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Ares-Blanco S, López-Rodríguez JA, Polentinos-Castro E, Del Cura-González I. Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe. BMC PRIMARY CARE 2024; 25:165. [PMID: 38750446 PMCID: PMC11094967 DOI: 10.1186/s12875-024-02400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. METHODS Cross-sectional study using data collected from the European Health Interview Survey 2013-2015 of individuals aged 40-74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. RESULTS 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43-8.15; colorectal screening aOR: 1.87, 95% CI: 1.80-1.95; mammography aOR: 1.76, 95% CI: 1.69-1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85-1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. CONCLUSIONS Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.
- Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- General Ricardos Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Elena Polentinos-Castro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Isabel Del Cura-González
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
- Aging Research Center, Karolinksa Instituted, Stockholm, Sweden
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Appiah EO, Appiah S, Oti-Boadi E, Boadu BA, Kontoh S, Adams RI, Appiah C, Sarpong C. Attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. PLoS One 2023; 18:e0290970. [PMID: 37682963 PMCID: PMC10490930 DOI: 10.1371/journal.pone.0290970] [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: 07/08/2022] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Pressure ulcers (PUs), which affect millions of people worldwide, are among the five most prevalent hospitalized cases causing adverse impairment. Nevertheless, pressure ulcers are largely preventable, and their management depends on their severity. The authors, therefore, explored the attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. METHODS An exploratory descriptive qualitative approach was employed for this study to help researchers explore the attitude and practices toward PU (Pressure Ulcer). Purposive sampling approach was employed, and data was analyzed using thematic content analysis. The sample size for this study was 30 which was obtained based on saturation. Participants were engaged in face-to-face interviews which were transcribed verbatim. FINDINGS Two themes and eight subthemes were generated from the analysis of this study. The two themes were preventive practices and attitude towards PU. The study identified that there were no specific protocols illustrated on the wards for managing pressure ulcers. Nevertheless, the study participants were keen on preventing pressure ulcers and hence engaged in practices such as early patients' ambulation, early identification of PU signs, removing creases and crumps from patient beds, nutritional management for PU prevention, and dressing of PU wounds. CONCLUSION Practices of pressure ulcer management were highly valued by the orthopedics nurses. Hence, the nurses recommended the need for accepted guidelines on pressure ulcer management to be illustrated in the various orthopedic wards in the country.
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Affiliation(s)
- Evans Osei Appiah
- School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
- Purdue University, West Lafayette, IN, United States of America
| | - Stella Appiah
- Head of Nursing Department, School of Nursing and Midwifery, Valley View University, Accra, Ghana
| | - Ezekiel Oti-Boadi
- School of Nursing, Heritage Christian College, Valley View University, Accra, Ghana
| | | | - Samuel Kontoh
- Department of Mental Health, School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | | | - Cyndi Appiah
- Ghana Christian University College, Amrahia, Ghana
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Min A, Miller WR, Rocha LM, Börner K, Correia RB, Shih PC. Understanding Contexts and Challenges of Information Management for Epilepsy Care. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2023; 2023:328. [PMID: 37786774 PMCID: PMC10544776 DOI: 10.1145/3544548.3580949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Epilepsy is a common chronic neurological disease. People with epilepsy (PWE) and their caregivers face several challenges related to their epilepsy management, including quality of care, care coordination, side effects, and stigma management. The sociotechnical issues of the information management contexts and challenges for epilepsy care may be mitigated through effective information management. We conducted 4 focus groups with 5 PWE and 7 caregivers to explore how they manage epilepsy-related information and the challenges they encountered. Primary issues include challenges of finding the right information, complexities of tracking and monitoring data, and limited information sharing. We provide a framework that encompasses three attributes - individual epilepsy symptoms and health conditions, information complexity, and circumstantial constraints. We suggest future design implications to mitigate these challenges and improve epilepsy information management and care coordination.
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Affiliation(s)
- Aehong Min
- Indiana University Bloomington, Bloomington, Indiana, USA
| | | | - Luis M Rocha
- Binghamton University, Binghamton, New York, USA
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Katy Börner
- Indiana University Bloomington, Bloomington, Indiana, USA
| | - Rion Brattig Correia
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Binghamton University, Binghamton, New York, USA
| | - Patrick C Shih
- Indiana University Bloomington, Bloomington, Indiana, USA
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Elliott TE, Asche SE, O'Connor PJ, Dehmer SP, Ekstrom HL, Truitt AR, Chrenka EA, Harry ML, Saman DM, Allen CI, Bianco JA, Freitag LA, Sperl-Hillen JM. Clinical Decision Support with or without Shared Decision Making to Improve Preventive Cancer Care: A Cluster-Randomized Trial. Med Decis Making 2022; 42:808-821. [PMID: 35209775 DOI: 10.1177/0272989x221082083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Innovative interventions are needed to address gaps in preventive cancer care, especially in rural areas. This study evaluated the impact of clinical decision support (CDS) with and without shared decision making (SDM) on cancer-screening completion. METHODS In this 3-arm, parallel-group, cluster-randomized trial conducted at a predominantly rural medical group, 34 primary care clinics were randomized to clinical decision support (CDS), CDS plus shared decision making (CDS+SDM), or usual care (UC). The CDS applied web-based clinical algorithms identifying patients overdue for United States Preventive Services Task Force-recommended preventive cancer care and presented evidence-based recommendations to patients and providers on printouts and on the electronic health record interface. Patients in the CDS+SDM clinic also received shared decision-making tools (SDMTs). The primary outcome was a composite indicator of the proportion of patients overdue for breast, cervical, or colorectal cancer screening at index who were up to date on these 1 y later. RESULTS From August 1, 2018, to March 15, 2019, 69,405 patients aged 21 to 74 y had visits at study clinics and 25,198 were overdue for 1 or more cancer screening tests at an index visit. At 12-mo follow-up, 9,543 of these (37.9%) were up to date on the composite endpoint. The adjusted, model-derived percentage of patients up to date was 36.5% (95% confidence interval [CI]: 34.0-39.1) in the UC group, 38.1% (95% CI: 35.5-40.9) in the CDS group, and 34.4% (95% CI: 31.8-37.2) in the CDS+SDM group. For all comparisons, the screening rates were higher than UC in the CDS group and lower than UC in the CDS+SDM group, although these differences did not reach statistical significance. CONCLUSION The CDS did not significantly increase cancer-screening rates. Exploratory analyses suggest a deeper understanding of how SDM and CDS interact to affect cancer prevention decisions is needed. Trial registration: ClinicalTrials.gov ID: NCT02986230, December 6, 2016.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel M Saman
- Essentia Institute of Rural Health, Duluth, MN, USA.,Nicklaus Children's Health System, Doral, FL, USA
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Taksler GB, Peterse EFP, Willems I, Ten Haaf K, Jansen EEL, de Kok IMCM, van Ravesteyn NT, de Koning HJ, Lansdorp-Vogelaar I. Modeling Strategies to Optimize Cancer Screening in USPSTF Guideline-Noncompliant Women. JAMA Oncol 2021; 7:885-894. [PMID: 33914025 DOI: 10.1001/jamaoncol.2021.0952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance In 2018, only half of US women obtained all evidence-based cancer screenings. This proportion may have declined during the COVID-19 pandemic because of social distancing, high-risk factors, and fear. Objective To evaluate optimal screening strategies in women who obtain some, but not all, US Preventive Services Task Force (USPSTF)-recommended cancer screenings. Design, Setting, and Participants This modeling study was conducted from January 31, 2017, to July 20, 2020, and used 4 validated mathematical models from the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network using data from 20 million simulated women born in 1965 in the US. Interventions Forty-five screening strategies were modeled that combined breast, cervical, colorectal, and/or lung cancer (LC) screenings; restricted to 1, 2, 3 or 4 screenings per year; or all eligible screenings once every 5 years. Main Outcomes and Measures Modeled life-years gained from restricted cancer screenings as a fraction of those attainable from full compliance with USPSTF recommendations (maximum benefits). Results were stratified by LC screening eligibility (LC-eligible/ineligible). We repeated the analysis with 2018 adherence rates, evaluating the increase in adherence required for restricted screenings to have the same population benefit as USPSTF recommendations. Results This modeling study of 20 million simulated US women found that it was possible to reduce screening intensity to 1 carefully chosen test per year in women who were ineligible for LC screening and 2 tests per year in eligible women while maintaining 94% or more of the maximum benefits. Highly ranked strategies screened for various cancers, but less often than recommended by the USPSTF. For example, among LC-ineligible women who obtained just 1 screening per year, the optimal strategy frequently delayed breast and cervical cancer screenings by 1 year and skipped 3 mammograms entirely. Among LC-eligible women, LC screening was essential; strategies omitting it provided 25% or less of the maximum benefits. The top-ranked strategy restricted to 2 screenings per year was annual LC screening and alternating fecal immunochemical test with mammography (skipping mammograms when due for cervical cancer screening, 97% of maximum benefits). If adherence in a population of LC-eligible women obtaining 2 screenings per year were to increase by 1% to 2% (depending on the screening test), this model suggests that it would achieve the same benefit as USPSTF recommendations at 2018 adherence rates. Conclusions and Relevance This modeling study of 45 cancer screening strategies suggests that women who are noncompliant with cancer screening guidelines may be able to reduce USPSTF-recommended screening intensity with minimal reduction in overall benefits.
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Affiliation(s)
- Glen B Taksler
- Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.,Population Health Research Institute, Case Western Reserve University at The MetroHealth System, Cleveland, Ohio
| | - Elisabeth F P Peterse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Isarah Willems
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik E L Jansen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Elliott TE, O'Connor PJ, Asche SE, Saman DM, Dehmer SP, Ekstrom HL, Allen CI, Bianco JA, Chrenka EA, Freitag LA, Harry ML, Truitt AR, Sperl-Hillen JM. Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial. Contemp Clin Trials 2021; 102:106271. [PMID: 33503497 DOI: 10.1016/j.cct.2021.106271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite decades of research the gap in primary and secondary cancer prevention services in the U. S. remains unacceptably wide. Innovative interventions are needed to address this persistent challenge. Electronic health records linked with Web-based clinical decision support may close this gap, especially if delivered to both patients and their providers. OBJECTIVES The Cancer Prevention Wizard (CPW) study is an implementation, clinic-randomized trial designed to achieve these aims: 1) assess impact of the Cancer Prevention Wizard-Clinical Decision Support (CPW-CDS) alone and CPW-CDS plus Shared Decision Making Tools (CPW + SDMTs) compared to usual care (UC) on tobacco cessation counseling and drugs, HPV vaccinations, and screening tests for breast, cervical, colorectal, or lung cancer; 2) assess cost of the CPW-CDS intervention; and 3) describe critical facilitators and barriers for CPW-CDS implementation, use, and clinical impact using a mixed-methods approach supported by the CFIR and RE-AIM frameworks. METHODS 34 predominantly rural, primary care clinics were randomized to CPW-CDS, CPW + SMDTs, or UC. Between August 2018 and October 2020, primary care providers and their patients who met inclusion criteria in intervention clinics were exposed to the CPW-CDS with or without SDMTs. Study outcomes at 12 months post index visit include patients up to date on screening tests and HPV vaccinations, overall healthcare costs, and diagnostic codes and billing levels for cancer prevention services. CONCLUSIONS We will test in rural primary care settings whether CPW-CDS with or without SDMTs can improve delivery of primary and secondary cancer prevention services. The trial and analyses are ongoing with results expected in 2021.
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Affiliation(s)
- Thomas E Elliott
- HealthPartners Institute, 8170 33rd Ave. South, Minneapolis, MN 55425, USA.
| | - Patrick J O'Connor
- HealthPartners Institute, 8170 33rd Ave. South, Minneapolis, MN 55425, USA.
| | - Stephen E Asche
- HealthPartners Institute, 8170 33rd Ave. South, Minneapolis, MN 55425, USA.
| | - Daniel M Saman
- Essentia Institute of Rural Health, 502 E. 2nd St., Duluth, MN 55805, USA.
| | - Steven P Dehmer
- HealthPartners Institute, 8170 33rd Ave. South, Minneapolis, MN 55425, USA.
| | - Heidi L Ekstrom
- HealthPartners Institute, 8170 33rd Ave. South, Minneapolis, MN 55425, USA.
| | - Clayton I Allen
- Essentia Institute of Rural Health, 502 E. 2nd St., Duluth, MN 55805, USA.
| | | | - Ella A Chrenka
- HealthPartners Institute, 8170 33rd Ave. South, Minneapolis, MN 55425, USA.
| | - Laura A Freitag
- Essentia Institute of Rural Health, 502 E. 2nd St., Duluth, MN 55805, USA.
| | - Melissa L Harry
- Essentia Institute of Rural Health, 502 E. 2nd St., Duluth, MN 55805, USA.
| | - Anjali R Truitt
- HealthPartners Institute, 8170 33rd Ave. South, Minneapolis, MN 55425, USA.
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Zhang JJ, Rothberg MB, Misra-Hebert AD, Gupta NM, Taksler GB. Assessment of Physician Priorities in Delivery of Preventive Care. JAMA Netw Open 2020; 3:e2011677. [PMID: 32716515 PMCID: PMC8103855 DOI: 10.1001/jamanetworkopen.2020.11677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Primary care physicians have limited time to discuss preventive care, but it is unknown how they prioritize recommended services. OBJECTIVE To understand primary care physicians' prioritization of preventive services. DESIGN, SETTING, AND PARTICIPANTS This online survey was administered to primary care physicians in a large health care system from March 17 to May 12, 2017. Physicians were asked whether they prioritize preventive services and which factors contribute to their choice (5-point Likert scale). Results were analyzed from July 8, 2017, to September 19, 2019. EXPOSURES A 2 × 2 factorial design of 2 hypothetical patients: (1) a 50-year-old white woman with hypertension, type 2 diabetes, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of breast cancer; and (2) a 45-year-old black man with hypertension, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of colorectal cancer. Two visit lengths (40 minutes vs 20 minutes) were given. Each patient was eligible for at least 11 preventive services. MAIN OUTCOMES AND MEASURES Physicians rated their likelihood of discussing each service during the visit and reported their top 3 priorities for patients 1 and 2. Physician choices were compared with the preventive services most likely to improve life expectancy, using a previously published mathematical model. RESULTS Of 241 physicians, 137 responded (57%), of whom 74 (54%) were female and 85 (62%) were younger than 50 years. Physicians agreed they prioritized preventive services (mean score, 4.27 [95% CI, 4.12-4.42] of 5.00), mostly by ability to improve quality (4.56 [95% CI, 4.44-4.68] of 5.00) or length (4.53 [95% CI, 4.40-4.66] of 5.00) of life. Physicians reported more prioritization in the 20- vs 40-minute visit, indicating that they were likely to discuss fewer services during the shorter visit (median, 5 [interquartile range {IQR}, 3-8] vs 11 [IQR, 9-13] preventive services for patient 1, and 4 [IQR, 3-6] vs 9 [IQR, 8-11] for patient 2). Physicians reported similar top 3 priorities for both patients: smoking cessation, hypertension control, and glycemic control for patient 1 and smoking cessation, hypertension control, and colorectal cancer screening for patient 2. Physicians' top 3 priorities did not usually include diet and exercise or weight loss (ranked in their top 3 recommendations for either patient by only 48 physicians [35%]), although these were among the 3 preventive services most likely to improve life expectancy based on the mathematical model. CONCLUSIONS AND RELEVANCE In this survey study, physicians prioritized preventive services under time constraints, but priorities did not vary across patients. Physicians did not prioritize lifestyle interventions despite large potential benefits. Future research should consider whether physicians and patients would benefit from guidance on preventive care priorities.
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Affiliation(s)
- Jessica J. Zhang
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Michael B. Rothberg
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anita D. Misra-Hebert
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Glen B. Taksler
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
- Center for Health Care Research and Policy, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio
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Hohmeier KC, Shelton C, Havrda D, Gatwood J. The need to prioritize "prioritization" in clinical pharmacy service practice and implementation. Res Social Adm Pharm 2020; 16:1785-1788. [PMID: 32414658 DOI: 10.1016/j.sapharm.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
Abstract
Pharmacists are increasingly asked to incorporate new and greater amounts of clinical services into their traditional medication distribution responsibilities, but many barriers exist. Given the demanding pharmacy practice environment, improved time management may improve implementation rates. One area not previously explored within this area is the clinical skill of "prioritization" of medication related problems (MRPs). Prioritization is vital as the workload demand for pharmacist time exceeds time available; however, the underdeveloped skills of prioritizing is a concern in the field of pharmacy practice, as it also is across professions in healthcare. Previous research has suggested that pharmacists and student pharmacists inexperienced in implementing clinical services struggle knowing where to begin when providing direct patient care, given the complex patient care regimens, a complex pharmacy practice workload, and the numerous preventative care interventions possible for a given patient. This paper provides a review of theory and science of prioritization in patient care service delivery, including Multicriteria Decision Analysis (MCDA), Lean Six Sigma (LSS), and Jaen's Competing Demands framework. A case study is shared which emphasizes both the need for and potential impact of a renewed focus on workload management skills, such as prioritization.
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Affiliation(s)
- Kenneth C Hohmeier
- University of Tennessee Health Science Center, College of Pharmacy, 301 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA.
| | - Chasity Shelton
- University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue Memphis, TN, 38103, USA
| | - Dawn Havrda
- University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue Memphis, TN, 38103, USA
| | - Justin Gatwood
- University of Tennessee Health Science Center, College of Pharmacy, 301 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA
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Crabtree BF, Miller WL, Howard J, Rubinstein EB, Tsui J, Hudson SV, O'Malley D, Ferrante JM, Stange KC. Cancer Survivorship Care Roles for Primary Care Physicians. Ann Fam Med 2020; 18:202-209. [PMID: 32393555 PMCID: PMC7213992 DOI: 10.1370/afm.2498] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/27/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors. METHODS We conducted digitally recorded interviews with 38 clinicians in 14 primary care practices that had national reputations as workforce innovators. Interviews took place during intense case study data collection and explored clinicians' perspectives regarding their role in cancer survivorship care. We analyzed verbatim transcripts using an inductive and iterative immersion-crystallization process. RESULTS Divergent views exist regarding primary care's role in cancer survivor care with a lack of coherence about the concept of survivorship. A few clinicians believed any follow-up care after acute cancer treatment was oncology's responsibility; however, most felt cancer survivor care was within their purview. Some primary care clinicians considered cancer survivors as a distinct population; others felt cancer survivors were like any other patient with a chronic disease. In further interpretative analysis, we discovered a deeply ingrained philosophy of whole-person care that creates a professional identity dilemma for primary care clinicians when faced with rapidly changing specialized knowledge. CONCLUSIONS This study exposes an emerging identity crisis for primary care that goes beyond cancer survivorship care. Facilitated national conversations might help specialists and primary care develop knowledge translation platforms to support the prioritizing, integrating, and personalizing functions of primary care for patients with highly complicated issues requiring specialized knowledge.
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Affiliation(s)
- Benjamin F Crabtree
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey .,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Jenna Howard
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Jennifer Tsui
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Denalee O'Malley
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jeanne M Ferrante
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Ashing KT, Lai L, Meyers E, Serrano M, George M. Exploring the association between diabetes and breast cancer morbidity: considerations for quality care improvements among Latinas. Int J Qual Health Care 2020; 32:120-125. [PMID: 32277234 PMCID: PMC8785947 DOI: 10.1093/intqhc/mzz130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/04/2019] [Accepted: 12/04/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cancer and diabetes are two severe chronic illnesses that often co-occur. In cancer patients, diabetes increases the risk for treatment complexities and mortality. Yet patient-reported outcomes with co-occurring chronic illness are understudied. DESIGN This preliminary study investigated the association of diabetes with breast cancer-related morbidity among underserved Latina breast cancer survivors (BCS). PARTICIPANTS 137 Latina BCS were recruited from the California Cancer Registry and hospitals.Setting and Main Outcome Measure(s): BCS completed a self-administered mailed questionnaire assessing demographic and medical characteristics e.g. Type2 diabetes mellitus (T2DM). RESULTS 28% Latina BCS reported co-occurring T2DM at twice the general population rate. Diabetes was most prevalent among Latina BCS > 65 years (43%). Latina BCS with diabetes were more likely to report advanced cancer staging at diagnosis (P = 0.036) and more lymphedema symptoms (P = 0.036). Results suggest non-significant but lower general health and greater physical functioning limitations among BCS with T2DM. CONCLUSIONS This study has relevance for precision population medicine by (i) consideration of routine diabetes screening in Latina BCS, (ii) underscoring attention to disease co-occurrence in treatment planning and care delivery and (iii) informing follow-up care and survivorship care planning e.g. patient self-management, oncology and primarily care surveillance and specialty care. Our findings can inform providers, survivors and caregivers about the impact of disease co-occurrence that influence clinically and patient responsive care for both initial treatment and long-term follow-up care to address disparities.
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Affiliation(s)
- Kimlin Tam Ashing
- Center of Community Alliance for Research and Education, Department of Population Sciences, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Lily Lai
- Department of Surgery, City of Hope Medical Center, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Eva Meyers
- Cecilia Gonzalez De La Hoya Cancer Center, White Memorial Medical Center, 1720 Cesar Chavez Ave., Los Angeles, CA 90033, USA
| | - Mayra Serrano
- Center of Community Alliance for Research and Education, Department of Population Sciences, City of Hope National Medical Center, 1500 E. Duarte Rd., Duarte, CA 91010, USA
| | - Marshalee George
- Department of Oncology: Breast & Ovarian Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1800 Orleans St, Baltimore, MD 21287, USA
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Taksler GB, Beth Mercer M, Fagerlin A, Rothberg MB. Assessing Patient Interest in Individualized Preventive Care Recommendations. MDM Policy Pract 2019; 4:2381468319850803. [PMID: 31192307 PMCID: PMC6540511 DOI: 10.1177/2381468319850803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/12/2019] [Indexed: 12/31/2022] Open
Abstract
Background. Few Americans obtain all 41 guideline-recommended preventive services for nonpregnant adults. We assessed patient interest in prioritizing their preventive care needs. Methods. We conducted a mixed-methods study, with 4 focus groups (N = 28) at a single institution and a nationwide survey (N = 2,103). Participants were middle-aged and older adults with preventive care needs. We obtained reactions to written materials describing the magnitude of benefit from major preventive services, including both absolute and relative benefits. Recommendations were individualized for patient risk factors (“individualized preventive care recommendations”). Focus groups assessed patient interest, how patients would want to discuss individualized recommendations with their providers, and potential for individualized recommendations to influence patient decision making. Survey content was based on focus groups and analyzed with logistic regression. Results. Patients expressed strong interest in individualized recommendations. Among survey respondents, an adjusted 88.2% (95% confidence interval [CI] = 86.7% to 89.7%) found individualized recommendations very easy to understand, 77.2% (95% CI = 75.3% to 79.1%) considered them very useful, and 64.9% (95% CI = 62.8% to 67.0%) highly trustworthy (each ≥6/7 on Likert scale). Three quarters of participants wanted to receive their own individualized recommendations in upcoming primary care visits (adjusted proportion = 77.5%, 95% CI = 75.6% to 79.4%). Both focus group and survey participants supported shared decision making and reported that individualized recommendations would improve motivation to obtain preventive care. Half of survey respondents reported that they would be much more likely to visit their doctor if they knew individualized recommendations would be discussed, compared with 4.2% who would not be more likely to visit their doctor. Survey respondents already prioritized preventive services, stating they were most likely to choose quick/easy preventive services and least likely to choose expensive preventive services (adjusted proportions, 63.8% and 8.5%, respectively). Results were consistent in sensitivity analyses. Conclusions. Individualized preventive care recommendations are likely to be well received in primary care and might motivate patients to improve adherence to evidence-based care.
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Affiliation(s)
- Glen B Taksler
- Medicine Institute, Division of Clinical Epidemiology, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
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B Sussman J, Holleman RG, Youles B, Lowery JC. Quality Improvement and Personalization for Statins: the QUIPS Quality Improvement Randomized Trial of Veterans' Primary Care Statin Use. J Gen Intern Med 2018; 33:2132-2137. [PMID: 30284172 PMCID: PMC6258630 DOI: 10.1007/s11606-018-4681-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/29/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Implementation of new practice guidelines for statin use was very poor. OBJECTIVE To test a multi-component quality improvement intervention to encourage use of new guidelines for statin use. DESIGN Cluster-randomized, usual-care controlled trial. PARTICIPANTS The study population was primary care visits for patients who were recommended statins by the 2013 guidelines, but were not receiving them. We excluded patients who were over 75 years old, or had an ICD9 or ICD10 code for end-stage renal disease, muscle pain, pregnancy, or in vitro fertilization in the 2 years prior to the study visit. INTERVENTIONS A novel quality improvement intervention consisting of a personalized decision support tool, an educational program, a performance measure, and an audit and feedback system. Randomization was at the level of the primary care team. MAIN MEASURES Our primary outcome was prescription of a medium- or high-strength statin. We studied how receiving the intervention changed care during the quality improvement intervention compared to before it and if that change continued after the intervention. KEY RESULTS Among 3787 visits to 43 primary care providers, being in the intervention arm tripled the odds of patients being prescribed an appropriate statin (OR 3.0, 95% CI 1.8-4.9), though the effect resolved after the personalized decision support ended (OR 1.7, 95% CI 0.99-2.77). CONCLUSIONS A simple, personalized quality improvement intervention is promising for enabling the adoption of new guidelines. CLINICALTRIALS. GOV IDENTIFIER NCT02820870.
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Affiliation(s)
- Jeremy B Sussman
- University of Michigan Department of Internal Medicine, Ann Arbor, MI, USA.
- VA Center for Clinical Management Research, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | | | - Bradley Youles
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Julie C Lowery
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
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Equils O, Kellogg C, Baden L, Berger W, Connolly S. Logistical and structural challenges are the major obstacles for family medicine physicians' ability to administer adult vaccines. Hum Vaccin Immunother 2018; 15:637-642. [PMID: 30395771 DOI: 10.1080/21645515.2018.1543524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study was conducted to characterize the vaccination practices and challenges of family medicine physicians in Los Angeles County, California. METHODS The Los Angeles Academy of Family Physicians (LA AFP) sent out electronic surveys to all of their active members (N = 1121) between December 2017 and January 2018, and asked them to answer questions about themselves, their practice, their patient population, and their immunization practices and challenges. We then analyzed the results through basic statistical calculations and Pearson's chi-squared tests. RESULTS Seventy-four people (6.6%) responded to the survey, and 75% of responders stated that they administer all Advisory Committee on Immunization Practices (ACIP) recommended vaccines. The lowest vaccine administration rates were for the high-dose influenza vaccine, which 66.2% (n = 49) of respondents reported to administer, followed by the meningococcal B vaccine (68.9%; n = 51). The respondents who belonged to practices with more than 11 providers, were part of a large hospital or healthcare system, had electronic medical records (EMRs), and used the California Immunization Registry (CAIR) were more likely to report to vaccinate. The number one responding physician-reported challenge to vaccination was limited time and resources to address patient resistance followed by vaccine cost and lack of infrastructure to store vaccines. CONCLUSIONS In this pilot study, structural and logistical challenges appeared to make the biggest impact on adult vaccination for the responding family medicine physicians. Solutions addressing these challenges will help improve the adult immunization rates.
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Affiliation(s)
- Ozlem Equils
- a Immunization Coalition of Los Angeles County, Department of Public Health , MiOra , Los Angeles, CA , USA
| | - Caitlyn Kellogg
- b University of California, San Diego School of Medicine , MiOra , San Diego, CA , USA
| | - Lucy Baden
- b University of California, San Diego School of Medicine , MiOra , San Diego, CA , USA
| | - Wendy Berger
- c Immunization Coalition of Los Angeles County, Department of Public Health , Los Angeles, CA , USA
| | - Shannon Connolly
- d Los Angeles Academy of Family Physicians , Los Angeles, CA , USA
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Taksler GB, Pfoh ER, Stange KC, Rothberg MB. Association Between Number of Preventive Care Guidelines and Preventive Care Utilization by Patients. Am J Prev Med 2018; 55:1-10. [PMID: 29773491 PMCID: PMC6014877 DOI: 10.1016/j.amepre.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The number of preventive care guidelines is rapidly increasing. It is unknown whether the number of guideline-recommended preventive services is associated with utilization. METHODS The authors used Poisson regression of 390,778 person-years of electronic medical records data from 2008 to 2015, in 80,773 individuals aged 50-75 years. Analyses considered eligibility for 11 preventive services most closely associated with guidelines: tobacco cessation; control of obesity, hypertension, lipids, or blood glucose; influenza vaccination; and screening for breast, cervical, or colorectal cancers, abdominal aortic aneurysm, or osteoporosis. The outcome was the rate of preventive care utilization over the following year. Results were adjusted for demographics and stratified by the number of disease risk factors (smoking, obesity, hypertension, hyperlipidemia, diabetes). Data were collected in 2016 and analyzed in 2017. RESULTS Preventive care utilization was lower when the number of guideline-recommended preventive services was higher. The adjusted rate of preventive care utilization decreased from 38.67 per 100 (95% CI=38.16, 39.18) in patients eligible for one guideline-recommended service to 31.59 per 100 (95% CI=31.29, 31.89) in patients eligible for two services and 25.43 per 100 (95% CI=24.68, 26.18) in patients eligible for six or more services (p-trend<0.001). Results were robust to disease risk factors and observed for all but two services (tobacco cessation, obesity reduction). However, for any given number of guideline-recommended services, patients with more disease risk factors had higher utilization rates. CONCLUSIONS The rate of preventive care utilization was lower when the number of guideline-recommended services was higher. Prioritizing recommendations might improve utilization of high-value services.
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Affiliation(s)
| | | | - Kurt C Stange
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio
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