DocStyles Survey Research Articles

Understanding primary care providers' attitudes towards preventive screenings to patients with inflammatory bowel disease.

Preventive care is important for managing inflammatory bowel disease (IBD), yet primary care providers (PCPs) often face challenges in delivering such care due to discomfort and unfamiliarity with IBD-specific guidelines. This study aims to assess PCPs' attitudes towards, and practices in, providing preventive screenings for IBD patients, highlighting areas for improvement in guideline dissemination and education. Using a web-based opt-in panel of PCPs (DocStyles survey, spring 2022), we assessed PCPs' comfort level with providing/recommending screenings and the reasons PCPs felt uncomfortable (n = 1,503). Being likely to provide/recommend screenings for depression/anxiety, skin cancer, osteoporosis, and cervical cancer were compared by PCPs' comfort level and frequency of seeing patients with IBD. We estimated adjusted odd ratios (AORs) of being likely to recommend screenings and selecting responses aligned with IBD-specific guidelines by use of clinical practice methods. About 72% of PCPs reported being comfortable recommending screenings to patients with IBD. The top reason identified for not feeling comfortable was unfamiliarity with IBD-specific screening guidelines (55%). Being comfortable was significantly associated with being likely to provide/recommend depression/anxiety (AOR = 3.99) and skin cancer screenings (AOR = 3.19) compared to being uncomfortable or unsure. Percentages of responses aligned with IBD-specific guidelines were lower than those aligned with general population guidelines for osteoporosis (21.7% vs. 27.8%) and cervical cancer screenings (34.9% vs. 43.9%), and responses aligned with IBD-specific guidelines did not differ by comfort level for both screenings. Timely review of guidelines specific to immunosuppressed patients was associated with being likely to provide/recommend screenings and selecting responses aligned with IBD-specific guidelines. Despite a general comfort among PCPs in recommending preventive screenings for IBD patients, gaps in knowledge regarding IBD-specific screening guidelines persist. Enhancing awareness and understanding of these guidelines through targeted education and resource provision may bridge this gap.

EARLY DETECTION AND MANAGEMENT OF COGNITIVE IMPAIRMENT PRACTICES AMONG PRIMARY CARE PROVIDERS

Abstract Primary care providers (PCPs) play a critical role in the early detection and management of cognitive impairment and dementia. Understanding their current practice patterns can help identify potential areas of need for additional support. Using 2022 DocStyles survey data (n=1,182), this study assessed US PCPs’ confidence levels in identifying symptoms of cognitive impairment and the actions they take when identifying a patient with cognitive impairment. In terms of their ability to identify symptoms of cognitive impairment, 22.3% of PCPs reported being very confident, 53.2% somewhat confident, 18.3% slightly confident, and 6.2% not at all confident or did not know. PCPs reported taking a variety of actions when they identify a patient with symptoms of cognitive impairment: 70.1% assess for potential underlying causes, 69.4% review medications, 65.7% conduct a cognitive assessment or test, 59.7% refer to a neurologist or other specialist, 43.3% coordinate with a care team, and 20.9% refer to community resources. Compared to PCPs who were very or somewhat confident, those who were slightly or not at all confident were less likely to report taking each action (e.g., 35.1% vs. 75.4% conduct a cognitive assessment or test, respectively), except for being more likely to refer to a neurologist or other specialist (68.8% vs. 56.9%) (p< 0.001). PCP practices in early detection and management of cognitive impairment vary by their confidence level. Findings can inform the development of resources to help increase PCPs’ confidence and support their practices in early detection and management of cognitive impairment and dementia.

Healthcare providers’ knowledge and clinical practice surrounding shigellosis — DocStyles Survey, 2020

BackgroundShigellosis is an acute diarrheal disease transmitted through contaminated food, water, objects, poor hand hygiene, or sexual activity. Healthcare providers (HCP) may not be aware of the multiple routes of Shigella transmission, populations at increased risk, or importance of antibiotic susceptibility testing (AST). This study assessed HCP knowledge and clinical practices regarding shigellosis and antibiotic resistance.MethodsPorter Novelli Public Services administered a web-based survey (Fall DocStyles 2020) to HCP in the United States. Pediatricians, primary care physicians, nurse practitioners, and physician assistants completed questions about knowledge and clinical practice of acute diarrhea and shigellosis.ResultsOf 2196 HCP contacted, 1503 responded (68% response rate). Most identified contaminated food (85%) and water (79%) as routes of Shigella transmission; fewer recognized person-to-person contact (40%) and sexual activity (18%). Men who have sex with men (MSM) were identified as being at risk for shigellosis by 35% of respondents. Most reported counseling patients to wash hands (86%) and avoid food preparation (77%) when ill with shigellosis; 29% reported recommending avoiding sex. Many HCP reported treating shigellosis empirically with ciprofloxacin (62%) and azithromycin (32%), and 29% reported using AST to guide treatment.ConclusionsWe identified several gaps in shigellosis knowledge among HCP including MSM as a risk group, person-to-person transmission, and appropriate antibiotic use. Improving HCP education could prevent the spread of shigellosis, including drug-resistant infections, among vulnerable populations.

COVID-19 Vaccination Recommendations and Practices for Women of Reproductive Age by Health Care Providers - Fall DocStyles Survey, United States, 2022.

Pregnant and postpartum women are at increased risk for severe illness from COVID-19 compared with nonpregnant women of reproductive age. COVID-19 vaccination is recommended for all persons ≥6 months of age. Health care providers (HCPs) have a unique opportunity to counsel women of reproductive age, including pregnant and postpartum patients, about the importance of receiving COVID-19, influenza, and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. Data from the Fall 2022 DocStyles survey were analyzed to examine the prevalence of COVID-19 vaccination attitudes and practices among HCPs caring for women of reproductive age, and to determine whether providers recommended and offered or administered COVID-19 vaccines to women of reproductive age, including their pregnant patients. Overall, 82.9% of providers reported recommending COVID-19 vaccination to women of reproductive age, and 54.7% offered or administered the vaccine in their practice. Among HCPs who cared for pregnant patients, obstetrician-gynecologists were more likely to recommend COVID-19 vaccination to pregnant patients (94.2%) than were family practitioners or internists (82.1%) (adjusted prevalence ratio [aPR]=1.1). HCPs were more likely to offer or administer COVID-19 vaccination on-site to pregnant patients if they also offered or administered influenza (aPR=5.5) and Tdap vaccines (aPR=2.3). Encouraging HCPs to recommend, offer, and administer the COVID-19 vaccines along with influenza or Tdap vaccines might help reinforce vaccine confidence and increase coverage among women of reproductive age, including pregnant women.

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States.

National organizations have issued comprehensive cancer survivorship care guidelines to improve care of cancer survivors, many of whom receive care from primary care providers (PCPs). We analyzed Porter Novelli's 2019 fall DocStyles survey to assess use of cancer survivorship care guidelines, receipt of survivorship training, types of survivorship services provided, and confidence providing care among PCPs in the United States. We grouped PCPs by use of any guideline ("users") versus no guideline use ("nonusers"). We calculated descriptive statistics and conducted multivariable logistic regression analyses to examine guideline use, having received training on providing survivorship care services, and confidence in providing care. Within the panel, sampling quotas were set so that 1000 primary care physicians, 250 OB/GYNs, 250 pediatricians, and 250 nurse practitioners/physician assistants were recruited. To reach selected quotas, 2696 health professionals were initially contacted to participate, resulting in a response rate of 64.9%. Sixty-two percent of PCPs reported using guidelines and 17% reported receiving survivorship care training. Use of any guidelines or receiving training was associated with reporting providing a range of survivorship services and confidence in providing care. After adjusting for demographic characteristics, guideline users were more likely than nonusers to report assessing genetic cancer risk (OR = 2.65 95% confidence interval (CI) (1.68, 4.17)), screening for cancer recurrence (OR = 2.32 95% CI (1.70, 3.18)) or a new cancer (OR = 1.63, 95% CI (1.20, 2.22)), and treating depression (OR = 1.64, 95% CI (1.20, 2.25)). Receipt of training was also positively associated with providing genetic risk assessment, surveillance for recurrence, as well as assessing late/long-term effects, and treating pain, fatigue, and sexual side effects. Survivorship care guidelines and training support PCPs in providing a range of survivorship care services.

Special Report from the CDC: Provider knowledge and practices around driving safety and fall prevention screening and recommendations for their older adult patients, DocStyles 2019

Introduction: Falls and motor-vehicle crashes (MVCs) are leading causes of unintentional injury deaths among older adults (65+) in the United States. Injury prevention resources exist to help healthcare providers reduce fall and MVC risk among older adult patients. However, awareness of these resources among healthcare providers is unclear. Methods: Questions were included in the 2019 DocStyles survey that assessed healthcare provider awareness of three injury prevention resources: (1) the American Geriatrics Society’s (AGS’s) Clinician’s Guide to Assessing and Counseling Older Drivers, (2) the Clinical Assessment of Driving Related Skills (CADReS), and (3) the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. We also explored the circumstances and current practices for counseling older adult patients on fall prevention and driving safety. Results: Only 20% of providers reported awareness of any of the injury prevention resources. Providers were more likely to report either screening for fall risk or unsafe driving when an older adult presented with a fall concern (74.5%) or driving concern or recent crash (85.1%), compared to annual screening for fall risk (67.7%) or driving safety (47.7%). More providers reported discussing the increased fall or MVC risk associated with patient medications, referring patient for driving fitness evaluations, or discussing alternative transportation options with the patient after adverse events or patient-initiated concerns compared to routine annual discussions. Conclusion: Healthcare gaps persist in the screening and assessment of older adult risk factors for falls and unsafe driving. Limited provider awareness of clinical resources related to preventing older adult falls and unsafe driving may be contributing to these healthcare gaps. Practical Applications: Improving healthcare provider awareness of these resources could help them identify older adults at risk of a fall or MVC and promote injury prevention efforts in their clinical practices.

Health care providers' attitudes and counseling behaviors related to obesity.

Obesity affects over 42% of the U.S. adult population, yet it remains undertreated. Many healthcare providers are biased in their perceptions and attitudes regarding obesity management and lack knowledge about how to treat it. The authors analyzed the results of the 2021 DocStyles survey to examine primary care providers' treatment and perceptions of obesity. The sample consisted of primary care physicians and nurse practitioners/physician assistants. Questions assessed healthcare providers' attitudes and counseling behaviors related to obesity, including referrals, use of medical therapy, barriers to care, and perceived risk factors for obesity. 1168 primary care providers who treat obesity participated in the survey. About half of the providers reported referring patients for obesity treatment. Almost two-thirds of providers had prescribed anti-obesity medications in the last 12months. Those who did not prescribe anti-obesity medications reported a lack of familiarity with the medications or concerns about safety. Over three-quarters of providers indicated at least one barrier to treating obesity. Over half of the providers reported that poverty and food insecurity contributed significantly to the high prevalence of obesity in communities of color. Increased familiarity with anti-obesity medications may improve treatment. Reasons for patients' low priority accorded to obesity care remain the focus of future research.

COVID-19 vaccination recommendations and practices for women of reproductive age, U.S. Physicians, Fall 2021

Pregnant people with COVID-19 are at increased risk for severe illness and adverse pregnancy outcomes. COVID-19 vaccinations are safe and effective, including for pregnant and recently pregnant people. The objective of this analysis was to describe the extent to which primary care physicians across the United States report confidence in talking with female patients of reproductive age about COVID-19 vaccination, recommending COVID-19 vaccinations to pregnant patients, and offering COVID-19 vaccinations at their practices in fall 2021.We analyzed cross-sectional data from the Fall 2021 DocStyles survey, a web-based panel survey of U.S. primary healthcare providers (64% response rate). Family practitioners/internists, obstetrician-gynecologists, and pediatricians were asked about confidence in talking with female patients of reproductive age about COVID-19 vaccination, vaccination practices regarding pregnant patients, and offering COVID-19 vaccinations. We describe results overall and by select physician characteristics. Among 1501 respondents, most were family practitioners/internists (67%), 17% were obstetrician-gynecologists, and 17% were pediatricians. Overall, 63% were very confident talking with female patients of reproductive age about COVID-19 vaccination, 80% recommended pregnant patients get vaccinated as soon as possible, and 50% offered COVID-19 vaccinations at their current practice. Obstetrician-gynecologists were most confident in talking with female patients, but only one-third offered the vaccine at their practices. This analysis found that most physicians felt confident talking about COVID-19 vaccinations and recommended pregnant patients get vaccinated as soon as possible. Provider recommendation for vaccination remains a key strategy for achieving high vaccination coverage, and consistent recommendations may improve vaccine acceptance among pregnant and postpartum people.

Healthcare provider awareness of the recent FDA approval on first diagnostic tests for extragenital testing for chlamydia and gonorrhea

To assess healthcare provider awareness of the Food and Drug Administration (FDA) 2019 approval of nucleic acid amplification tests (NAAT) using extragenital specimens for chlamydia and gonorrhea, several questions were included in fall 2020 Porter Novelli's DocStyles survey, a US nationally representative semi-annual web-based survey of healthcare providers. There were 1502 respondents included in this study, 1000 family practitioners/internists as primary care physicians (PCPs), 251 obstetricians/gynecologists (OBs/GYNs), and 251 nurse practitioners/physician assistants (NP/PA). Awareness of this FDA approval was 34.3% overall and significantly varied by provider specialty: 45.0% for OB/GYN versus 23.5% for NP/PA, p < 0.01. OB/GYN had the lowest rate of ordering any extragenital gonorrhea and chlamydia tests in the past 12 months (31.6%) versus the other providers (ranging from 46.2% for NP/PA to 60.7% for PCP). The respondents were more likely to be aware of the FDA approval if they had ordered extragenital chlamydia or gonorrhea testing for men who have sex with men (MSM) than those who did not order the tests for MSM (72.3% versus 43.7%, p < 0.01). Of 1502 respondents, lack of reimbursement as a barrier to ordering extragenital tests for chlamydia and gonorrhea was most mentioned (16.6%) overall and did not significantly vary by provider's specialty. Further outreach is needed to educate healthcare providers on the changes in the FDA approval for extragenital gonorrhea and chlamydia testing so that they can provide comprehensive care to their patients and to reduce the potential for antimicrobial resistance.

Clinical Practice Changes in Monitoring Hypertension Early in the COVID-19 Pandemic.

BackgroundClinical practices can use telemedicine and other strategies (e.g., self-measured blood pressure [SMBP]) for remote monitoring of hypertension to promote control while decreasing risk of exposure to SARS-CoV-2, the virus that causes COVID-19.MethodsThe DocStyles survey collected data from primary care providers (PCPs), obstetricians-gynecologists (OB/GYNs), and nurse practitioners/physician assistants (NP/PAs) in fall 2020 (n=1,502). We investigated clinical practice changes for monitoring hypertension that were implemented early in the COVID-19 pandemic and examined differences by clinician and practice characteristics (p<0.05).ResultsOverall, 369 (24.6%) of clinicians reported their clinical practices made no changes in monitoring hypertension early in the pandemic, 884 (58.9%) advised patients to monitor blood pressure at home or a pharmacy, 699 (46.5%) implemented or increased use of telemedicine for blood pressure monitoring visits, and 545 (36.3%) reduced the frequency of office visits for blood pressure monitoring. Compared with NP/PAs, PCPs were more likely to advise SMBP monitoring (adjusted prevalence ratios (aPR) 1.28, 95% confidence intervals (CI) 1.11-1.47), implement or increase use of telemedicine (aPR 1.23, 95% CI 1.04-1.46) and reduce the frequency of office visits (aPR 1.37, 95% CI 1.11-1.70) for blood pressure monitoring, and less likely to report making no practice changes (aPR 0.63, 95% CI 0.51-0.77).ConclusionsWe noted variation in clinical practice changes by clinician type and practice characteristics. Clinical practices may need additional support and resources to fully maximize telemedicine and other strategies for remote monitoring of hypertension during pandemics and other emergencies that can disrupt routine health care.

1194. Assessing Healthcare Professionals’ Knowledge of Shigella Transmission, Risk Factors, and Prevention – DocStyles Survey, 2020

Abstract Background Shigella infection typically manifests as a self-limited gastrointestinal illness (shigellosis) and affects some populations disproportionately, including children, travelers, people experiencing homelessness, and men who have sex with men (MSM). Healthcare professionals (HCPs) are positioned to play an active role in the prevention and control of shigellosis but may not be aware of the multiple routes of Shigella transmission, risk factors, and prevention strategies. Methods Porter Novelli Public Services’ Fall DocStyles 2020 web-based survey was administered to HCPs in the United States to assess their clinical practice and knowledge about many health-related issues. Questions about acute diarrhea and shigellosis were completed by pediatricians, primary care physicians, nurse practitioners, and physician assistants. We analyzed responses to four questions related to Shigella transmission, risk factors, prevention, and barriers to patient education. Results Of the 2196 panelists contacted, 1503 were included (68% response rate). Most identified contaminated food and water as potential routes of Shigella transmission (84.9% and 78.8%, respectively), but substantially fewer recognized person-to-person contact (39.5%), fomite transmission (32.5%), or sexual activity (17.6%) as ways adults can become infected. Similarly, MSM were infrequently identified as being at risk for shigellosis (34.5%). Many HCPs reported counseling patients to wash hands and avoid food preparation when ill with Shigella (85.9% and 77.2%), but only 29.4% reported recommending avoiding sex. Only 7.1% of respondents correctly identified all routes of transmission, 21% identified all risk factors, and 22% identified all prevention strategies. Delay in diagnosis was the most frequently reported barrier to educating patients about shigellosis. Conclusion HCP knowledge of shigellosis is incomplete. Identified gaps in knowledge were related to MSM as an at-risk population and transmission of Shigella through fomites and person-to-person contact (including sexual contact). Informing HCPs about transmission, risk factors, and opportunities for prevention could improve recognition and stop the spread of shigellosis in vulnerable communities. Disclosures All Authors: No reported disclosures

COVID-19 and family planning service delivery: Findings from a survey of U.S. physicians

Equitable access to contraception is critical for reproductive autonomy. Using cross-sectional data from the DocStyles survey administered September–October 2020 (68% response rate), we compared changes in family planning-related clinical services and healthcare delivery strategies before and during the COVID-19 pandemic and assessed service provision issues among 1063 U.S. physicians whose practice provided family planning services just before the pandemic. About one-fifth of those whose practices provided the following services or strategies just before the pandemic discontinued these services during the pandemic: long-acting reversible contraception (LARC) placement (16%); LARC removal (17%); providing or prescribing emergency contraceptive pills (ECPs) in advance (18%); and reminding patients about contraception injections or LARC removal or replacement (20%). Many practices not providing the following services or strategies just before the pandemic initiated these services during the pandemic: telehealth for contraception initiation (43%); telehealth for contraception continuation (48%); and renewing contraception prescriptions without requiring an office visit (36%). While a smaller proportion of physicians reported service provision issues in the month before survey completion than at any point during the pandemic, about one-third still reported fewer adult females seeking care (37%) and technical challenges with telehealth (32%). Discontinuation of key family planning services during the COVID-19 pandemic may limit contraception access and impede reproductive autonomy. Implementing healthcare service delivery strategies that reduce the need for in-person visits (e.g., telehealth for contraception, providing or prescribing ECPs in advance) may decrease disruptions in care. Resources exist for public health and clinical efforts to ensure contraception access during the pandemic.

Healthcare Providers' Self-Reported Pediatric Mild Traumatic Brain Injury Diagnosis, Prognosis, and Management Practices: Findings From the 2019 DocStyles Survey.

To assess adherence to 5 key recommendations in the Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury, this article presents results from the 2019 DocStyles survey. Cross-sectional, web-based survey of 653 healthcare providers. Most healthcare providers reported adhering to the recommendations regarding the use of computed tomography and providing education and reassurance to patients and their families. However, less than half reported routinely examining their patients with mild traumatic brain injury (mTBI) using age-appropriate, validated symptom scales, assessing for risk factors for prolonged recovery, and advising patients to return to noncontact, light aerobic activities within 2 to 3 days. Self-reported mTBI diagnosis, prognosis, and management practices varied by specialty. Only 3.8% of healthcare providers answered all 7 questions in a way that is most consistent with the 5 recommendations examined from the Centers for Disease Control and Prevention Pediatric mTBI Guideline. This study highlights several important information gaps regarding pediatric mTBI diagnosis and management. Further efforts to improve adoption of guideline recommendations may be beneficial to ensure optimal outcomes for children following an mTBI.

Diagnosis, Treatment, and Prevention Practices for Lyme Disease by Clinicians, United States, 2013-2015.

Although tick-borne diseases account for a large number of health care visits in the United States, clinical practices for tick bite and Lyme disease treatment and prevention are not well understood. The objective of this study was to better understand factors associated with clinical practices related to tick bites and Lyme disease. In 2013-2015, questions about tick-bite evaluation, Lyme disease diagnosis and treatment, appropriate use of Lyme disease testing, and tick-bite prevention were included in Porter Novelli's DocStyles survey, a nationally representative annual web-based survey of health care providers. We performed analyses of responses by provider license type and state-level incidence (high or low) of Lyme disease in 2019. A total of 4517 providers were surveyed across the 3 study years. Overall, 80.9% of providers reported that they had evaluated at least 1 patient for a tick bite, 47.6% had diagnosed at least 1 patient with Lyme disease, and 61.9% had treated at least 1 patient for Lyme disease in the previous year. Providers from states with a high incidence of Lyme disease saw more patients for tick bites and Lyme disease than providers from states with a low incidence of Lyme disease. Few providers correctly chose Lyme disease testing as clinically useful in the hypothetical case of a patient from a state with a high incidence of Lyme disease with an arthritic knee (36.0%) or with new-onset atrioventricular block (39.5%), and respondents across all provider types incorrectly chose testing when not clinically indicated. Most providers (69.7%) reported routinely recommending tick-bite prevention methods to patients. Many providers evaluate patients for tick bites and treat patients for Lyme disease, but knowledge about appropriate testing is low. Providers may benefit from tailored education about appropriate Lyme disease diagnosis, testing, and effective tick-bite prevention.

Do healthcare providers assess for risk factors and talk to patients about return to driving after a mild traumatic brain injury (mTBI)? Findings from the 2020 DocStyles Survey

BackgroundThere is a dearth of information and guidance for healthcare providers on how to manage a patient’s return to driving following a mild traumatic brain injury (mTBI).MethodsUsing the 2020 DocStyles...

Pre-exposure Prophylaxis (PrEP) Awareness and Prescribing Behaviors Among Primary Care Providers: DocStyles Survey, 2016-2020, United States.

Few studies have assessed providers' intent of prescribing PrEP in the future. We analyzed cross-sectional web-based surveys to estimate trends from 2016 to 2020 in PrEP awareness and prescribing behaviors in the United States among primary care providers. Multivariable logistic regression was used to estimate prevalence of PrEP awareness, prescribing behaviors, and likelihood of prescribing PrEP in the next 12months. The adjusted prevalence for PrEP awareness was significantly higher in 2019 (93.7%, 95% CI 91.9%, 95.2%) compared to 2018 (88.1%, 95% CI 85.5%, 90.3%). The adjusted prevalence for prescribing PrEP was significantly higher in 2019 (16.4%, 95% CI 13.6%, 19.6%) and 2020 (15.6%, 95% CI 13.0%, 18.7%) compared to 2018 (12.2%, 95% CI 10.0%, 14.7%). Practicing in the West and regularly screening for HIV were associated with higher PrEP awareness and provision. Studies should examine factors associated with PrEP provision for groups with increased risk for HIV.

Differences in Evaluating Fall Risk by Primary Care Provider Type

This study assessed differences in clinical fall risk assessment of older adults (aged 65 and older) and clinical resources used by primary care providers (PCP). Porter Novelli’s 2016 DocStyles survey was used to examine clinical behavior data from PCPs (n = 1128). Compared with other practitioners, nurse practitioners (NP) reported that a higher percentage of their patients were older adults. The majority of NPs reported screening for falls risk routinely, but most did not use standardized fall-risk assessments to assess risk factors. There were also differences in the types of clinical resources used by NPs and other PCPs to evaluate the safety profile of medications.

Screening and Referral for Childhood Obesity: Adherence to the U.S. Preventive Services Task Force Recommendation

The U.S. Preventive Services Task Force recommends clinicians screen children aged 6 years or older for obesity and offer or refer children with obesity to intensive weight management programs. This study explores clinician awareness of weight management programs meeting the recommendation, adherence to the recommendation of screening and referral, and associations between provider and practice characteristics and weight management program referrals. This cross-sectional study used data from the DocStyles survey 2017, a web-based panel survey, analyzed in 2017. Among 1,023 clinicians who see pediatric patients, this study examined clinician awareness of weight management programs in their communities that met the recommendation, practice of screening for childhood obesity, and referral to weight management programs. Multivariable logistic regression estimated associations between the demographic and practice characteristics of clinicians and weight management program referrals. Only 24.6% of surveyed clinicians were aware of a weight management program that met the U.S. Preventive Services Task Force recommendation in their community; of those aware, 88.9% referred patients to these weight management programs. Most (83.6%) clinicians screened children for obesity in ≥75% of visits. Overall, 53.5% of clinicians provided referrals to weight management programs. Referral was higher among female clinicians and clinicians serving mostly middle-income patients. Providers without teaching hospital privileges had lower odds of referral. Adherence to clinical recommendations is essential to curbing the childhood obesity epidemic. Only one in four surveyed clinicians were aware of weight management programs in their community meeting U.S. Preventive Services Task Force criteria. Half of clinicians referred pediatric patients with obesity to a weight management program. Results suggest efforts are needed to increase awareness of, and referral to, weight management programs meeting the recommendation.

Clinical Implementation of Self-Measured Blood Pressure Monitoring, 2015–2016

Self-measured blood pressure monitoring (SMBP) plus additional clinical support is an evidence-based strategy that improves blood pressure control. Despite national recommendations for SMBP use and potential cost savings, insurance coverage for implementation is limited in the U.S. and little is known regarding clinical implementation. In 2017, using 2015 and 2016 DocStyles survey data from 1,590 primary care physicians and nurse practitioners in U.S. outpatient facilities, SMBP-related clinical practices and provider roles were assessed. Almost all (97%) respondents reported using SMBP. Among 1,539 who used SMBP, more than half (60%) used SMBP for a combination of diagnostic and treatment purposes, whereas 24% used SMBP for diagnosis only and 16% used SMBP for treatment only. The most common methods for patients to share SMBP results with clinical staff were paper log (68%); during appointments (66%); by telephone (37%); by secure website (22%); or by secure e-mail (19%). Nearly all (98%) respondents reported that medication adjustments were provided to patients based on SMBP readings. About 15% did not counsel patients regarding cuff size, and 8% did not validate patient devices. Only 13% of respondents reported having monitor loaner programs, and availability did not vary by the financial status of the patient population (p=0.59). SMBP is used widely in outpatient facilities as reported in the survey, although provider roles and SMBP-related practices vary, and gaps exist regarding patient counseling, device validation, and loaner program availability. As part of efforts to improve hypertension control, healthcare professionals can promote increased use of best practices for SMBP, whereas insurers can implement standardization and support of SMBP.

Knowledge, attitudes, and practices regarding the use of ovulation induction and ovarian stimulation without in vitro fertilization (IVF): healthcare provider survey

To assess provider practices of recommending non-IVF fertility treatments to patients, their knowledge about treatment safety, and their attitudes about using non-IVF fertility treatments. Cross-sectional, web-based survey of U.S. healthcare providers. We used data from the 2017 DocStyles survey of a random sample of providers with respondents’ distribution of age, sex, and region matching the American Medical Association's master file (39.5% response rate). We assessed responses of family practitioners, internists, nurse practitioners, and obstetrician-gynecologists who provided care for infertility patients in the past year. Non-IVF fertility treatments were defined as ovulation induction or ovarian stimulation with timed intercourse or insemination with no intention of performing IVF. Of 1,510 respondents, 603 (40%) reported providing care for infertility patients in the past year, including 182 family practitioners, 118 internists, 72 nurse practitioners, and 231 obstetrician-gynecologists. The most common non-IVF fertility treatments recommended by providers were natural cycle insemination (66%), clomiphene citrate (57%), and Metformin (57%). Primary reasons for recommending non-IVF fertility treatments were patient or couple’s prior success in conceiving a pregnancy (41%), duration of infertility (39%), and infertility diagnosis (38%). Most providers (53%) recommended non-IVF fertility treatments before IVF because they considered them less risky. While 44% of providers believe non-IVF fertility treatments were not associated with more adverse infant outcomes than IVF, 18% considered IVF to be safer. Only 35% of providers considered oral fertility drugs to be safer than injectable drugs, while 18% disagreed; 47% had no opinion. Nearly one-third (29%) of obstetrician-gynecologists and the majority of family practitioners (68%), internists (55%), and nurse practitioners (74%) reported not using any specific strategy to limit the risk of multiple births when using non-IVF fertility treatments. The most common strategies of preventing multiple births were beginning treatment with clomiphene citrate (29%), monitoring hormone levels and adjusting treatment protocols (16%), and monitoring follicular size using ultrasound and aspirating excess follicles if needed (14%). While study generalizability may be limited, many providers involved in infertility care may not be aware of the risk of adverse infant outcomes for non-IVF versus IVF fertility treatments, and do not attempt to limit the risk of multiple births while using these treatments. These results can inform provider education efforts.