Family Practice Clinic Research Articles

Abdominal Ultrasonography Used for Abdominal Pain in the Rural Outpatient Setting of South Texas: Impact on Patient Outcomes.

Introduction Abdominal ultrasonography is a key diagnostic tool used in complaints of abdominal pain. The rationale for this study is to examine abdominal ultrasonography's impact on the conclusion of care of abdominal pain in a predominantly Hispanic/Latino patient population. Materials and methods A chart review of 350 patients with a new diagnosis of abdominal pain from a rural family practice clinic in Texas was performed. These patients' charts were reviewed for a new diagnosis of abdominal pain, medications prescribed for abdominal pain, whether abdominal ultrasonography was completed, and the number of visits regarding their complaint. The last visit for their abdominal pain was denoted as the conclusion of care of abdominal pain within the clinic. The primary analyses were logistic regressions with conclusion of pain care or number of visits as the outcome and abdominal ultrasound completion as the primary predictor. Results The sample size was 216 of the 350. Patients were excluded due to age under 18 and if the patient's pain was not coded as epigastric, generalized, or right upper quadrant pain. The patient age range was 18-88 years, and they were all of Hispanic/Latino origin. Abdominal ultrasound was completed on 59 of the patients, and 65 patients experienced conclusion of primary care for abdominal pain. Regarding the number of visits for abdominal pain, 69% had one visit, 25% had two visits, and 6% had three or more visits. Patients who had abdominal ultrasounds were more likely to have multiple visits (typically just two visits) but had markedly higher conclusions of care for abdominal pain. These relationships remained when adjusting for demographic and medical covariates such as age, abdominal pain (all types), and medical treatments used. Conclusion In the outpatient rural care of Hispanic/Latino patients residing in the Rio Grande Valley, patients who had a new complaint of abdominal pain were more likely to have conclusion of primary care for abdominal pain, with only a slight increase in primary care healthcare consumption, if abdominal ultrasonography was completed for abdominal pain.

Montreal Cognitive Assessment (MoCA) XpressO: Validation of a digital self-administered cognitive prescreening tool.

The need for cognitive testing is increasing with the aging population and the advent of new Alzheimer disease therapies. To respond to the increased demand, the XpressO was developed as a self-administered digital cognitive prescreening tool that will help distinguish between populations of subjective and objective cognitive impairment according to the Montreal Cognitive Assessment (MoCA). This is a prospective validation study. XpressO is composed of tasks that assess memory and executive functions. It is validated compared to the digital MoCA as a gold standard. Out of 118 participants screened from the MoCA Clinic and a family practice clinic, 88 met inclusion criteria, two participants had missing data due to incomplete tasks, 86 participants were included in the analysis; the mean age was 70.34 years. A logistic regression model was built, and its accuracy was evaluated by the sensitivity, specificity, and Area Under the Curve (AUC) of the Receiver Operating Characteristic. Analysis showed strong correlation between (1) XpressO memory tasks scores and the MoCA Memory Index Score (p-values < 0.001), and between (2) XpressO sub-test scores and MoCA total score (p-values < 0.005). The AUC for predicting MoCA performance is 0.845. To classify individuals with normal and abnormal MoCA scores, two threshold values were introduced for the total XpressO scores: sensitivity of 91% at a cutoff of 72, specificity of 90% at a cutoff of 42, and an undetermined range in between. XpressO demonstrated high AUC, high sensitivity and specificity to predict cognitive performance compared to the digital MoCA. It may provide efficient cognitive prescreening by identifying individuals who would benefit from further clinical assessments, potentially reducing waiting times and high burden on healthcare clinics.

Are we ready for human papillomavirus testing? Assessment of patient knowledge of and preferences for cervical cancer screening in Ontario.

To determine patient knowledge and preferences about primary human papillomavirus (HPV) testing. Cross-sectional survey. Two family practice clinics (urban and suburban) and the social media platforms of 2 hospitals in the greater Toronto area between January and February 2023. A total of 413 Ontario residents aged 25 to 69 years, with a cervix, who qualified for Papanicolaou (Pap) screening and could communicate in English. Electronic survey containing questions about knowledge of, and preferences for, cervical cancer screening, including types of screening and screening intervals, and about education related to HPV and screening intervals. Of 441 potential participants, 426 were eligible and consented to participate in the study; ultimately 413 provided completed or partially completed surveys (96.9% response rate). Of those who completed a recent Pap test, 57.8% (208 of 360) knew of HPV testing. Initially, 27.8% thought HPV testing was better than Pap testing for cervical cancer screening. After learning HPV tests exist and have self-sampling options, most participants preferred HPV testing (self-sampling 46.3%, provider sampling 34.1%). Annual cervical cancer screening was preferred by 50.1% of participants despite knowing that, for most people, Pap tests should be conducted every 3 years (74.8%). After learning about HPV testing, participants were more likely to prefer 5-year screening intervals (43.8%); however, those in the family practice group were still more likely to prefer 3-year intervals compared with those in the social media group (P<.01). Participants in this study identified a preference for HPV testing and self-sampling options. Concerns were raised about extended screening intervals and the safety of self-collected samples that need to be addressed in public health education initiatives during rollout of new screening programs.

Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training

BackgroundHealth care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits.MethodUsing a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment.ResultsClinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians.ConclusionsPatient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed.Trial registrationClinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.

Functional Dyspepsia (FD) and the Use of Sulpiride (Atypical Antipsychotic) in Family Practice– A Case Report

Functional dyspepsia (FD), a commonly prevalent multifactorial disorder of gut-brain interaction (DGBI), is encountered and managed in family practice and gastroenterology clinics. The diagnosis is solely clinical based on Rome-IV criteria, excluding the organic, systemic, or metabolic causes. Management is often challenging ranging from lifestyle modifications, H-pylori eradication, H2-receptor antagonists, proton pump inhibitors, and prokinetics (1st-line) to antidepressants, and antipsychotics (2nd line) of therapy, once the patient shows no response to 1st line. In severe cases, refractory to 1st &amp; the 2nd line of treatment needs a team approach and gut-brain behavioral therapy. Herein, we present a young female patient diagnosed with FD, managed well with 2nd-line treatment (Sulpiride), an atypical antipsychotic medication, as the patient's symptoms showed no improvement with first-line treatment.

Addressing Burnout inthe Primary Care Setting: The Impact ofan Evidence-Based Mindfulness Toolkit.

Burnout is insidious and manifests over prolonged, repeated exposure to occupational stressors. There is a growing crisis among health care workers (HCWs) due to high levels of burnout and associated adverse outcomes. Identifying and addressing burnout can be problematic due to extensive variances of perceived occupational stressors across HCWs. Mindfulness-based training can enhance individual HCWs' abilities to perceive and constructively respond to stresses endemic in the health care environment. It can reduce the prevalence of burnout in the primary care setting. An evidence-based multimodal Mindfulness-Based Stress Reduction toolkit (MBSR TK) was designed, implemented, and evaluated for its impact on HCWs' self-reported stress levels (SRSL). A pre-post-program evaluation explored the impact of a multimodal toolkit program on HCW SRSL with the Mini-Z burnout survey (MZBS). The MBSR TK program, consisting of a 45 minute introduction and 4 biweekly 15 minute mindfulness sessions offering acupressure, meditation, journaling for gratitude, and self-compassion was designed, delivered, and evaluated with HCWs across 2 military primary care clinics in South Texas. All HCWs across 2 Air Force family practice clinics were invited to participate in all toolkit components. Seventy percent of all HCWs (N = 90) attended the introduction session. Thirty-seven (41%) HCWs completed pre and post MZBSs, and these responses are included in the data analysis section. The most represented HCWs were registered nurses, physician assistants, and technicians, respectively, at 24%, 21%, and 18%. The Wilcoxon Signed-Rank test examined changes in HCWs' SRSL after participation in the MBSR TK program. HCWs who attended the introduction plus one biweekly session showed statistically significant decreases in self-reported stress (P = 0.018) and burnout (P = 0.045) and a significant increase in electronic health record proficiency (P = 0.033). Multimodal mindfulness toolkits to address SRSL burnout are practical, accessible, easily implemented, adaptive to any environment, and can decrease burnout with participation with just one 15 minute session. This MBSR TK implementation effectively lowered self-reported stress in HCWs who are repeatedly challenged to adapt to various settings around the world during peacetime, wars, natural disasters, humanitarian crises, and now, pandemics.

Prevalence of Depression Among Adults With Diabetes Mellitus and the Relationship Between Improvement in Depressive Symptoms and Glycemic Control.

Depression is one of many comorbid conditions associated with diabetes.The rationale for this study is to examine the prevalence of depressive symptoms in adults with diabetes mellitus type II.Furthermore, the association between depressive symptoms and glycemic control will also be analyzed. A chart review of 59 diabetes mellitus type II patients from a family practice clinic in San Juan, Texas was performed.These patients were screened for depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) during their annual physical exam.Since many of these patients have been treated in this clinic for many years for their multiple comorbidities, it is possible to evaluate their responses to the PHQ-9 over consecutive years and compare them with their glycemic control using a HbA1c level.Data was evaluated by using biological parameters, such as age and gender, and the clinical parameter of a HbA1c level.Inferential statistics, such as prevalence, frequency, correlation, and p-value,were also used in analyzing the data. Depressive symptoms were analyzed using the PHQ-9.In 2016, 2017, and 2018, female diabetics were found to have a higher prevalence of depressive symptoms.When comparing diabetes and age, in 2016, those who were between the ages of 65 and 74 and 75 and olderhad a higher incidence of depressive symptoms.Furthermore, in 2017 and 2018, patients 75 and older also had a higher frequency of depressive symptoms.The controlled diabetic population was also found to have a greater rate of depressive symptoms.However, after careful analyzation, there was no significant relationship between glycemic control and depressive symptoms. Many diabetics have comorbid depressive symptoms.Even though this study showed no relationship between depressive symptoms and glycemic control, the treatment of depressive symptoms in diabetics may help to prevent the multiple life altering complications that diabetes can cause.

Rural patient and provider perceptions of telehealth implemented during the COVID-19 pandemic

BackgroundUnderstanding perceptions of telehealth implementation from patients and providers can improve the utility and sustainability of these programs, particularly in under-resourced rural settings. The purpose of this study was to evaluate both patient and provider perceptions of telehealth visits in a large rural healthcare system during the COVID-19 pandemic. To promote sustainability of telehealth approaches, we also assessed whether the percentage of missed appointments differed between in-person and telehealth visits.MethodsUsing anonymous surveys, we evaluated patient preferences and satisfaction with telehealth visits from November 2020 -March 2021 and assessed perceptions of telehealth efficiency and value among rural providers from September–October 2020. We examined whether telehealth perceptions differed according to patients’ age, educational attainment, insurance status, and distance to clinical site and providers’ age and length of time practicing medicine using ANOVA test. We also examined whether the percentage of missed appointments differed between in-person and telehealth visits at a family practice clinic within the rural healthcare system from April to September 2020 using a Chi-square test.ResultsOver 73% of rural patients had favorable perceptions of telehealth visits, and satisfaction was generally higher among younger patients. Patients reported difficulty with scheduling follow-up appointments, lack of personal contact and technology challenges as common barriers. Over 80% of the 219 providers responding to the survey reported that telehealth added value to their practice, while 36.6% agreed that telehealth visits are more efficient than in-person visits. Perception of telehealth value and efficiency did not differ by provider age (p = 0.67 and p = 0.67, respectively) or time in practice (p = 0.53 and p = 0.44, respectively). Technology challenges for the patient (91.3%) and provider (45.1%) were commonly reported. The percentage of missed appointments was slightly higher for telehealth visits compared to in-person visits, but the difference was not statistically significant (8.7% vs. 8.0%; p = 0.39).ConclusionsTelehealth perceptions were generally favorable among rural patients and providers, although satisfaction was lower among older patients and providers. Our findings suggest that telehealth approaches may add value and efficiency to rural clinical practice. However, technology issues for both patients and providers and gaps in care coordination need to be addressed to promote sustainability of telehealth approaches in rural practice.

Diabetes Educational Intervention for Nurse Practitioner Students Within a Family Practice Clinic

Diabetes mellitus (DM) prevalence is rising. Nurse practitioner (NP) students must enter practice ready to implement current treatment guidelines in practice. This quality improvement project aimed to increase NP students’ knowledge and confidence for managing patients with DM by implementing an educational intervention. The intervention entailed 6 educational sessions led by a preceptor during morning huddles in a primary care clinic. Outcomes were measured by comparing pre- and postintervention survey item means. NP students’ knowledge and confidence increased across multiple DM management topics. Novel educational interventions delivered in clinical agencies by precepting providers may help increase NP students’ practice readiness.

Patient Satisfaction With Speech Recognition in the Exam Room: Exploratory Survey.

Medical speech recognition technology uses a microphone and computer software to transcribe the spoken word into text and is not typically used in outpatient clinical exam rooms. Patient perceptions regarding speech recognition in the exam room (SRIER) are therefore unknown. This study aims to characterize patient perceptions of SRIER by administering a survey to consecutive patients scheduled for acute, chronic, and wellness care in three outpatient clinic sites. We used a microphone and medical speech recognition software to complete the "assessment and plan" portion of the after-visit summary in the patient's presence, immediately printed the after-visit summary, and then administered a 4-question exploratory survey to 65 consecutive patients in internal medicine and pulmonary medicine clinics at an academic medical center and a community family practice clinic in 2021 to characterize patient perceptions of SRIER. All questions were completed by all participants. When compared to patients' recollection of usual care (visits with no microphone and an after-visit summary without an "assessment and plan"), 86% (n=56) of respondents agreed or strongly agreed that their provider addressed their concerns better, and 73% (n=48) agreed or strongly agreed that they understood their provider's advice better. A total of 99% (n=64) of respondents agreed or strongly agreed that a printed after-visit summary including the "assessment and plan" was helpful. By comparing the "agree" and "strongly agree" responses to the neutral responses, we found that patients felt that clinicians using SRIER addressed their concerns better (P<.001), they understood their clinician's advice better (P<.001), and receiving a paper summary was helpful (P<.001). Patients were likely to recommend a provider using a microphone based on the Net Promoter Score of 58. This survey suggests patients have a very positive perception of speech recognition use in the exam room.

Understanding Implementation of Evidence-Based Interventions to Address Human Papillomavirus Vaccination: Qualitative Perspectives of Middle Managers.

Engaging individuals in middle management positions (eg, nurse or clinic managers) could facilitate implementation of evidence-based interventions (EBIs) to improve uptake of human papillomavirus (HPV) vaccination. Our goal was to understand middle managers' role in and perspectives on implementation of EBIs for HPV vaccination. We conducted qualitative interviews with middle managers in pediatric and family practice clinics. We used constructs from the Consolidated Framework for Implementation Research (CFIR) to design the interview guide and as a coding framework. Participants (n = 19) reported overseeing implementation related to HPV vaccination. Across interviews, CFIR inner setting constructs (eg, structural characteristics and implementation climate) were identified as being both barriers and facilitators. As evidenced in this study, middle managers have a deep understanding of organizational factors, and they have the ability to facilitate implementation efforts related to HPV vaccination. Future efforts could focus on engaging middle managers and leveraging their expertise and understanding of barriers and facilitators.

The outcome of medical nutrition therapy on glycemic control among type 2 diabetic patients.

the global prevalence of type 2 diabetes in adults is estimated to be 6.4%. The current prevalence of type 2 diabetes in Egyptians aged 20 to 79 is approximately 15.6%. The objective of medical nutrition therapy (MNT) is to optimize the management of the "ABC" for diabetes control, glycated hemoglobin, blood pressure, and cholesterol. Our study aimed to assess the effect of MNT on glycemic control in patients with type 2 diabetes attending the family practice clinic. a quasi-experimental intervention trial was conducted with 40 diabetic patients seeking medical service in the Suez Canal University Hospital family practice clinic. The participants were over 20 years old and had uncontrolled type 2 diabetes. Patients were surveyed using El-Gilany questionnaire to evaluate the socio-demographic traits, physical examination data, and laboratory investigations at baseline and after 12 weeks. medical nutrition therapy (MNT) significantly reduced glycated hemoglobin level (p<0.001); the median level of glycated hemoglobin was 10% with a minimum level of 7.5% vs. a maximum of 14% in the pre-intervention phase. In comparison, the median glycated hemoglobin level was 9.5%, with a minimum level of 5.6% vs. a maximum of 13.5% in the post-intervention phase. In addition, there was a significant improvement in blood pressure, weight, body mass index, fasting plasma glucose, and lipid profile. Conclusion: there is evidence that MNT is a crucial component of type 2 diabetes therapy.

Predictors of weight reduction in a Nigerian family practice setting.

This study identified the predictors of weight reduction among adult obese patients in a Family Practice Setting and developed a statistical model to predict weight reduction. A prospective cohort design. The Family Practice Clinic, University College Hospital, Ibadan, Nigeria. Obese adults were recruited into a three-month weight reduction program. Patient Information Leaflets were used for counselling, while questionnaires were administered to obtain socio-demographic and lifestyle factors. Potential predictors were assessed using the Multidimensional Scale of Perceived Social Support, Zung Depression Scale, Rosenberg Self-Esteem scale, Garner's Eating Attitude Test-26 (EAT-26), 24-hour dietary recall and International Physical Activity Questionnaire-short form. Anthropometric indices, blood pressure and Fasting Lipid Profile were assessed. Descriptive and inferential statistics were used for analysis with a significance set at α0.05. Most 99(76.2%) of the 130 participants achieved weight reduction and had a median weight change of -2.3kg (IQR-4, -0.5), with 66 (66.7%) out of 99 attaining the weight reduction target of 10%. The regression model showed predictors of weight reduction to be Total Cholesterol [TC] (p=0.01) and Low-Density Lipoprotein Cholesterol [LDL-C] (p=0.03). The statistical model derived for Weight reduction = 0.0028 (LDL-C) -0.029 (TC)-0.053 (EAT-26) +0.041(High-Density Lipoprotein Cholesterol). The proportion of variance of the model tested was R2 = 0.3928 (adjusted R2 = 0.2106). Predictors of weight reduction among patients were eating attitude score, Total Cholesterol, Low-Density Lipid and High-Density Lipoprotein Cholesterol levels. A statistical model was developed for managing obesity among patients. Self-funded, with a discount from the Public-Private Partnership Laboratory obtained for the patients recruited.

Establishing priorities for diabetes action goals according to key opinion leaders and health professionals

BackgroundThe ever-increasing burden of diabetes and the limited resources highlight the need for prioritization of national action goals for diabetes management. The Israeli National Diabetes Council (INDC) initiated a prioritization process aiming to set a top list of diabetes related goals, as suggested by decision makers and health professionals.MethodsA 2-step prioritization process, including a small (n = 32) circle of key opinion leaders of the INDC and a larger (n = 195) nationwide circle of diabetes health professionals consisting of physicians, nurses, and dieticians working in diabetes care centers, hospitals and family practice clinics, was established. An online questionnaire presenting 45 different action areas in diabetes prevention and care was distributed to the INDC members who ranked the 3 top diabetes priorities based on their individual interpretation of importance and applicability. The 7 highest ranking priorities were later presented to hospital-based and community diabetes health professionals. These professionals selected the 3 top priorities, based on their perceived importance.ResultsCouncil members opted mostly for action areas regarding specific populations, such as clinics for adult type-1 diabetes patients, diabetic foot, and pediatric and adolescent patients, while the health professionals’ top priorities were mostly in the general field of prevention, namely high-risk prediabetes population, prevention of obesity, and promotion of healthy life-style. In addition, priorities differed between hospital and community health professionals as well as between different professional groups.ConclusionsA national prioritization process of action areas in diabetes prevention and care is attainable. The resulting item list is affected by professional considerations. These priorities may direct efforts in the implementation of interventions to improve national-level diabetes management.

Design details for overdose education and take-home naloxone kits: Codesign with family medicine, emergency department, addictions medicineand community.

Overdose education and naloxone distribution (OEND) programmes equip and train people who are likely to witness an opioid overdose to respond with effective first aid interventions. Despite OEND expansion across North America, overdose rates are increasing, raising questions about how to improve OEND programmes. We conducted an iterative series of codesign stakeholder workshops to develop a prototype for take-home naloxone (THN)-kit (i.e., two doses of intranasal naloxone and training on how to administer it). We recruited people who use opioids, frontline healthcare providersand public health representatives to participate in codesign workshops covering questions related to THN-kit prototypes, training on how to use it, and implementation, including refinement of design artefacts using personas and journey maps. Completed over 9months, the workshops were audio-recorded and transcribed with visible results of the workshops (i.e., sticky notes, sketches) archived. We used thematic analyses of these materials to identify design requirements for THN-kits and training. We facilitated 13 codesign workshops to identify and address gaps in existing opioid overdose education training and THN-kits and emphasize timely response and stigma in future THN-kit design. Using an iterative process, we created 15 prototypes, 3 candidate prototypesand a final prototype THN-kit from the synthesis of the codesign workshops. The final prototype is available for a variety of implementation and evaluation processes. The THN-kit offers an integrated solution combining ultra-brief training animation and physical packaging of nasal naloxone to be distributed in family practice clinics, emergency departments, addiction medicine clinicsand community settings. The codesign process was deliberately structured to involve community members (the public), with multiple opportunities for public contribution. In addition, patient/public participation was a principle for the management and structuring of the research team.

A Quality Improvement Project to Adopt United States Preventive Services Task Force Lung Cancer Screening Guidelines at a Primary Care Clinic

The aim of this quality improvement project was to determine whether a provider and patient educational intervention based on the latest United States Preventive Services Task Force lung cancer screening guidelines would increase the number of low-dose computed tomographic (LDCT) studies completed. This project, which was conducted at a Michigan family practice clinic over a 3-month period, compared the number of pre- and postintervention LDCT studies completed for eligible patients (N = 276). Although there was no statistically significant increase in the number of postintervention LDCT studies completed, there was a statistically significant increase in the number of eligible patients who received lung cancer screening education.

Perceived Adherence and Barriers to Dietary Recommendations among Type 2 Diabetic Patients in a Family Practice Clinic, Suez Canal University Hospitals

Perceived Adherence and Barriers to Dietary Recommendations among Type 2 Diabetic Patients in a Family Practice Clinic, Suez Canal University Hospitals

Associations between Patient- and Provider Level Factors, and Telemedicine Use in Family Medicine Clinics.

Increased telemedicine implementation may promote primary care access. However, gaps in telemedicine uptake may perpetuate existing disparities in primary care access. This study assessed provider- and patient-level factors associated with telemedicine use in community-based family practice clinics. This retrospective study used electronic medical records data from a large Federally Qualified Health Center. A 3-level mixed-effects logistic regression model explored predictors of telemedicine use, with provider and patient as random effects. The analytic sample included 37,428 unique patients with 106,567 primary care encounters with 42 family medicine providers. Fifty-seven percent of the sample identified as Hispanic, 28% non-Hispanic White, and 11% non-Hispanic Black. Compared to Hispanics, non-Hispanic White patients had 61% higher odds of a telemedicine visit, and non-Hispanic Black patients had 32% higher odds of a telemedicine visit. The odds of telemedicine use were lower for those who were uninsured. Those residing in metropolitan areas or medically underserved areas had greater odds of a telemedicine appointment. Commute time exhibited a dose-response relationship with telemedicine use. Provider characteristics were not significantly associated with telemedicine use. While provider characteristics were not associated with telemedicine use, greater focus on patient characteristics specific to the population served is necessary.

Expanding Access to Social Support in Primary Care via Telemedicine: A Pilot Study.

The coronavirus pandemic quickly exposed the need for efficient and widespread implementation of telehealth services. Additionally, it further unveiled the impact of social and environmental barriers to healthcare in underserved, rural populations. This in-practice pilot study tested the utility of a geographically centralized social worker providing services between a patient and a primary care provider via telecommunication at two high volume rural outpatient family practice clinics. Outcome measures included patient and provider satisfaction. Twenty-two telehealth social work encounters occurred spanning both adult and pediatric patients. Data collected from patients, primary care providers, and social work staff revealed positive feedback. The data from our small pilot study demonstrated that social work triage delivered via a tablet was an acceptable and valued resource in busy primary care practices.

SCREENING OF PATIENTS AT RISK FOR WILD TYPE ATTR-CM USING A COMPUTATIONAL MACHINE LEARNING ALGORITHM

BACKGROUND Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive, life-threatening disease that is an underdiagnosed cause of heart failure (HF). To enable the identification of patients with suspected ATTRwt-CM, a machine learning algorithm (MLA) was developed using U.S. medical claims data sourced from IQVIA and Optum. Our goal was to test high-yield clinical combinations derived from the MLA in undiagnosed and diagnosed patients with ATTRwt-CM. METHODS AND RESULTS 21 combinations of clinical characteristics associated with ATTRwt-CM were tested within University of Utah Health. The undiagnosed cohort included patients 50 years of age or older with at least 1 office visit within the past 18 months, diagnosis of heart failure (HF), and no prior diagnosis of amyloidosis or end stage renal disease. High-yield combinations and the clinical profile of patients at risk for ATTRwt-CM were identified. A second cohort of diagnosed patients was included to analyze the sensitivity of the combinations. 9,051 HF patients met inclusion criteria, of whom 1,091 (12%) were identified as at risk for ATTRwt-CM by the clinical combinations (mean age 74 years, 54% female). Higher yielding clinical combinations included 1) systolic or combined HF and diastolic HF (n = 537, 49%), 2) carpal tunnel (n = 340, 31%), and 3) atrial flutter and/or atrial fibrillation (AFl/AF) and joint disorders and diastolic HF (n = 196, 18%). Common clinical features of patients at risk included osteroarthrosis (60%), AFl/AF (56%), and chronic kidney disease (36%). Over the previous 18 months, patients identified as ‘at risk’ visited cardiology (77%), family practice (48%), and orthopedics (30%) clinics. In cohort 2, 1 of the 21 clinical combinations was observed in 52 (75%) patients with confirmed ATTRwt-CM (mean age 80 years, 6% female). CONCLUSION The MLA combinations identified patients at risk for ATTRwt-CM using clinical characteristics. Integration of the clinical combinations within electronic health records may improve the identification of patients with ATTRwt-CM. Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive, life-threatening disease that is an underdiagnosed cause of heart failure (HF). To enable the identification of patients with suspected ATTRwt-CM, a machine learning algorithm (MLA) was developed using U.S. medical claims data sourced from IQVIA and Optum. Our goal was to test high-yield clinical combinations derived from the MLA in undiagnosed and diagnosed patients with ATTRwt-CM. 21 combinations of clinical characteristics associated with ATTRwt-CM were tested within University of Utah Health. The undiagnosed cohort included patients 50 years of age or older with at least 1 office visit within the past 18 months, diagnosis of heart failure (HF), and no prior diagnosis of amyloidosis or end stage renal disease. High-yield combinations and the clinical profile of patients at risk for ATTRwt-CM were identified. A second cohort of diagnosed patients was included to analyze the sensitivity of the combinations. 9,051 HF patients met inclusion criteria, of whom 1,091 (12%) were identified as at risk for ATTRwt-CM by the clinical combinations (mean age 74 years, 54% female). Higher yielding clinical combinations included 1) systolic or combined HF and diastolic HF (n = 537, 49%), 2) carpal tunnel (n = 340, 31%), and 3) atrial flutter and/or atrial fibrillation (AFl/AF) and joint disorders and diastolic HF (n = 196, 18%). Common clinical features of patients at risk included osteroarthrosis (60%), AFl/AF (56%), and chronic kidney disease (36%). Over the previous 18 months, patients identified as ‘at risk’ visited cardiology (77%), family practice (48%), and orthopedics (30%) clinics. In cohort 2, 1 of the 21 clinical combinations was observed in 52 (75%) patients with confirmed ATTRwt-CM (mean age 80 years, 6% female). The MLA combinations identified patients at risk for ATTRwt-CM using clinical characteristics. Integration of the clinical combinations within electronic health records may improve the identification of patients with ATTRwt-CM.