Family Practice Clinic Research Articles

Functional Disability and Their Associated Chronic Diseases among Elderly Patients Attending an Egyptian Family Practice Clinic

Functional Disability and Their Associated Chronic Diseases among Elderly Patients Attending an Egyptian Family Practice Clinic

Does Losing 5-7% of Prediabetic Body Weight from a Diabetes Prevention Program decrease Cardiovascular Risks?

INTRODUCTIONAccording to the Centers for Disease Control and Prevention (CDC), one-third of adults have prediabetes (i.e., at risk for developing type 2 diabetes), a leading risk factor for cardiovascular disease. The Diabetes Prevention Program (DPP) focuses on lifestyle modifications to help participants lose 5-7% of their body weight and prevent Type 2 Diabetes. The purpose of this community-based pilot study was to investigate how successful completion of the DPP might be associated with decreases in body weight and atherosclerotic cardiovascular disease (ASCVD) risks.METHODSSingle-site, prospective cohort study. The DPP was implemented at the Farmington Village Family Practice Clinic and delivered virtually via Zoom from January 2020 through December 2020. During the first six months, participants met weekly for one hour. In the remaining six months, monthly sessions were held for one hour. Each session began with a private weigh-in followed by a uniquely designed lesson plan. A total of 14 prediabetic patients, based on hemoglobin A1c (A1c), fasting blood glucose levels, or diabetic risk calculator scores, were enrolled. For analyses, data concerning body mass index (BMI), smoking status, anti-hypertensive medications, age, race, sex, A1c, fasting blood glucose, total cholesterol, and high-density lipoprotein (HDL) levels were measured at baseline, six and 12 months. These parameters were used to calculate composite ASCVD risk percentages based on the 2013 Risk Calculator from the American Heart Association/American College of Cardiology.RESULTSUsing a series of Wilcoxon Matched Signed Rank Pair T test procedures, initial base-to six-month analyses showed a statistically significant improvement in ASCVD risk scores (p < 0.01), BMI (p < 0.01), HDL (p < 0.01), estimated weekly minutes of physical activity (p =< 0.01), and total cholesterol (p = 0.048) levels. In addition, base-to-12-month differences for ASCVD, BMI, HDL and physical activity outcomes remained statistically significant.DISCUSSIONAfter completion of the DPP program, both initial (base to six month) as well as follow up (base to 12-month) statistically significant improvements in ASCVD, HDL, BMI, physical activity levels, and total cholesterol were observed.CONCLUSIONSThese pilot study results are promising and consistent with the reduction of cardiovascular risk factors. These findings support the value of a structured, evidence-based educational curriculum focused on nonpharmacologic intervention to decrease weight loss and ASCVD risk scores for prediabetes adults.

Awareness of Family Physician Residents of their Roles in Disaster Health Management: A Cross-Sectional Study in Saudi Arabia

Background: Family physicians have a pivotal role in responding to the medical community's needs and have a crucial role in disaster health management. Family physicians have several tasks and duties during and after the disaster, such as event detection, critical information’ collection and distribution, and rehabilitative activities. It is important to identify the level of awareness of the family physicians regarding their role in the management of disasters.&#x0D; Aim: To assess the awareness of family physician residents of their roles in disaster health management, Saudi Arabia.&#x0D; Methods: This study was cross-sectional; it was performed on Saudi family physician residents in family practice clinics and centers in Saudi Arabia. A self-administrated questionnaire has been sent electronically to the participants to investigate their awareness. IMB SPSS version 22 was used to analyze the collected data.&#x0D; Results: This study included 400 family physicians; more than one-half 52.75%were in the age of 28-30 years old. There were 61.5% worked previously at hospital emergency services. A few percentages reported receiving training on disaster medicine management in the clinic, 38.5%. 47.75% reported willingness to train on disaster management. There was 71% of physicians had high knowledge regarding their role in disaster management.&#x0D; Conclusion: There was high awareness among the family physicians regarding their role in the management of disaster with an acceptable attitude toward receiving training.

Assessing the prevalence and correlates of prenatal cannabis consumption in an urban Canadian population: a cross-sectional survey.

Background:Recreational cannabis use was legalized in Canada in October 2018. We aimed to determine the prevalence and correlates of cannabis consumption among pregnant individuals in a single Canadian city following national legalization.Methods:Over the period May to October 2019, we distributed an anonymous cross-sectional survey to pregnant patients attending family practice, midwifery, and low-risk and high-risk obstetrics clinics in Hamilton, Ontario. Eligibility was based on English literacy and current pregnancy. The survey included questions regarding lifetime and in-pregnancy cannabis use, intent for postpartum use and patterns of use. We also collected demographic information. We calculated descriptive statistics and performed logistic regression analyses to explore the relations between cannabis consumption and demographic characteristics.Results:Of 531 pregnant individuals approached, 478 agreed and were able to participate, for a 90% participation rate. Among these 478 respondents, 54 (11%) reported consuming cannabis at some point during the pregnancy and 20 (4%) reported currently consuming cannabis. Among the 460 respondents who intended to breastfeed, 23 (5%) planned to consume cannabis during the postpartum period. Of 20 current users, 13 (65%) reported consuming cannabis at least weekly and 19 (95%) reported nausea, sleep problems or anxiety as reasons for use. Respondents without postsecondary education had 10.0-fold (95% confidence interval [CI] 4.6–23.5) greater odds of prenatal cannabis consumption than university-educated respondents. In addition, respondents who reported that their partners used cannabis had 3.9-fold (95% CI 2.2–7.3) greater odds of prenatal cannabis consumption than those who reported that their partners did not use cannabis.Interpretation:Lower educational attainment and partners’ cannabis consumption were associated with greater odds of inpregnancy cannabis use. These results may help to inform early intervention strategies to decrease cannabis consumption during this vulnerable period of fetal and neonatal development.

Sigara İçen ve İçmeyen Yetişkinlerin Ekspiryum Havasındaki Karbonmonoksit Düzeylerinin Bağımlılık Puanları ile İlişkisinin Değerlendirilmesi

Objectıve: Smoking; along with psychological factors and habits, it causes addiction in people. The level of smoking addiction is determined in clinical practices with the Fagerström Test for Nicotine Dependence (FTND). CO level measurement in expiratory air is frequently used today as a biomarker in the diagnosis, treatment and follow-up stages of addiction. In this study, it was aimed to evaluate the relationship between CO levels and FTND of smokers. Materials and Methods: The questionnaire was applied to smokers and healthy volunteers coming to the Selcuk University Faculty of Medicine Family Practice Clinic. 68 smoker patients and 60 non-smoker volunteers were included. Patients' sociodemographic characteristics, age of starting smoking, CO levels in expiratory air and FTND scores were recorded. The relationship between FTND scores and CO levels in expiratory air was investigated. Chi-square test was used to examine the comparison of categorical data. P value p&amp;lt;0,05 was considered statistically significant. Results: The mean age of the individuals included in the scope of the study was 53.0±6.9 and 39.1% of them were women, 60.9% of them were men. There was a statistically significant difference was found between the participants' gender, age, occupational characteristics and marital status and smoking status. FNBT score of smokers was found to be 5.00 ± 2.44 points. The average number of cigarettes smoked/year was 31.00±17.87 years, the average number of cigarettes smoked per day was 20.00±8.76 and the average age to start smoking was 18.00±4.82. There was a positive correlation between the CO results and FTND scores (p≤0.001). There was a negative correlation between the CO results and FEV1/FVC scores(p≤0.001). Conclusıon: Among the scales that measure nicotine addiction level, FTND is the most used one in smoking cessation clinics today. In our study, there was a positive correlation between CO levels and FTND scores, which was found statistically significant. Measuring CO during patient follow-up is both an objective criterion for evaluating smoking cessation and enhances patient compliance. Therefore, CO levels can also be used as a guiding factor in determining the severity of cigarette addiction. Keywords: Addiction, Carbonmonoxide, Smoking.

Magnitude of missed opportunities for prediabetes screening among non-diabetic adults attending the family practice clinic in Western Nigeria: Implication for diabetes prevention.

BackgroundFor many decades, hypertension guidelines recommended dual-arm blood pressure measurement. However, this practice is poor in Nigeria and its significance is largely unidentified. Hence, this study was done to determine the point prevalence of inter-arm blood pressure difference and its relationship with hypertension and diabetes mellitus.MethodsA cross-sectional study was conducted among 214 respondents at the general outpatient clinic of a tertiary hospital in Nigeria. Demographic characteristics and anthropometric indices were obtained. Blood pressure readings were obtained through sequentially repeated measurements in respondents’ arms.ResultsOne-hundred and eighty-six respondents had complete data given a completion rate of 86.9%. Systolic blood pressure was higher on the right and left arm in 102 (54.8%) and 56 (30.1%) of the respondents, respectively. Diastolic blood pressure was higher on the right and left arm in 73 (39.2%) and 63 (33.9%) of the respondents, respectively. The overall prevalence of significant systolic inter-arm difference (≥ 10 mmHg) and diastolic inter-arm difference (≥ 10 mmHg) were 24.2% and 18.8%, respectively. Significant systolic inter-arm difference (p = 0.033) and diastolic inter-arm difference (p = 0.01) were significantly more among respondents with hypertension and/or diabetes mellitus.ConclusionThe blood pressure readings in both arms were different among the majority of the respondents, being higher on the right arm in many of them. The prevalence of significant inter-arm difference was high in the unselected primary care patients studied especially among patients with hypertension and/or diabetes mellitus. Blood pressure measurement in both arms should become a routine practice during initial patients’ visits in primary care.

Metabolik Sendrom İlişkili Parametrelerin Aşırı Aktif Mesane Üzerine Etkisi

Objective : Over active bladder (OAB) is a situation characterized by urgency which negatively affects quality of life. Associations have been shown between situations like age, obesity, parity, DM and hyperlipidemia with OAB. In this study, patients attending a family practice clinic without urologic symptoms had demographic and laboratory data researched for correlation with OAB. Material and Methods : A total of 100 female patients attending a family practice clinic had demographic features like age, height, weight, BMI, waist/hip ratio, and waist/height ratio and laboratory values like blood glucose, cholesterol, TG, hemoglobin, TSH, vitamin D3 and vitamin B12 compared for their effect on the OAB-V8 survey. Results : The OAB-V8 symptom score of patients was identified to have correlations with age, weight, BMI, waist circumference, waist-hip ratio, waist-height ratio and total cholesterol levels. Elevated total cholesterol, presence of more than one chronic disease, hemoglobin above 12 and central-type obesity were identified to increase OAB-V8 symptom score. Conclusion : OAB is a multifactorial disease and age, central-type obesity and more than one chronic disease may affect OAB symptoms.

Patient experience of an integrated care model in a family practice clinic & FQHC.

In order to investigate the patient experience of integrated behavioral health care in primary care settings, we implemented a patient cohort model from a combined site sample (N = 727) consisting of a family practice clinic and a Federally Qualified Health Center. Patient experience was measured using 12 questions from a validated measure, the Agency for Healthcare Research and Quality's Consumer Assessment of Health Care Providers and Systems (CAHPS®), Home and Community Based Services version, and six additional questions about interactions with an integrated behavioral health care team. We assessed bivariate relationships between satisfaction with integration and the clinic practice and self-reported physical health or self-reported mental/emotional health. We also utilized multiple regression to evaluate this relationship. Our analyses showed a statistically significant and small to moderate direct correlation between patients' self-reported health (both physical and mental/emotional health) and their ratings of the practice as a whole (p = .0003), such that patients who rated their physical and/or mental/emotional health as better were more likely to rate their overall satisfaction with the practice higher. The results of this study suggest that primary care patients with only mild to moderate health conditions (physical and/or mental/emotional) may experience greater satisfaction with integrated behavioral health care than patients with multiple and/or severe health conditions. In contrast, patients with multiple and/or severe health conditions may experience lower satisfaction with integrated behavioral health care and may be better served through higher levels of care.

Pregnant Canadians' Perceptions About the Transmission of Cannabis in Pregnancy and While Breastfeeding and the Impact of Information From Health Care Providers on Discontinuation of Use.

Rates of cannabis use during pregnancy and while breastfeeding are increasing in Canada. Some observational studies have found associations between cannabis use in pregnancy and low birthweight, preterm labour, and admission to the intensive care unit. This study aimed to evaluate women's perceptions about transmission of cannabis to the fetus, and whether receiving information from a health care provider influenced their decision to stop using cannabis during pregnancy. Pregnant women presenting to obstetrical, midwifery, and family practice clinics in the greater Hamilton, Ontario area were asked to complete an anonymous survey. Chi-square tests were used to investigate whether patient knowledge was influenced by health care providers or by self-directed learning and if this information influenced their decision to discontinue cannabis use. Of the 478 women surveyed, the vast majority perceived that cannabis is transmitted to the fetus during pregnancy and to the infant while breastfeeding (94.3% and 91.2%, respectively). The majority of women (99%) indicated that the advent of cannabis legalization did not influence their choice to use cannabis in pregnancy. Women who continued to use cannabis during pregnancy were more likely to report receiving information on cannabis from a health care provider (52%) than those who chose to discontinue use in pregnancy (35%) (P = 0.035). In our study, the proportion of pregnant women who understood that cannabis could be transmitted to the fetus in utero and to the infant via breastmilk was high. Despite this, 4.2% of women reported that they continued to use cannabis in pregnancy. More work is needed to understand why some women continue to use cannabis in pregnancy despite being informed of its risks.

Enhancing medication adherence in older adults at two nurse practitioner-owned clinics.

The World Health Organization identified medication adherence as the greatest opportunity to improve outcomes related to chronic disease. Adherence rates of 80% or greater, or taking medication as prescribed at least 80% of the time, can positively impact health outcomes. A prior study at two nurse practitioner (NP)-owned family practice clinics in New Hampshire measured medication adherence among adult type-2 diabetes mellitus (DM) patients at 77% and declining over a 4-year period. Patients' hemoglobin A1c rates were stagnant despite previous initiative to improve this biomarker. Nurse practitioners were educated on provider-driven strategies to improve medication adherence in the older adult with DM, hypertension, and hyperlipidemia. A review of medical records was performed on patients for 52 weeks before seminar and 13 weeks after seminar to capture medication adherence rates and clinical biomarkers. Pre- and postseminar data were analyzed to determine whether the seminar resulted in improved adherence and clinical outcomes. Preseminar medication adherence rates exceeded evidence-based standards of 80% for each condition. Postseminar, statistically significant improved adherence rates were seen among DM patients with hypertension. Adherence worsened among hyperlipidemia patients, although this change was not statistically significant. Clinical biomarkers saw little change. This quality improvement project found that educating NPs on strategies to improve medication adherence can improve adherence among DM and hypertension patients. Continued education and measurement of adherence and clinical biomarkers are encouraged to capture more postseminar visits. This project adds to the growing body of knowledge about patients managed by NPs and NP-owned practices.

Prevalence and correlates of cannabis use in pregnancy and while breastfeeding: A survey-based study

<h3>Objectives</h3> Recreational cannabis use has been legal in Canada since October 2018. This study sought to determine current prevalence and trends of cannabis use among pregnant women in the greater Hamilton area. <h3>Methods</h3> An anonymous survey was distributed in May–October 2019 to pregnant patients attending family practice, midwifery, low- and high-risk obstetrical clinics. It was carried out via electronic tablet, and included lifetime and in-pregnancy cannabis use, intent for postpartum cannabis use, and characteristics of use. Demographic data included age, relationship status, partner cannabis use, educational attainment, and household income. Descriptive statistics were calculated, and logistic regression analyses were performed to explore relationships between cannabis use and demographics. <h3>Results</h3> Among 478 respondents, 11.3% had used cannabis at any point in pregnancy, 4.2% were currently using and 4.8% intended to use while breastfeeding. Of current users, 65.0% reported using at least weekly and 95.0% reported nausea, sleep, or anxiety as reasons for use. Women who used cannabis in pregnancy and intended to use while breastfeeding were more likely to report partner cannabis use and lower educational attainment. Women reporting partner cannabis use were 3.3-fold more likely to use cannabis in pregnancy (p<0.001; 95% CI 1.77–6.17) and women without post-secondary education were 8.6-fold more likely to use cannabis than university-educated women (P<0.0001; 95% CI 3.78–19.52). <h3>Conclusions</h3> Partner cannabis use and lower educational attainment predict likelihood of in-pregnancy cannabis use and intent for postpartum use. Education about safer alternatives for coping with nausea, sleep difficulties and anxiety may help reduce the prevalence of cannabis use in pregnancy.

Community pharmacist and family medicine clinic provision of chronic care management services for Medicare beneficiaries with uncontrolled hypertension

AbstractIntroductionPharmacist‐physician collaboration has shown positive results in improving patient outcomes. Chronic care management (CCM) is a reimbursable service for Medicare beneficiaries in the community setting which includes comprehensive care management and other activities. The pharmacist contribution to CCM services and their associated impact on patient health outcomes has not been fully explored.ObjectivesThe objectives of this study were to: (a) implement a collaborative CCM service between a community pharmacy and family medicine clinic for their common hypertensive patients; (b) measure blood pressure change for patients receiving the CCM intervention; and (c) report financial viability for the community pharmacy and family practice clinic partnership.MethodsSingle group prospective pilot intervention in an independent community pharmacy and family medicine clinic in a small city in the Midwest United States. Forty‐five patients with uncontrolled hypertension who are patients to both community pharmacy and clinic were recruited, and 26 received CCM interventions in person or over the telephone from the community pharmacists to manage medications for hypertension. Our main outcomes were blood pressure values and financial viability.ResultsTwenty‐six patients received at least one community pharmacist encounter. These patients had an average 7.3 mm Hg decline (P = .006) in systolic blood pressure (SBP) and a 2.4 mm Hg decline (P = .079) in diastolic blood pressure (DBP) at 9 months. The total revenue over the study period was $5842. Total revenue for the community pharmacy and clinic was $2785 and $3057, respectively.ConclusionThe community pharmacy/clinic collaboration resulted in improved blood pressure control, a new source of revenue for the community pharmacy, and increased revenue for the clinic. Further research is needed on CCM revenue sharing between physicians and pharmacists to generalize the results.

Adverse childhood experiences: Assessing the impact on physical and psychosocial health in adulthood and the mitigating role of resilience

BackgroundMore than 2000 studies demonstrate adverse childhood experiences ACEs are universal and that experiencing multiple ACEs increases risk for developing physical and psychosocial health problems in adulthood. A challenge faced by clinicians is identifying those most at risk. Recent evidence suggests socio-ecological resilience may mitigate the consequences ACEs. We hypothesize that integrated assessment of ACEs and resilience might improve identification of those at highest risk. ObjectivesWe examined ACEs among adults attending a rural family practice clinic and explored associations between ACE, socio-ecological resilience and health. MethodsA cross-sectional survey measured ACEs, resilience, and health in adult patients attending a collaborative family health care centre in Lunenburg, Nova Scotia, Canada. Correlation analyses were used to determine associations between the measures. The impact of socio-economic status, level of education and gender was considered. ResultsTwo hundred and twenty-six persons participated in this study.Approximately 73 % of participants had experienced at least one ACEs and 31 % experienced 4 or more. Overall with increasing numbers of ACEs prevalence of health problems increased. However, individuals with high resilience scores had lower prevalence of health problems. Regression analyses indicated that the number of ACEs were slightly more important predictor of health issues than level of resilience, though both were important. Social economic status, education level and gender were not significant predictors of the impact of ACEs on person's health. Conclusion: The results suggest integrated assessment for resilience and ACEs may facilitate identification of those at higher risk and in need of preventative intervention.

The risk of obstructive sleep apnea and its association with indices of general and abdominal obesity in a Nigerian family practice clinic: a cross-sectional study

ABSTRACT Introduction: Obstructive sleep apnea (OSA) is associated with considerable morbidity and mortality. This study assessed the prevalence of high risk of OSA and investigated which anthropometric measure best predicts the OSA risk among patients attending a family practice clinic in a tertiary hospital. Methods: We conducted a descriptive cross-sectional study of 362 consecutive patients (64% females; median age of 54 years). OSA risk was assessed by the Berlin Questionnaire and the patients were divided into two groups according to OSA risk: high and low risk. Anthropometric measurements were conducted as stated in the protocol established in the 3rd National Health and Nutrition Examination Survey. Results: Out of 362 participants, 84 [23.2% (95% CI 19.0%, 28.0%)] had high risk of OSA. Subjects with a high risk of OSA had significantly higher body mass index, waist circumference, hip circumference, and waist-to-height ratio (24.9 vs 23.8, p = 0.002; 89.0 vs 84.0, p < 0.001; 95.0 vs 91.0, p < 0.001; 0.56 vs 0.52, p < 0.001, respectively). Body mass index, waist circumference, hip circumference, and waist-to-height ratio performed similarly in predicting high risk of OSA with Area Under the Curve (AUC) of 0.661, 95% CI (0.592,0.730); 0.659, 95% CI (0.596,0.723); 0.668, 95% CI (0.604,0.733); 0.659 95% CI (0.592,0.725) respectively. The AUCs were similar when the analysis was restricted to those who were overweight. Conclusion: High risk of OSA is moderately prevalent in this population, with measures of central and abdominal adiposity equally predicting the risk.

Evaluation of the trends and appropriateness of fluoroquinolone use in the outpatient treatment of acute uncomplicated cystitis at five family practice clinics.

Despite recommendations to avoid fluoroquinolones (FQs) as a first-line treatment for uncomplicated cystitis, recent data suggest that FQs remain widely prescribed. Therefore, the objectives of this study were to evaluate the appropriateness of empiric FQ use compared to nitrofurantoin for uncomplicated cystitis and to determine whether there are any trends or predictors of empiric FQ versus nitrofurantoin use for uncomplicated cystitis. This retrospective study included women ages 19-64years who were seen at five family medicine clinics and were prescribed targeted antibiotics (nitrofurantoin, ciprofloxacin or levofloxacin) for uncomplicated cystitis. Charts were reviewed to collect data, including symptoms, comorbidities, allergies, creatinine clearance, recent antibiotic use and urine culture data. Appropriateness of empiric selection was determined based on national guidelines and local susceptibility data. A total of 677 patient encounters were screened for inclusion. Of those, 567 met the inclusion criteria: 395 nitrofurantoin and 172 FQs. Treatment was considered appropriate in 86.8% and 10.5% of cases that were prescribed nitrofurantoin and FQs, respectively (P<.01). There were four independent predictors of FQ use identified by multivariate logistical regression: clinic at which the patient was treated, age, nitrofurantoin use within 90days prior to encounter and previous urine culture within one year with an organism non-susceptible to nitrofurantoin. Despite recommendations against FQs for uncomplicated cystitis, they continue to be widely prescribed, and their use for this indication is often inappropriate. This highlights the need for additional interventions and education to improve use and preserve the utility of FQs.

An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study.

BackgroundDecisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology.ObjectiveIn this mixed methods study, we aim to (1) assess women’s needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness.MethodsIn phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants’ attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics.ResultsRecruitment for phase 1 will begin in 2019. We expect results to be available in 2021.ConclusionsThis study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team.International Registered Report Identifier (IRRID)DERR1-10.2196/13321

Patient Alcohol Consumption and Knowledge of Safe Alcohol Use at Dr. George Mukhari Academic Hospital, Pretoria

Background: According to the World Health Organisation (WHO), there were 3.3 million deaths globally due to alcohol use in 2012. Establishing patients’ knowledge of safe alcohol use and practices regarding alcohol consumption could reform intervention policies. Objectives: The aim of this study was to assess patients’ knowledge of safe alcohol use and practices regarding alcohol consumption among patients attending the Family Practice Clinic at Dr. George Mukhari Academic Hospital (DGMAH) in Pretoria. Methods: The sample consisted of 300 patients (150 males; 150 females). Data relating to patients’ baseline characteristics, knowledge of safe alcohol use and practice were collected by means of a researcher administered questionnaire. The SAS, Release 9.3 was used for data analysis. The statistical level of significance was set at p &lt; 0.05. Results: Majority of the respondents had lack of knowledge on safe quantities of alcohol use per day, for male and female individuals [268 (89.3%) vs 32 (10.7%); p &lt; 0.0001] and [279 (93.0%) vs 21 (7.0%); p &lt; 0.0001], respectively. Respondents mostly consumed alcohol on special occasions (152; 50.7%), and on weekends (100; 33.3%). Age groups ≥ 38 years consumed more alcohol per day (100; 33.3%). Majority of the respondents (179; 59.7%) were binge drinkers. Relatively less patients with higher levels of education were chronic harmful users of alcohol (p ≤ 0.001). Conclusion: The finding that majority of the patients lacked knowledge on safe quantities of alcohol use for males and females, and the unsafe use of alcohol, including binge drinking, warrant introduction of safe alcohol use awareness campaigns at primary health care, particularly targeting the middle aged and the elderly.

Adolescent Endocrine Challenges: A Diagnostic Case Study

In this case study challenge, a relatively healthy 15-year-old female adolescent presents to a family practice clinic with complaints of frequent urination, chills, constant drowsiness, difficulty concentrating, and thirst. Distinguishing between possible disorders can be challenging for practitioners because many endocrine disease processes present with similar clinical features. The key to successfully diagnosing endocrine disorders includes rapidly ruling out the most urgent and life-threatening possibilities. Knowing when to refer and to whom is essential. Abnormal laboratory results may require immediate referral for specialized diagnosis and management.

Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016.

Early influenza antiviral treatment within 2 days of illness onset can reduce illness severity and duration. Reliance on low sensitivity rapid influenza diagnostic tests (RIDTs) to guide antiviral prescribing has been reported. We describe antiviral prescribing practices among primary care providers from a large surveillance network in the United States. From 2009-2016, a network of 36 to 68 outpatient clinics per year collected respiratory specimens and clinical data for patients with influenza-like illness (ILI). Specimens were tested for influenza using polymerase chain reaction (PCR). We used multivariable logistic regression to assess factors influencing antiviral prescribing. Among 13 540 patients with ILI, 2766 (20%) were prescribed antivirals. In age groups recommended to receive empiric antiviral treatment for suspected influenza, 11% of children <2 years and 23% of adults ≥65 years received a prescription. Among 3681 patients with a positive PCR test for influenza, 40% tested negative by RIDT. In multivariable analysis, prescription receipt was strongly associated with a positive RIDT (adjusted odds ratio [aOR] 12, 95% CI 11-14) and symptom onset ≤2 days before visit (aOR 4.3, 95% CI 3.8-4.9). Antiviral prescribing was also more frequent among pediatric and private family practice clinics compared with community health centers (aOR 1.9, 95% CI 1.6-2.2, and 1.3, 95% CI 1.1-1.5, respectively). Primary care providers were more likely to prescribe antivirals to patients with a positive RIDT, but antivirals were prescribed infrequently even to patients in high-risk age groups. Understanding patient and provider characteristics associated with antiviral prescribing is important for communicating treatment recommendations.

Utilization of computerized clinical decision support for potentially inappropriate medications.

Background: Electronic medical record (EMR) alerts may inform point of care decisions, including the decision to prescribe potentially inappropriate medications (PIM) identified in the Beers criteria. EMR alerts may not be considered relevant or informative in the clinician context, leading to a phenomenon colloquially known as “alert fatigue.”Objective: To assess the frequency of clinical interaction with EMR alerts and associated deprescribing behaviors in ambulatory settings.Methods: This is a retrospective observational study in two ambulatory clinics (the Kaye Edmonton Clinic Senior’s Clinic and the Lynnwood Family Practice Clinic) in Edmonton over an observational period of 30 months. Statistical analysis was done using descriptive statistics, chi-square and regression analysis.Results: The reminder performance for interactions with the alert was 17.2% across the two clinics. The Number Needed to Remind (NNR) or mean number of alerts shown on clinician screens prior to a single interaction of any kind with the alert was 5.8. When actions were defined as a deprescribing (ie discontinuation) event that was related to the alert and that particular interaction in the EMR, the reminder performance was 1.2%, for an NNR of 82.8.Conclusion: The configuration of alerts in the EMR was not associated with a clinically detectable increase in the uptake of the Beers criteria for high hazard medications.