ME, Hedden L, Katz A, Keresteci M, Kovacina N, Lavergne MR, Lofters A, Martin D, Mitra G, Newbery S, Stringer K, MacLeod P, van der Linden C. Public experiences and perspectives of primary care in Canada: results from a cross-sectional survey. CMAJ 2024; 196:E646-E656. [PMID: 38772606 PMCID: PMC11104576 DOI: 10.1503/cmaj.231372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care. METHODS We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models. RESULTS We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who "knows me as a person and considers all the factors that affect my health." After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. INTERPRETATION More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting.
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Affiliation(s)
- Tara Kiran
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont.
| | - Maryam Daneshvarfard
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Ri Wang
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Alexander Beyer
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Jasmin Kay
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Mylaine Breton
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Danielle Brown-Shreves
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Amanda Condon
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Michael E Green
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Lindsay Hedden
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Alan Katz
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Maggie Keresteci
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Neb Kovacina
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - M Ruth Lavergne
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Aisha Lofters
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Danielle Martin
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Goldis Mitra
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Sarah Newbery
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Katherine Stringer
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Peter MacLeod
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
| | - Clifton van der Linden
- Department of Family and Community Medicine (Kiran, Lofters, Martin), Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine (Kiran), and MAP Centre for Urban Health Solutions (Kiran, Daneshvarfard, Wang), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran, Martin), University of Toronto, Toronto, Ont.; Department of Political Science (Beyer, van der Linden), McMaster University, Hamilton, Ont.; Vox Pop Labs (Beyer, van der Linden); MASS LBP (Kay, MacLeod), Toronto, Ont.; Department of Community Health (Breton), Université de Sherbrooke, Longueuil, Que.; Department of Family Medicine (Brown-Shreves), University of Ottawa; Restore Medical Clinics (Brown-Shreves), Ottawa, Ont.; Department of Family and Community Medicine (Brown-Shreves), Queen's University, Kingston, Ont.; Department of Family Medicine (Condon), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Green), and Health Services and Policy Research Institute (Green), Queens University; ICES Queen's (Green), Kingston, Ont.; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; Departments of Community Health Sciences and Family Medicine (Katz), University of Manitoba, Winnipeg, Man.; Canadian Association for Health Services and Policy Research (Keresteci), Ottawa, Ont.; Department of Family Medicine (Kovacina), McGill University, Montréal, Que.; Department of Family Medicine (Lavergne, Stringer), Dalhousie University, Halifax, NS; Peter Gilgan Centre for Women's Cancers (Lofters), and Department of Family and Community Medicine (Martin), Women's College Hospital, Toronto, Ont.; Department of Family Practice (Mitra), University of British Columbia, Vancouver, BC; Clinical Faculty (Newbery), Section of Family Medicine, NOSM University, Thunder Bay, Ont
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We do. Can J Kidney Health Dis 2024; 11:20543581241252506. [PMID: 38764602 PMCID: PMC11102772 DOI: 10.1177/20543581241252506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary-care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, USA
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | | | - Fiona Loud
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Vasundhara Raghavan
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
| | - Marianella Sierra
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Nigeria
| | - Bill Wang
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Blood Purif 2024; 53:691-703. [PMID: 38754386 PMCID: PMC11397411 DOI: 10.1159/000539071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Fernandes C, Campbell-Scherer D, Lofters A, Grunfeld E, Aubrey-Bassler K, Cheung H, Latko K, Tink W, Lewanczuk R, Shea-Budgell M, Heisey R, Wong T, Yang H, Walji S, Wilson M, Holmes E, Lang-Robertson K, DeLonghi C, Manca DP. Harmonization of clinical practice guidelines for primary prevention and screening: actionable recommendations and resources for primary care. BMC PRIMARY CARE 2024; 25:153. [PMID: 38711031 PMCID: PMC11071261 DOI: 10.1186/s12875-024-02388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations. We describe the process used to harmonize high-quality cancer and chronic disease prevention and screening (CCDPS) CPGs to update the BETTER program. METHODS A review of CPG databases, repositories, and grey literature was conducted to identify international and Canadian (national and provincial) CPGs for CCDPS in adults 40-69 years of age across 19 topic areas: cancers, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hepatitis C, obesity, osteoporosis, depression, and associated risk factors (i.e., diet, physical activity, alcohol, cannabis, drug, tobacco, and vaping/e-cigarette use). CPGs published in English between 2016 and 2021, applicable to adults, and containing CCDPS recommendations were included. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and a three-step process involving patients, health policy, content experts, primary care providers, and researchers was used to identify and synthesize recommendations. RESULTS We identified 51 international and Canadian CPGs and 22 guidelines developed by provincial organizations that provided relevant CCDPS recommendations. Clinical recommendations were extracted and reviewed for inclusion using the following criteria: 1) pertinence to primary prevention and screening, 2) relevance to adults ages 40-69, and 3) applicability to diverse primary care settings. Recommendations were synthesized and integrated into the BETTER toolkit alongside resources to support shared decision-making and care paths for the BETTER program. CONCLUSIONS Comprehensive care requires the ability to address a person's overall health. An approach to identify high-quality clinical guidance to comprehensively address CCDPS is described. The process used to synthesize and harmonize implementable clinical recommendations may be useful to others wanting to integrate evidence across broad content areas to provide comprehensive care. The BETTER toolkit provides resources that clearly and succinctly present a breadth of clinical evidence that providers can use to assist with implementing CCDPS guidance in primary care.
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Affiliation(s)
- Carolina Fernandes
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Heidi Cheung
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Katherine Latko
- College of Physicians and Surgeons of Ontario, Toronto, ON, Canada
| | - Wendy Tink
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Richard Lewanczuk
- Alberta Health Services, Alberta, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Ruth Heisey
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
- Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Tracy Wong
- Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | | | - Sakina Walji
- Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | | | | | - Donna Patricia Manca
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Hung A, Wilson L, Smith VA, Pavon JM, Sloan CE, Hastings SN, Farley J, Maciejewski ML. Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure. JAMA HEALTH FORUM 2024; 5:e240807. [PMID: 38700854 PMCID: PMC11069085 DOI: 10.1001/jamahealthforum.2024.0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/06/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourage the use of CMRs. Objective To examine trends in CMR completion rates before and after 2016 and whether racial, ethnic, and socioeconomic disparities in CMR completion changed. Design, Setting, and Participants This observational study using interrupted time-series analysis examined 2013 to 2020 annual cohorts of community-dwelling Medicare beneficiaries aged 66 years and older eligible for a CMR as determined by Part D plans and by objective minimum eligibility criteria. Data analysis was conducted from September 2022 to February 2024. Exposure Adoption of CMR completion as a Star Rating quality measure in 2016. Main Outcome and Measures CMR completion modeled via generalized estimating equations. Results The study included a total of 561 950 eligible beneficiaries, with 253 561 in the 2013 to 2015 cohort (median [IQR] age, 75.8 [70.7-82.1] years; 90 778 male [35.8%]; 6795 Asian [2.7%]; 24 425 Black [9.6%]; 7674 Hispanic [3.0%]; 208 621 White [82.3%]) and 308 389 in the 2016 to 2020 cohort (median [IQR] age, 75.1 [70.4-80.9] years; 126 730 male [41.1%]; 8922 Asian [2.9%]; 27 915 Black [9.1%]; 7635 Hispanic [2.5%]; 252 781 White [82.0%]). The unadjusted CMR completion rate increased from 10.2% (7379 of 72 225 individuals) in 2013 to 15.6% (14 185 of 90 847 individuals) in 2015 and increased further to 35.8% (18 376 of 51 386 individuals) in 2020, in part because the population deemed by Part D plans to be MTM-eligible decreased by nearly half after 2015 (90 487 individuals in 2015 to 51 386 individuals in 2020). Among a simulated cohort based on Medicare minimum eligibility thresholds, the unadjusted CMR completion rate increased but to a lesser extent, from 4.4% in 2013 to 12.6% in 2020. Compared with White beneficiaries, Asian and Hispanic beneficiaries experienced greater increases in likelihood of CMR completion after 2016 but remained less likely to complete a CMR. Dual-Medicaid enrollees also experienced greater increases in likelihood of CMR completion as compared with those without either designation, but still remained less likely to complete CMR. Conclusion and Relevance This study found that adoption of CMR completion as a Star Rating quality measure was associated with higher CMR completion rates. The increase in CMR completion rates was achieved partly because Part D plans used stricter eligibility criteria to define eligible patients. Reductions in disparities for eligible Asian, Hispanic, and dual-Medicaid enrollees were seen, but not eliminated. These findings suggest that quality measures can inform plan behavior and could be used to help address disparities.
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Affiliation(s)
- Anna Hung
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Lauren Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Valerie A. Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Juliessa M. Pavon
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Caroline E. Sloan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Susan N. Hastings
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Joel Farley
- Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis
| | - Matthew L. Maciejewski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Family Med Prim Care 2024; 13:1594-1611. [PMID: 38948565 PMCID: PMC11213387 DOI: 10.4103/jfmpc.jfmpc_518_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Vasundhara Raghavan
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Stefanos Roumeliotis
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Makoul G, Noble L, Gulbrandsen P, van Dulmen S. Reinforcing the humanity in healthcare: The Glasgow Consensus Statement on effective communication in clinical encounters. PATIENT EDUCATION AND COUNSELING 2024; 122:108158. [PMID: 38330705 DOI: 10.1016/j.pec.2024.108158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
Contemporary healthcare is characterized by multidisciplinary teamwork across a vast array of primary, secondary and tertiary services, augmented by progressively more technology and data. While these developments aim to improve care, they have also created obstacles and new challenges for both patients and health professionals. Indeed, the increasingly fragmented and transactional nature of clinical encounters can dehumanize the care experience across disciplines and specialties. Effective communication plays a pivotal role in reinforcing the humanity of healthcare through the delivery of person-centered care - compassionate, collaborative care that focuses on the needs of each patient as a whole person. After convening at the International Conference on Communication in Healthcare (Glasgow, 2022), an interdisciplinary group of researchers, educators and health professionals worked together to develop a framework for effective communication that both acknowledges critical challenges in contemporary health services and reinforces the humanity of healthcare. The Glasgow Consensus Statement is intended to function as a useful international touchstone for the training and practice of health professionals, fully recognizing and respecting that different countries are at different stages when it comes to teaching, assessment and policy. It also provides a vocabulary for monitoring the impact of system-level challenges. While effective communication may not change the structure of healthcare, it can improve the process if health professionals are supported in infusing the system with their own innate humanity and applying the framework offered within this consensus statement to reinforce the humanity in everyday practice.
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Affiliation(s)
- Gregory Makoul
- Department of Medicine, Yale School of Medicine, New Haven, USA; Human Understanding Institute, NRC Health, Lincoln, USA.
| | - Lorraine Noble
- UCL Medical School, University College London, London, UK; EACH: International Association for Communication in Healthcare, Salisbury, UK
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Akershus University Hospital, Nordbyhagen, Norway
| | - Sandra van Dulmen
- NIVEL - Netherlands Institute for Health Services Research, Utrecht, Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Morrow R, Stahl MG, Liu E, Shull M, Germone M, Nagle S, Griffith I, Mehta P. Food insecurity screening practices in a pediatric gastroenterology population. JPGN REPORTS 2024; 5:135-139. [PMID: 38756126 PMCID: PMC11093937 DOI: 10.1002/jpr3.12058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/04/2024] [Accepted: 02/03/2024] [Indexed: 05/18/2024]
Abstract
Food insecurity is a rising concern for US households and leads to adverse child health outcomes. Pediatric gastroenterology providers are uniquely equipped to help guide families experiencing this challenge given their specialized training in nutritional support and dietary therapy for disease management. Hence, this study aimed to evaluate food insecurity screening practices from the perspectives of patient caregivers and healthcare providers in a tertiary pediatric gastroenterology practice. A survey was administered to 1279 caregivers and 121 providers. Of the 248 completed caregiver responses, 10%-15% reported being asked about food insecurity. Among the 36 healthcare provider responses, 53% expressed comfort in conducting food insecurity screening but only 14% routinely screened. The most cited barrier to screening was the lack of readily available patient resources. Further research is imperative to address these screening barriers and assess the impact of food insecurity screening and interventions on pediatric gastrointestinal health outcomes.
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Affiliation(s)
- Ryan Morrow
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and NutritionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Marisa G. Stahl
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and NutritionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Colorado Center for Celiac Disease, Digestive Health InstituteChildren's Hospital ColoradoAuroraColoradoUSA
| | - Ed Liu
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and NutritionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Colorado Center for Celiac Disease, Digestive Health InstituteChildren's Hospital ColoradoAuroraColoradoUSA
| | - Mary Shull
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and NutritionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Colorado Center for Celiac Disease, Digestive Health InstituteChildren's Hospital ColoradoAuroraColoradoUSA
| | - Monique Germone
- Colorado Center for Celiac Disease, Digestive Health InstituteChildren's Hospital ColoradoAuroraColoradoUSA
- Department of PsychiatryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Sadie Nagle
- Colorado Center for Celiac Disease, Digestive Health InstituteChildren's Hospital ColoradoAuroraColoradoUSA
| | - Isabel Griffith
- Colorado Center for Celiac Disease, Digestive Health InstituteChildren's Hospital ColoradoAuroraColoradoUSA
| | - Pooja Mehta
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and NutritionUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Colorado Center for Celiac Disease, Digestive Health InstituteChildren's Hospital ColoradoAuroraColoradoUSA
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Aubrey-Bassler K, Patel D, Fernandes C, Lofters AK, Campbell-Scherer D, Meaney C, Moineddin R, Wong T, Pinto AD, Shea-Budgell M, McBrien K, Grunfeld E, Manca DP. Chronic disease prevention and screening outcomes for patients with and without financial difficulty: a secondary analysis of the BETTER WISE cluster randomised controlled trial. BMJ Open 2024; 14:e078938. [PMID: 38626970 PMCID: PMC11029378 DOI: 10.1136/bmjopen-2023-078938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Building on Existing Tools To improvE chronic disease pRevention and screening in primary care Wellness of cancer survIvorS and patiEnts (BETTER WISE) was designed to assess the effectiveness of a cancer and chronic disease prevention and screening (CCDPS) programme. Here, we compare outcomes in participants living with and without financial difficulty. DESIGN Secondary analysis of a cluster-randomised controlled trial. SETTING Patients of 59 physicians from 13 clinics enrolled between September 2018 and August 2019. PARTICIPANTS 596 of 1005 trial participants who responded to a financial difficulty screening question at enrolment. INTERVENTION 1-hour CCDPS visit versus usual care. OUTCOME MEASURES Eligibility for a possible 24 CCDPS actions was assessed at baseline and the primary outcome was the percentage of eligible items that were completed at 12-month follow-up. We also compared the change in response to the financial difficulty screening question between baseline and follow-up. RESULTS 55 of 265 participants (20.7%) in the control group and 69 of 331 participants (20.8%) in the intervention group reported living with financial difficulty. The primary outcome was 29% (95% CI 26% to 33%) for intervention and 23% (95% CI 21% to 26%) for control participants without financial difficulty (p=0.01). Intervention and control participants with financial difficulty scored 28% (95% CI 24% to 32%) and 32% (95% CI 27% to 38%), respectively (p=0.14). In participants who responded to the financial difficulty question at both time points (n=302), there was a net decrease in the percentage of participants who reported financial difficulty between baseline (21%) and follow-up (12%, p<0.001) which was similar in the control and intervention groups. The response rate to this question was only 51% at follow-up. CONCLUSION The BETTER intervention improved uptake of CCDPS manoeuvres in participants without financial difficulty, but not in those living with financial difficulty. Improving CCDPS for people living with financial difficulty may require a different clinical approach or that social determinants be addressed concurrently with clinical and lifestyle needs or both. TRIAL REGISTRATION NUMBER ISRCTN21333761.
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Affiliation(s)
- Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Dhruvesh Patel
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Denise Campbell-Scherer
- Covenant Health, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Wong
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Andrew David Pinto
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Melissa Shea-Budgell
- Charbonneau Cancer Institute and Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Donna P Manca
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Covenant Health, Grey Nuns Community Hospital, Edmonton, Alberta, Canada
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Porterfield L, Ram M, Kuo YF, Gaither ZM, O'Connell KP, Roy K, Bhardwaj N, Fingado E. Disparities in the Timeliness of Addressing Patient-Initiated Telephone Calls in a Primary Care Clinic: The Impact of Quality Improvement Interventions. HEALTH COMMUNICATION 2024:1-9. [PMID: 38567512 DOI: 10.1080/10410236.2024.2335056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A timely response to patient-initiated telephone calls can affect many aspects of patient health, including quality of care and health equity. Historically, at a family medicine residency clinic, at least 1 out of 4 patient calls remained unresolved three days after the call was placed. We sought to explore whether there were differential delays in resolution of patient concerns for certain groups and how these were affected by quality improvement interventions to increase responsiveness to patient calls. A multidisciplinary team at a primary care residency clinic applied Lean education and tools to improve the timeliness of addressing telephone encounters. Telephone encounter data were obtained for one year before and nine months after the intervention. Data were stratified by race, ethnicity, preferred language, sex, online portal activation status, age category, zip code, patient risk category, and reason for call. Stratified data revealed consistently worse performance on telephone encounter closure by 72 hours for Black/African American patients compared to Hispanic and non-Hispanic White patients pre-intervention. Interventions resulted in statistically significant overall improvement, with an OR of 2.9 (95% CI: 2.62 to 3.21). Though interventions did not target a specific population, pre-intervention differences based on race and ethnicity resolved post-intervention. Telephone calls serve as an important means of patient communication with care teams. General interventions to improve the timeliness of addressing telephone encounters can lead to sustainable improvement in a primary care academic clinic and may also alleviate disparities.
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Affiliation(s)
| | - Mythili Ram
- System Optimization & Performance, University of Texas Medical Branch
| | - Yong Fang Kuo
- Department of Biostatistics and Data Science, University of Texas Medical Branch
| | - Zanita M Gaither
- Department of Family Medicine, University of Texas Medical Branch
| | | | - Khushali Roy
- School of Medicine, University of Texas Medical Branch
| | - Namita Bhardwaj
- Department of Family Medicine, University of Texas Medical Branch
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch
| | - Elizabeth Fingado
- System Optimization & Performance, University of Texas Medical Branch
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Abstract
This Viewpoint discusses how artificial intelligence can be used to increase efficiency of primary care processes for clinicians and patients.
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Affiliation(s)
- Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Chae S, Lee E, Lindenberg J, Shen K, Anderson TS. Evaluation of a benzodiazepine deprescribing quality improvement initiative for older adults in primary care. J Am Geriatr Soc 2024; 72:1234-1241. [PMID: 38147454 PMCID: PMC11018491 DOI: 10.1111/jgs.18728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/05/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Older adults are commonly prescribed long-term benzodiazepines for anxiety and insomnia despite evidence of risks and limited evidence of long-term benefits. Recent quality measures and guidelines have recommended benzodiazepine deprescribing, yet there is little real-world data on clinic-based deprescribing programs. METHODS We developed a benzodiazepine deprescribing quality improvement program for older adults at a large US academic medical center. The program targeted adults aged 65 years and older who were prescribed chronic benzodiazepines by their primary care physician (PCP). PCPs were contacted to opt-out patients not suitable for deprescribing; then eligible patients were mailed a letter discussing patient-specific risks and advising them to discuss deprescribing with their PCP or a pharmacist who was available to support tapering. The primary outcomes were the number of patients who discussed deprescribing and who initiated a taper within 90 days of outreach. RESULTS Of 504 older adults prescribed benzodiazepines, 133 (26%) were opted out by their PCPs leaving a cohort of 371 (median age 71 years [IQR 68-75], 58% female, 82% White). The median daily diazepam milligram equivalent was 5 mg (IQR 3-6 mg) and 30% were prescribed long-acting benzodiazepines. Three months following patient outreach, 97 patients (26%) had a documented discussion of benzodiazepines with their PCP or clinic pharmacist. Of these patients, 35 (36%) had documentation of a deprescribing discussion and 25 (26%) initiated a taper. At 12 months, 16 patients (64%) were tapered successfully, with nine (36%) patients taking a lower benzodiazepine dose and seven (28%) discontinuing benzodiazepines completely. CONCLUSIONS A low-intensity benzodiazepine deprescribing outreach program led to deprescribing conversations for a minority of patients, but one-quarter of older adults who engaged in a conversation chose to taper and nearly two-thirds sustained reduced use. Incorporating benzodiazepine deprescribing into routine care may require more intensive population-health efforts to engage patients and clinicians.
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Affiliation(s)
- Sulgi Chae
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Psychiatry, Kaiser Permanente, Santa Clara, CA Long-acting benz
| | - Emma Lee
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA
| | - Julia Lindenberg
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kaden Shen
- Northeastern University Bouve College of Health Sciences, Boston, MA
| | - Timothy S. Anderson
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- University of Pittsburgh, Pittsburgh, PA
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Nguyen MLT, Honcharov V, Ballard D, Satterwhite S, McDermott AM, Sarkar U. Primary Care Physicians' Experiences With and Adaptations to Time Constraints. JAMA Netw Open 2024; 7:e248827. [PMID: 38687477 PMCID: PMC11061766 DOI: 10.1001/jamanetworkopen.2024.8827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
Importance The primary care workforce shortage is significant and persistent, with organizational and policy leaders urgently seeking interventions to enhance retention and recruitment. Time constraints are a valuable focus for action; however, designing effective interventions requires deeper understanding of how time constraints shape employees' experiences and outcomes of work. Objective To examine how time constraints affect primary care physicians' work experiences and careers. Design, Setting, and Participants Between May 1, 2021, and September 31, 2022, US-based primary care physicians who trained in family or internal medicine were interviewed. Using qualitative analysis of in-depth interviews, this study examined how participants experience and adapt to time constraints during a typical clinic day, taking account of their professional and personal responsibilities. It also incorporates physicians' reflections on implications for their careers. Main Outcomes and Measures Thematic analysis of in-depth interviews and a measure of well-being (American Medical Association Mini-Z survey). Results Interviews with 25 primary care physicians (14 [56%] female and 11 [44%] male; median [range] age, 43 [34-63] years) practicing in 11 US states were analyzed. Two physicians owned their own practice, whereas the rest worked as employees. The participants represented a wide range of years in practice (range, 1 to ≥21), with 11 participants (44%) in their first 5 years. Physicians described that the structure of their work hours did not match the work that was expected of them. This structural mismatch between time allocation and work expectations created a constant experience of time scarcity. Physicians described having to make tradeoffs between maintaining high-quality patient care and having their work overflow into their personal lives. These experiences led to feelings of guilt, disillusionment, and dissatisfaction. To attempt to sustain long-term careers in primary care, many sought ways to see fewer patients. Conclusions and Relevance These findings suggest that organizational leaders must align schedules with work expectations for primary care physicians to mitigate physicians' withdrawal from work as a coping mechanism. Specific strategies are needed to achieve this realignment, including incorporating more slack into schedules and establishing realistic work expectations for physicians.
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Affiliation(s)
| | - Vlad Honcharov
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Dawna Ballard
- Department of Communication Studies, University of Texas at Austin, Austin
| | - Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, California
| | - Aoife M. McDermott
- School of Public Health, University of California, Berkeley
- Aston Business School, Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
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Abrams R, Jones B, Campbell J, de Lusignan S, Peckham S, Gage H. The effect of general practice team composition and climate on staff and patient experiences: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0111. [PMID: 37827584 PMCID: PMC11169989 DOI: 10.3399/bjgpo.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multidisciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. AIM To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. DESIGN & SETTING A systematic literature review of international evidence. METHOD Four different searches were carried out using MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science. Evidence from English language articles from 2012-2022 was identified, with no restriction on study design. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and data were synthesised thematically. RESULTS In total, 11 studies in primary healthcare settings were included, 10 from US integrated healthcare systems, one from Canada. Findings indicated that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care quality in situations of high workload. Good team dynamics and stable team membership are important for patient care coordination and job satisfaction. Female physicians are at greater risk of burnout. CONCLUSION Evidence regarding team composition and team climate in relation to staff and patient outcomes in general practice remains limited. Challenges exist when drawing conclusions across different team compositions and definitions of team climate. Further research is needed to explore the conditions that generate a 'good' climate.
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Affiliation(s)
- Ruth Abrams
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Bridget Jones
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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Dunn J, Coravos A, Fanarjian M, Ginsburg GS, Steinhubl SR. Remote digital health technologies for improving the care of people with respiratory disorders. Lancet Digit Health 2024; 6:e291-e298. [PMID: 38402128 PMCID: PMC10960683 DOI: 10.1016/s2589-7500(23)00248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/01/2023] [Accepted: 11/30/2023] [Indexed: 02/26/2024]
Abstract
Respiratory diseases are a leading cause of morbidity and mortality globally. However, existing systems of care, built around scheduled appointments, are not well designed to support the needs of people with chronic and acute respiratory conditions that can change rapidly and unexpectedly. Home-based and personal digital health technologies (DHTs) allow implementation of new models of care catering to the unique needs of individuals. The high number of respiratory triggers and unique responses to them require a personalised solution for each patient. The real-world, repetitive monitoring capabilities of DHTs enable identification of the normal operating characteristics for each individual and, therefore, recognition of the earliest deviations from that state. However, despite this potential, the number of clinical efficacy studies of DHTs is quite small. Evaluation of clinical effectiveness of DHTs in improving health quality in real-world settings is urgently needed.
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Affiliation(s)
- Jessilyn Dunn
- Biomedical Engineering Department, Duke University, Durham, NC, USA
| | | | | | - Geoffrey S Ginsburg
- Department of Medicine, Duke University, Durham, NC, USA; All of Us Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Steven R Steinhubl
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
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Braddock AS, Bosworth KT, Ghosh P, Proffitt R, Flowers L, Montgomery E, Wilson G, Tosh AK, Koopman RJ. Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study. Appl Clin Inform 2024; 15:368-377. [PMID: 38458233 PMCID: PMC11078569 DOI: 10.1055/a-2283-9036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. OBJECTIVES We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. METHODS In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. RESULTS Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. CONCLUSION Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.
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Affiliation(s)
- Amy S. Braddock
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - K. Taylor Bosworth
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Parijat Ghosh
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Rachel Proffitt
- School of Health Professions, University of Missouri, Columbia, Missouri, United States
| | - Lauren Flowers
- School of Medicine, University of Missouri, Columbia, Missouri, United States
| | - Emma Montgomery
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Gwendolyn Wilson
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
| | - Aneesh K. Tosh
- Department of Child Health, University of Missouri, Columbia, Missouri, United States
| | - Richelle J. Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, United States
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Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. Kidney Int 2024; 105:406-417. [PMID: 38375622 DOI: 10.1016/j.kint.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 02/21/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
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Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA; Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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50
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Bradley SH, Harper AM, Smith L, Taylor N, Delap H, Pyke H, Girkin J, Sinnott C, Watson J. Great expectations? GPs' estimations of time required to deliver BMJ's '10 minute consultations'. BMJ Open 2024; 14:e079578. [PMID: 38413154 PMCID: PMC10900324 DOI: 10.1136/bmjopen-2023-079578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To estimate the time required to undertake consultations according to BMJ's 10-minute consultation articles.To quantify the tasks recommended in 10-minute consultation articles.To determine if, and to what extent, the time required and the number of tasks recommended have increased over the past 22 years. DESIGN Analysis of estimations made by four general practitioners (GPs) of the time required to undertake tasks recommended in BMJ's 10-minute consultation articles. SETTING Primary care in the UK. PARTICIPANTS Four doctors with a combined total of 79 years of experience in the UK National Health Service following qualification as GPs. MAIN OUTCOME MEASURES Median minimum estimated consultation length (the estimated time required to complete tasks recommended for all patients) and median maximum estimated consultation length (the estimated time required to complete tasks recommended for all patients and the additional tasks recommended in specific circumstances). Minimum, maximum and median consultation lengths reported for each year and for each 5-year period. RESULTS Data were extracted for 44 articles. The median minimum and median maximum estimated consultation durations were 15.7 minutes (IQR 12.6-20.9) and 28.4 minutes (IQR 22.4-33.8), respectively. A median of 17 tasks were included in each article. There was no change in durations required over the 22 years examined. CONCLUSIONS The approximate times estimated by GPs to deliver care according to 10-minute consultations exceed the time available in routine appointments. '10 minute consultations' is a misleading title that sets inappropriate expectations for what GPs can realistically deliver in their routine consultations. While maintaining aspirations for high-quality care is appropriate, practice recommendations need to take greater account of the limited time doctors have to deliver routine care.
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Affiliation(s)
- Stephen Henry Bradley
- Academic Unit of Primary Care, University of Leeds, Leeds, UK
- York Street Practice, Leeds, UK
| | - Alice M Harper
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Lesley Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | | | | | - Carol Sinnott
- The Healthcare Improvement Studies (THIS) Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Court St Medical Practice, Enniscorthy, Ireland
| | - Jessica Watson
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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