Perceptions Of Primary Care Physicians Research Articles

Primary care physicians and laypersons' perceptions of multicancer detection clinical trial designs.

The National Cancer Institute Cancer Screening Research Network is launching a pilot study (Vanguard) to determine feasibility of successful completion of a clinical trial of multicancer detection tests. This focus group study reports perceptions of primary care physicians and laypersons of different clinical trial designs and willingness to participate in a multicancer detection clinical trial. We undertook 14 focus groups with 88 laypersons and 6 focus groups with 45 primary care physicians. Participants were shown graphics of clinical trial designs and asked for their reactions. Focus group recordings were transcribed verbatim, and thematic analysis of the transcripts were conducted to identify emergent themes. Primary care physician and layperson participants recognized the importance of conducting clinical trials to determine the clinical utility of multicancer detection tests. Primary care physicians expressed reluctance to participate in trials because of workload burden, and laypersons expressed hesitancy about enrolling in the control group. Primary care physicians and laypersons expressed concern about a study design in which multicancer detection test results would not be returned to the control group (intended effect), but they respectively indicated a willingness to refer patients to, or participate in, a multicancer detection test clinical trial given transparent and clear communication on collection and use of biospecimens and data, particularly if a multicancer detection test would eventually be run and results eventually returned. This study yielded important insights to guide trial design in planning prospective evaluation of multicancer detection testing. Maintaining transparency and trust while possibly withholding multicancer detection test results to maximize trial feasibility and efficiency is of particular concern.

Large Language Model–Based Responses to Patients’ In-Basket Messages

Virtual patient-physician communications have increased since 2020 and negatively impacted primary care physician (PCP) well-being. Generative artificial intelligence (GenAI) drafts of patient messages could potentially reduce health care professional (HCP) workload and improve communication quality, but only if the drafts are considered useful. To assess PCPs' perceptions of GenAI drafts and to examine linguistic characteristics associated with equity and perceived empathy. This cross-sectional quality improvement study tested the hypothesis that PCPs' ratings of GenAI drafts (created using the electronic health record [EHR] standard prompts) would be equivalent to HCP-generated responses on 3 dimensions. The study was conducted at NYU Langone Health using private patient-HCP communications at 3 internal medicine practices piloting GenAI. Randomly assigned patient messages coupled with either an HCP message or the draft GenAI response. PCPs rated responses' information content quality (eg, relevance), using a Likert scale, communication quality (eg, verbosity), using a Likert scale, and whether they would use the draft or start anew (usable vs unusable). Branching logic further probed for empathy, personalization, and professionalism of responses. Computational linguistics methods assessed content differences in HCP vs GenAI responses, focusing on equity and empathy. A total of 16 PCPs (8 [50.0%] female) reviewed 344 messages (175 GenAI drafted; 169 HCP drafted). Both GenAI and HCP responses were rated favorably. GenAI responses were rated higher for communication style than HCP responses (mean [SD], 3.70 [1.15] vs 3.38 [1.20]; P = .01, U = 12 568.5) but were similar to HCPs on information content (mean [SD], 3.53 [1.26] vs 3.41 [1.27]; P = .37; U = 13 981.0) and usable draft proportion (mean [SD], 0.69 [0.48] vs 0.65 [0.47], P = .49, t = -0.6842). Usable GenAI responses were considered more empathetic than usable HCP responses (32 of 86 [37.2%] vs 13 of 79 [16.5%]; difference, 125.5%), possibly attributable to more subjective (mean [SD], 0.54 [0.16] vs 0.31 [0.23]; P < .001; difference, 74.2%) and positive (mean [SD] polarity, 0.21 [0.14] vs 0.13 [0.25]; P = .02; difference, 61.5%) language; they were also numerically longer (mean [SD] word count, 90.5 [32.0] vs 65.4 [62.6]; difference, 38.4%), but the difference was not statistically significant (P = .07) and more linguistically complex (mean [SD] score, 125.2 [47.8] vs 95.4 [58.8]; P = .002; difference, 31.2%). In this cross-sectional study of PCP perceptions of an EHR-integrated GenAI chatbot, GenAI was found to communicate information better and with more empathy than HCPs, highlighting its potential to enhance patient-HCP communication. However, GenAI drafts were less readable than HCPs', a significant concern for patients with low health or English literacy.

U.S. primary care physician perceptions on barriers to providing guideline-driven care for UTI and recurrent UTI: a qualitative study

BackgroundUrinary tract infections (UTI) affect almost two-thirds of all women during their lives and many experience recurrent infections. There are evidence-based guidelines from multiple international societies for evaluation and treatment; however, recent claims-based analyses have demonstrated that adherence to these guidelines is poor. This study seeks to understand the barriers experienced by U.S. primary care providers (PCPs) to providing guideline-based care for UTI and recurrent UTI (rUTI).MethodsSemi-structured interviews of 18 PCPs, recruited from the greater Los Angeles area, examined real-world clinical management of UTI/rUTI episodes, decisions to refer to subspecialty care, and resources guiding counseling and management. Grounded theory methodology served to analyze interview transcripts and identify preliminary and major themes.ResultsParticipants expressed the desire to obtain urine cultures for each cystitis episode, but felt pressured to make compromises by patient demands or barriers to care. PCPs had lower thresholds to empirical treatment if patients had a history of rUTIs, were elderly, or declined evaluation. Laboratory data was minimally utilized in clinical decision-making: urinalyses were infrequently considered when interpreting culture data. PCPs treated a broad set of urologic and non-urologic symptoms as UTI, even with negative cultures. PCPs did not feel comfortable initiating UTI prophylaxis, instead seeking specialist evaluation for anatomic causes. They were unaware of management guidelines, typically utilizing UpToDate® as their primary resource. Few evidence-based UTI prevention interventions were recommended by providers.ConclusionsLow availability of succinct and clear professional guidelines are substantial barriers to appropriate UTI/rUTI care. Poor useability of clinical guidance documents results in substantial confusion about the role of preventative measures and additional diagnostic testing. Difficulties in patient access to care providers lead to expectations for presumptive treatment. Future studies are needed to determine if improved educational materials for providers and/or management algorithms can improve guideline concordance of UTI management.

Perceptions and Attitudes of Primary Care Physicians Toward Dermatologic Surgery.

Dermatologic surgery is a well-established subspecialty in dermatology that involves various therapeutic and esthetic procedures. To date, perceptions of primary care physicians (PCPs) regarding dermatologic surgery are poorly understood. This study aimed to assess the perception and attitude of PCPs toward dermatologic surgery and explore the factors that might affect their perception and attitude toward it. This cross-sectional study used an online survey. The survey was distributed among PCPs working in various regions of Saudi Arabia and contained questions about demographics, medical training information, participants' awareness of dermatologic surgery, and a list of 10 cutaneous procedures to select the most qualified physician performing these procedures. Univariate and multivariate analyses were performed. P≤0.05 was considered statistically significant. In total, 440 PCPs participated in this study. Overall, 70% of the PCPs had heard about dermatologic surgery, whereas 30% had never heard about it. PCPs reported that dermatologic surgeons were the most qualified physicians to perform laser procedures (60.5%), hair transplantation (60.5%), excision of small benign and malignant skin tumors (46.1%), excision of small melanocytic nevi (55.7%), filler injection (44.8%), and injection of botulinum toxin (48.9%); 64.5% considered plastic surgeons to be the most qualified for liposuction. Both physicians were equally selected for performing cyst excision, procedures involving the fingernails and toenails, and scar correction. Multivariate analysis showed that female physicians had heard significantly more about dermatologic surgery (P=0.047, OR: 1.57, 95% CI: 1.006-2.45) and reported that dermatologic surgeons were the most qualified physicians (P=0.042, OR: 1.51, 95% CI: 1.016-2.25) than male physicians. PCPs working at secondary and tertiary health care hospitals heard more about dermatologic surgery (P=0.015, OR: 2.36, 95% CI: 1.18-4.71) than those working at primary health care centers. Most PCPs were aware of dermatologic surgery and recognized dermatologic surgeons as the most qualified physicians to perform most cutaneous procedures.

A264 Perception of Primary Care Physicians on the Role of Bariatric Surgery for the Management of Obesity

A264 Perception of Primary Care Physicians on the Role of Bariatric Surgery for the Management of Obesity

Impact of a Pharmacist-Run Electronic Consult Service in a Network of Primary Care Patient-Centered Medical Homes.

Electronic consults (eConsults) allow for asynchronous, consultative, provider-to-provider communication. A pharmacy run eConsult service was initiated in a group of primary care clinics composed of 60 attending internal medicine primary care physicians (PCP), 100 internal medicine residents, and 10 pharmacists serving more than 60,000 patients. This study aims to describe (1) the number and types of eConsults placed to pharmacists; (2) the number of eConsults completed, converted to an office visit, or declined by a pharmacist; (3) the number of pharmacist recommendations made and implemented within 30 days of eConsult placement; and (4) PCP perceptions of the eConsult service. A retrospective chart review of all pharmacy eConsults placed between February 25, 2020, and July 6, 2021, was completed to describe eConsult utilization. In addition, an electronic survey was used to assess attending physician perceptions of pharmacy eConsults. A total of 513 eConsults were placed during the study period. The most common type of eConsult placed was "cost savings/formulary med questions" (110, 21.4%). Of the 435 eConsults completed by a pharmacist, 339 (78%) eConsults resulted in specific recommendations for medication therapy and 332 (98%) of these recommendations were implemented by the PCP. A total of 17 PCPs completed the survey assessing the perceived benefits of pharmacy eConsults. The top perceived benefits were improvement in patient outcomes (15, 88%) and ability to save provider time spent on patient care (14, 82%). eConsults to pharmacists resulted in specific drug therapy recommendations that were routinely implemented by PCPs and perceived as a benefit to both providers and patients.

Survey of Primary Care Physicians’ Knowledge, Practices &amp; Perceptions of Prediabetes in Bahrain

Background: Prediabetes is a condition that develops before diabetes and can be treated with intensive Lifestyle Modifications (LSM). This study aimed to assess the knowledge, practices, and perceptions of Primary Care Physicians (PCPs) toward prediabetes in Bahrain. Methods: PCPs in the study were surveyed using a cross-sectional questionnaire in all 28 governmentrun Primary Healthcare Centres (PHCs) in Bahrain. We used descriptive statistics to analyse the data, which were then reported as percentages. Results: From 378 PCPs, 263 completed the questionnaire. The physician’s knowledge of prediabetes Risk Factors (RFs) and HbA1C laboratory criteria to diagnose prediabetes was inadequate. As an initial step to manage prediabetes, 12.5% of PCPs refer patients to Diabetes Prevention lifestyle change Programs (DPPs). Moreover, 15.6% recommend 7% minimum weight loss, 57.8% recommend 150 minutes per week of physical activity and 67.7% recommend prescribing metformin. Overall, our study revealed that General Practitioners (GPs) had inferior knowledge to Family Physicians (FPs). According to PCPs, diabetes prevention is hindered by both individual and system-level challenges (e.g., Inadequate motivation and resources to lose weight). Furthermore, PCPs consider that improved access to DPPs and coordinated referrals to them could delay diabetes. Conclusion: Risk stratification, appropriate diagnosis, and intervention at the prediabetes stage are of critical importance for preventing diabetes. Increasing awareness of the public regarding prediabetes complications and educating healthcare providers, especially GPs, on screening guidelines, diagnostic criteria, and evidence-based management options for prediabetes can bring us one step closer to slowing the diabetes epidemic in Bahrain. Keywords: Bahrain, Primary care physician, Knowledge, Practice, Perception, Prediabetes

Perceptions of primary healthcare physicians in Jordan of their role in the COVID-19 pandemic: A cross-sectional study.

BackgroundFollowing the remarkable spread of coronavirus disease 2019 (COVID‐19), worldwide, it quickly became apparent that many public health systems worldwide were not prepared to manage such a pandemic. We aimed to assess the perceptions of primary care physicians (PCPs) in Jordan towards their role during COVID‐19.MethodsA cross‐sectional study using a self‐administered questionnaire was performed. The study participants included PCPs from the Ministry of Health, academic institutions, and the private sector in Jordan.ResultsA total of 221 PCPs participated in the study. Most participants reported not having received any training on infection control (59.7%) or COVID‐19 (81%). More than half PCPs (53.4%) felt positive about the way patients received and/or complied with their instructions. More than half PCPs (55.7%) educated their patients on protective measures against COVID‐19 infection and considered this as part of their role and responsibility. Over 80% of the participants would apply social distancing, hand sanitation, facial masks, and patient education, but only half (51.1%) reported planning to order COVID‐19 test kits.ConclusionsPCPs had a positive attitude towards controlling COVID‐19 infection and showed a willingness to educate patients on how to protect themselves. However, PCPs should be provided special training on COVID‐19.

From Passive Gatekeeper to Quarterback: Evolving Perceptions of Primary Care Among Medical Students in Longitudinal Outpatient Clerkships.

Longitudinal clerkships provide students with meaningful clinical care roles that promote learning and professional development. It remains unclear how longitudinal primary care clerkships inform students' perceptions of primary care. To explore perceptions of primary care among medical students enrolled in longitudinal primary care clerkships. Qualitative, semi-structured interviews with medical students over 4 years. Thirty-eight medical students participated at baseline; 35 participated in a 2-year follow-up interview; 24 participated at 4 years. Each student was enrolled in one of two longitudinal primary care clerkships: a team-based Education-Centered Medical Home (ECMH) or a one-on-one individual preceptorship (IP). De-identified interview transcripts were analyzed using a process of open and axial coding, followed by elaborative coding for longitudinal analysis. Codes were compiled into a set of themes and compared across time periods and between clerkships. Students reported that primary care serves as a first point of contact, emphasizing longitudinal care with a wide scope of practice and approaching patient care with a biopsychosocial perspective. Student perceptions of primary care greatly expanded over the course of 4 years: for instance, initial perceptions of primary care physicians evolved from "passive gatekeeper" to a more nuanced "quarterback." Students in ECMH, whose clerkship provided more opportunity for patient continuity, further reflected on the relationships they themselves developed with patients. Regardless of their eventual specialty choice, longitudinal experiences may aid all students in fostering a sense of the broad scope and importance of primary care. However, without numerous opportunities to witness continuity of care, students may perceive primary care as having limited scope and importance. Longitudinal clerkships, emphasizing continuity with patients and preceptors, may foster in students a broad and nuanced perspective of the scope of primary care as a field.

Primary Care Physician Perceptions of Shared Decision Making in Lung Cancer Screening.

The Centers for Medicare and Medicaid Services (CMS) supports lung cancer screening (LCS) with annual low-dose computed tomography (LDCT) for patients who undergo shared decision-making (SDM) about LCS. Unfortunately, SDM and LCS rates are low in primary care, and, as a result, the potential benefits of LCS are not being realized. The research team interviewed 16 primary care physicians in a large urban medical center (7 in Family and Community Medicine and 9 in Internal Medicine) on their views of SDM and LCS. Interview audio-recordings were transcribed. Coders analyzed the interview transcripts independently using direct content analysis to identify major themes and subthemes. Results of interview analyses show that physicians were aware of LCS but believed that they and their patients would benefit from receiving more information about screening guidelines. Physicians knew about SDM and felt that SDM performance could help to identify issues that are important to patients and may affect their receptivity to LCS. However, many physicians expressed concerns about the time required for SDM and completing SDM about LCS when other issues need to be addressed. They also acknowledged the challenge of engaging patients, especially those with low health literacy, in SDM. In practice, some physicians reported instead of engaging eligible patients in SDM, they simply encourage them to screen. Importantly, most physicians said that they would like to receive training in SDM. Findings from this study indicate that primary care physicians support the dissemination of information about LCS and understand the importance of SDM. Physicians also feel that performing SDM in routine care is challenging but are receptive to additional training in SDM. Health systems should take steps to support SDM and LCS performance in primary care.

Community Health Centers Primary Care Physicians' Asthma Management Perception of Uninsured Patients.

Explore the perceptions of primary care physicians (PCPs) from community health care centers (CHCs) in Franklin County, Ohio, regarding factors that contribute to their inability to consistently provide sustainable asthma management services to their uninsured patient population. Asthmatic patients are not consistently receiving sustainable asthma management in CHCs in Ohio. Primary care physicians in CHCs play a pivotal role in closing health care gaps for asthmatic patients. To minimize the barriers that impede the efforts of PCPs to control asthma for their uninsured patients, asthma disease management programs that include case management services in CHCs in Franklin County, Ohio, are needed. A convenience sample of 4 PCPs from 2 CHCs in Franklin County, Ohio, was interviewed face-to-face. Interviews, direct observation, and previously published research were the sources of data utilized for this study. Results indicated that 75% of participants did not use standard guidelines while treating their patients. Physician time constraints and access to affordable medication were identified as some of the barriers to providing sustainable asthma management services. Asthma is a complex chronic disease. Disease case managers not only are capable of coordinating health care services for a variety of patient populations but are also effective in managing complex diseases such as asthma for disadvantaged populations. Evidence-based case management models are needed to support PCPs in CHCs. Without the inclusion of asthma-specific case managers as part of the care delivery structure, CHCs may continue to provide subpar disease management services for uninsured asthmatic patients.

Streamlining survivorship care plan (SCP) creation and delivery to primary care providers in poor, rural, and minority patients.

e24181 Background: The number of cancer survivors is rapidly climbing due to increased screening and improved treatment. Survivorship Care Plans (SCPS) summarize the patients’ treatment and is a communication tool between oncologists and primary care physicians (PCP)s. Creation and delivery of the SCPs has been labor intensive and costly for many healthcare systems and a previous paper based system at our institution was ineffective. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population of lower socioeconomic status (SES) (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively) patients in a large rural state. Methods: Beginning March 2019, UNMCCC initiated a process for creation and delivery of SCPs through the Electronic Medical Record (EMR). EMRs are not designed to delivery SCPs to patients and PCPs, so EMR functions were creatively repurposed. Upon identification of eligible patients, providers would place an electronic SCP order through the EMR. Designated staff then partially completes the SCPs based on medical record review while the EMR imports demographics, PCP, cancer and stage. Then the EMR flags SCPs ready for delivery and the provider edits, approves and prints the SCP for the patient at the next encounter. Once printed, the EMR alerts medical records to send the SCP to the PCP via mail or EMR routing. Results: 282 SCPs were ordered, 222 (78.7%) were created and 86 (38.7%) given to patients after definitive therapy of Breast (77.9%), Colorectal (7.0%), Gynecological (9.3%) and Prostate Cancer (5.8%). Of 72 SCPs eligible to be sent to PCPs, 48 (66.7%) were successfully mailed or sent via EMR, 13 (18.1%) had PCP discrepancies, 6 (8.3%) had no PCP and 5 (6.9%) had PCPs in systems which do not accept unsolicited records. Conclusions: The UNMCCC cares for low SES, rural and minority patients and was able to create and deliver SCPs to a significant number of patients and PCPs. Future process steps will involve creating tailored SCPs for other diagnoses, resolving PCP discrepancy issues and creating an EMR alert for PCPs when they receive an SCP. Additionally, assessment of both patient and PCP perceptions is ongoing.

Perceptions of primary care physicians about early diagnosis of rheumatoid arthritis and methotrexate monitoring

Background: Current guidelines recommend the early recognition and diagnosis of rheumatoid arthritis and treatment with disease-modifying antirheumatic drugs (DMARDs). Methotrexate is the first drug of choice for most patients with rheumatoid arthritis, but this medication has contraindications and side effects that need monitoring. This survey analysis aims to explore the level of knowledge of primary healthcare physicians towards the early detection of rheumatoid arthritis and monitoring treatment with methotrexate.Methods: A self-administered structured questionnaire was distributed to primary healthcare physicians in the region of Riyadh, Saudi Arabia. The survey consists of sections including the demographics of respondents, knowledge about rheumatoid arthritis, and methotrexate. Data were analyzed using SPSS version 22.Results: In total, 249 physicians responded to the survey. Physicians with more years of experience showed a significantly higher level of knowledge about rheumatoid arthritis and methotrexate monitoring (p-value &lt;0.001). The responses of physicians regarding knowledge about the disease were better than their responses about the drug.Conclusions: The knowledge of primary healthcare physicians in Riyadh, Saudi Arabia, is considered satisfactory in regard to rheumatoid arthritis diagnosis, but the level of knowledge about methotrexate requires improvement.

General practitioner attitudes and confidence to deprescribing for elderly patients

Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.

Confident Perception of Primary Care Physicians Correlates to the Attitude Toward Donation and Organ Transplantation: A Multicenter Study of Medical And Nursing Spanish Students

A primary care physician (PCP) not only accompanies the patient in the process of an illness, but throughout his or her life. The confidence we have in these health professionals is fundamental, and their favorable attitude toward organ donation and transplantation (ODT) has a significant influence on the population. ObjectiveTo analyze trust in PCPs among Spanish medical and nursing students, the relationship with their attitude toward ODT, and the factors that condition it. Methods and DesignA sociologic, multicenter, and observational study. Population: medical and nursing students in Spanish universities. Database: Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. A sample of 9598 medical and 10,566 nursing students (99% confidence and precision of ±1%), stratified by geographic area and year of study. ResultsCompletion rate: 90%. With respect to students’ trust in their physician, 18% (n = 3267) of them totally trust (completely), 45% (n = 8101) trust enough, 30% (n = 5478) of them have not enough trust, and 7% not at all. Comparing groups, medical students totally trust more in PCPs than nursing students (55% vs 45%; P < .000), however, nursing students have less than enough trust in their PCP than medical students (53% vs 47%; P < .000). Students that totally trust in their PCP were more in favor toward ODT than students with not enough trust (83% vs 77%; P < .000). ConclusionOnly 18% of Spanish medical and nursing students totally trust in their PCP. Attitude toward ODT is related to a higher level of trust in PCPs among these students.

Violência contra a mulher e enfrentamento na percepção dos profissionais de saúde da atenção básica

Objective: To know the perception of primary care physicians and nurses about violence against women and their coping. Method: A cross-sectional study with a qualitative approach, carried out with professionals from the Family Health Strategy of a municipality in the interior of Ceara, Brazil, who answered a semi-structured interview. The discourses were organized through thematic categorization and analyzed based on relevant literature. The data was also processed in the IRAMUTEQ software. Results: Twelve health professionals, four physicians and eight nurses, who describe the main manifestations of violence in women participated in the study. They point out that for various reasons, among them the low qualification, they do not have capacity to act on complaints of violent acts, emphasizing educational activities as important the recognition of the grievance. As for the notification, it has proved a difficulty for its operation, associated with the fear of retaliation due to the breach of professional secrecy. The word cloud processed by IRAMUTEC reinforces the results, by highlighting the word no, demonstrating that professionals do not feel safe when confronted with these cases, and most of them do not report the grievance. Conclusions: The professionals do not act effectively in coping with violence against women in basic care.

A Gap Analysis Assessing the Perceptions of Primary Care Physicians in the Management of Kidney Recipients After Transplantation.

To examine the practice patterns and perceptions of primary care physicians in the management of chronic diseases in kidney recipients, assess care provided to recipients, and identify barriers to the optimal delivery of primary care to recipients. A self-administered questionnaire on the primary care of kidney recipients was developed and implemented. The survey investigated physician comfort and practice patterns in providing preventive and chronic care to recipients, patient self-management support, and physician perceptions on communication with transplant centers and barriers to ideal care. A total of 210 physicians completed the survey (response rate of 22%). Among the respondents, 73% indicated they were currently providing care to kidney recipients. The majority of physicians specified that they rarely (57%) or never (20%) communicate with transplant centers. Most physicians felt comfortable providing care to recipients for non-transplant-related issues (92.5%), vaccinations (85%), and periodic health examinations (94%). The majority (75.3%) of physicians felt uncomfortable managing the immunosuppressive medications of recipients. Physicians' most commonly stated barriers to delivering optimal care to recipients were insufficient guidelines provided by the transplant center (68.9%) and lack of knowledge in managing recipients (58.8%). Suggested resources by physicians to improve their comfort level in managing recipients included guidelines and continuing medical educational activities related to transplantation. Our results suggest that there are barriers to delivering optimal primary care to kidney recipients. The approach to providing resources needed to bridge the knowledge gap for physicians in the management of recipients requires further exploration.

National Survey of Primary Care Physicians' Knowledge, Practices, and Perceptions of Prediabetes.

Despite strong evidence and national policy supporting type 2 diabetes prevention, little is known about type 2 diabetes prevention in the primary care setting. Our objective was to assess primary care physicians' knowledge and practice regarding perceived barriers and potential interventions to improving management of prediabetes. Cross-sectional mailed survey. Nationally representative random sample of US primary care physicians (PCPs) identified from the American Medical Association Physician Masterfile. We assessed PCP knowledge, practice behaviors, and perceptions related to prediabetes. We performed chi-square and Fisher's exact tests to evaluate the association between PCP characteristics and the main survey outcomes. In total, 298 (33%) eligible participants returned the survey. PCPs had limited knowledge of risk factors for prediabetes screening, laboratory diagnostic criteria for prediabetes, and management recommendations for patients with prediabetes. Only 36% of PCPs refer patients to a diabetes prevention lifestyle change program as their initial management approach, while 43% discuss starting metformin for prediabetes. PCPs believed that barriers to type 2 diabetes prevention are both at the individual level (e.g., patients' lack of motivation) and at the system level (e.g., lack of weight loss resources). PCPs reported that increased access to and insurance coverage of type 2 diabetes prevention programs and coordination of referral of patients to these resources would facilitate type 2 diabetes preventive efforts. Addressing gaps in PCP knowledge may improve the identification and management of people with prediabetes, but system-level changes are necessary to support type 2 diabetes prevention in the primary care setting.

Family physician perceptions of the role and value of the clinical pharmacist in the management of patients with type 2 diabetes

AbstractPurposeClinical pharmacists can help primary care physicians (PCPs) manage medications for patients with poorly controlled type 2 diabetes. Studies have shown that clinical pharmacist involvement in care can improve outcomes such as glycosylated hemoglobin (A1C), blood pressure and lipid control, and decrease episodes of hypoglycemia. Despite these findings, some PCPs may be slow or disinclined to refer to clinical pharmacists when available. This study addressed PCP perceptions regarding referral to clinical pharmacists and endocrinologists for patients with poorly controlled type 2 diabetes.MethodsPhysicians from five family medicine sites were surveyed. Physicians were queried regarding their patterns for patient referral to endocrinologists and/or clinical pharmacists. Clinical contributions and importance of factors to consider when referring were compared between clinical pharmacists and endocrinologists using paired t tests.ResultsFifty physicians responded to the survey, resulting in a response rate of 73.5%. The majority of PCPs indicated that they have referred to endocrinologists (89.5%) and clinical pharmacists (93.5%) for specialty care. PCPs tended to refer to clinical pharmacists sooner and at lower A1C values than to endocrinologists. PCPs also considered multiple medical comorbidities, history of noncompliance with medical recommendations, low reading ability or math skills, complex psychosocial situations, fear of needles, or difficulty affording medications or supplies to be more important when referring patients to clinical pharmacists than endocrinologists.ConclusionWe hypothesized that referrals to a clinical pharmacist or endocrinologist are made with careful consideration of the patients' needs. PCPs reported increased utilization of clinical pharmacists for patients with nonmedical needs, indicating that extra time, education, and psychosocial support provided by the clinical pharmacist is highly valued.

Patient and Primary Care Physician Perceptions of Penicillin Allergy Testing and Subsequent Use of Penicillin-Containing Antibiotics: A Qualitative Study

Removal of an inaccurate penicillin allergy record following testing allows patients to access first-line treatment for infections, and reduce the use of broad-spectrum antibiotics, which contribute to antibiotic resistance. However, it is seldom undertaken. To identify clinicians' working in primary care and patients' views on barriers and enablers for penicillin allergy testing and subsequent antibiotic use. Fifty interviews with patients and clinicians, including 31 patients with a record of penicillin allergy, 16 with experience of testing, and 19 clinicians. Interviews were analyzed thematically. Patients were often unaware of the benefits of penicillin allergy testing and only those patients who had experienced negative consequences of having a penicillin allergy label were motivated to get tested. Clinicians were reluctant to change patient records on the basis of their clinical judgment alone but had limited experience of referring patients with suspected penicillin allergy and were often uncertain about referral criteria and what the testing involved. Clinicians felt that allergy testing could be beneficial and patients who had attended testing reported benefits of the test. Clinicians expressed uncertainty related to whose responsibility it was to make sure that the patient understood allergy test results. Clinicians would benefit from information about penicillin allergy testing to be able to use these services appropriately, and to discuss referral with patients. Patients might be more motivated to seek testing if they were more informed regarding its benefits. Good communication between primary and secondary care would facilitate the updating of medical records, and promote better patient education.