Practices Of Primary Care Clinicians Research Articles

Assessing the knowledge, perceptions, and practices of primary care clinicians toward pharmacogenetics

AbstractIntroductionPharmacogenetics (PGx) testing is becoming increasingly available to patients and clinicians, but investigations of PGx testing in primary care and the pharmacist's role in educating clinicians have been limited.ObjectivesThe objectives of this study were to: (a) determine the utilization of PGx testing in primary care clinics, (b) identify how clinicians document and act on PGx test results, and (c) determine clinician interest in PGx education or consultation from pharmacists.MethodsA 16‐item survey was distributed via email. Eligible participants included physicians, physician assistants, nurse practitioners, and pharmacists who work in family medicine, general medicine, geriatric, or pediatric primary care clinics at one academic medical center. Descriptive statistics were used to characterize the frequency of PGx tests ordered in primary care clinics, provider comfort with PGx test interpretation, documentation practices, and interest in PGx education or consultation from pharmacists.ResultsThe overall survey response rate was 15.8% (n = 55). Most respondents were physicians (84%). Nearly 40% of respondents reported having a patient bring PGx test results to a visit, while only 9% reported ordering a PGx test. Documentation practices were variable, and response to PGx results was most commonly no change in therapy (52%). Only two (3.6%) respondents agreed with the statement, “I feel confident in my ability to interpret PGx test results,” and the majority reported interest in PGx education. Eighty percent of respondents reported they would be likely or very likely to consult a PGx‐trained pharmacist for help interpreting PGx results.DiscussionClinicians in this survey were more likely to have patients bring in results than to order PGx tests, did not feel confident in result interpretation, and expressed interest in working with pharmacists for PGx test interpretation. This research can help guide the development of PGx‐focused pharmacy services and education for clinicians who are encountering PGx testing in their practice.

Attitudes and Current Practices of Primary Care Clinicians in Performing Anal Cancer Screening

Attitudes and Current Practices of Primary Care Clinicians in Performing Anal Cancer Screening

The evolving role of the primary care provider in the comprehensive cancer care paradigm: Knowledge, attitudes, beliefs, and practices of primary care clinicians.

28 Background: Due to increasing numbers of individuals diagnosed with cancer, a burgeoning cohort of cancer survivors with significant medical co-morbidities, and oncology workforce challenges, the optimal integration of Primary Care Providers (PCPs) into the comprehensive cancer care paradigm is of timely importance. The goal of this investigation is to determine the knowledge, attitudes, beliefs, and practices of primary care clinicians -- pertaining to their existing and potential roles in cancer care. Methods: 1,069 clinical affiliates of the University of Pittsburgh Medical Center, who provide primary care services (e.g. Cardiology, Family Medicine, Geriatric Medicine, Gynecology, and Internal Medicine), were invited to participate in a 77-question, IRB-approved, online survey questionnaire [Qualtrics (Provo, Utah)]. Three “reminder emails” were generated. Results: Note: These results reflect the analysis of an initial, preliminary subset of survey responders (N=90). The full data set will be utilized for the final poster presentation. Eighty percent of the responders are physicians. Seventy-one percent reported that 50%+ of their time is spent providing primary care services and 66% have been in-practice for 15+ years. 73%, 63% and 59% respectively have participated in “cancer surveillance”, “cancer treatment/disease-related adverse event (AE) monitoring”, and “AE management” activities. Cardiotoxicity (42%), lymphedema (61%), and vasomotor flushing (63%) represented those AEs that the responders felt least comfortable monitoring independently. Twelve percent were aware of the PCP-targeted December/2015 “ACS-ASCO Breast Cancer Guideline” and 24% of the term “Survivorship Care Plan”. Twenty-two percent were “very confident” with regard to conducting a “low dose CT” lung cancer screening decision-making patient conversation. Twenty-one percent felt that their formal training did not adequately prepare them and that their present educational opportunities are inadequate pertaining to PCP-Cancer Survivorship issues. “Communication between the Oncology Team and PCP” was noted as the most stated “major issue”. Conclusions: To fully optimize the interface between Oncologists and PCPs with regard to best practices cancer care, strategies targeting competency training, enhanced information/guideline dissemination, and the development of collaborative-based delivery models will likely be necessary.

The New Lipid Guidelines: What Do Primary Care Clinicians Think?

BackgroundLittle is known about the opinions of primary care clinicians regarding the newly released 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Prevention of Primary and Secondary Atherosclerotic Disease. This survey was created to assess the awareness, attitudes, and practices of primary care clinicians on adoption of the new guidelines and to explore obstacles to implementation and suggestions for improving shared decision-making. MethodsSix hundred practicing clinicians within the San Francisco Bay Area Collaborative Research Network were invited to participate in this cross-sectional, Internet-based pilot survey of primary care clinicians. These survey data were collected in March 2014, approximately 4 months after the release of the new guidelines and 1 month after the release of the ACC/AHA risk estimator application. ResultsOne hundred eighty-three clinicians responded to the survey. Of those respondents, 176 (96%) were aware of the guidelines. The majority (64%) reported implementing the new guidelines with at least some of their patients, while a minority (25%) reported adopting the guidelines for many of their patients. Disagreeing with the guidelines was the main hindrance to adoption. ConclusionsWhile many primary care clinicians are aware of the new guidelines, a substantial proportion has yet to implement them into their clinical practice, and obstacles remain for full adoption. Further understanding of clinicians' views, opinions, and needs is necessary to optimize the approach to lipid management and ensure integration into current practice.

Screening for colorectal cancer on the front line.

The aim of this study was to assess knowledge, beliefs, and practices of primary care clinicians regarding colorectal cancer screening. We surveyed 77 primary care providers in six clinics in central Massachusetts to evaluate several factors related to colorectal cancer screening. Most agreed with guidelines for fecal occult blood test (97%) and sigmoidoscopy (87%), which were reported commonly as usual practice. Although the majority (86%) recommended colonoscopy as a colorectal cancer screening test, it was infrequently reported as usual practice. Also, 36% considered barium enema a colorectal cancer screening option, and it was rarely reported as usual practice. Despite lack of evidence supporting effectiveness, digital rectal examinations and in-office fecal occult blood test were commonly reported as usual practice. However, these were usually reported in combination with a guideline-endorsed testing option. Although only 10% reported that fecal occult blood test/home was frequently refused, 60% reported sigmoidoscopy was. Frequently cited patient barriers to sigmoidoscopy compliance included fear the procedure would hurt and that patients assume symptoms occur if there is a problem. Perceptions of health systems barriers to sigmoidoscopy were less strong. Most providers recommended guideline-endorsed colorectal cancer screening. However, patient refusal for sigmoidoscopy was common. Results indicate that multiple levels of intervention, including patient and provider education and systems strategies, may help increase prevalence.

Screening for colorectal cancer on the front line

Objective The aim of this study was to assess knowledge, beliefs, and practices of primary care clinicians regarding colorectal cancer screening. Methods We surveyed 77 primary care providers in six clinics in central Massachusetts to evaluate several factors related to colorectal cancer screening. Results Most agreed with guidelines for fecal occult blood test (97%) and sigmoidoscopy (87%), which were reported commonly as usual practice. Although the majority (86%) recommended colonoscopy as a colorectal cancer screening test, it was infrequently reported as usual practice. Also, 36% considered barium enema a colorectal cancer screening option, and it was rarely reported as usual practice. Despite lack of evidence supporting effectiveness, digital rectal examinations and in-office fecal occult blood test were commonly reported as usual practice. However, these were usually reported in combination with a guideline-endorsed testing option. Although only 10% reported that fecal occult blood test/home was frequently refused, 60% reported sigmoidoscopy was. Frequently cited patient barriers to sigmoidoscopy compliance included fear the procedure would hurt and that patients assume symptoms occur if there is a problem. Perceptions of health systems barriers to sigmoidoscopy were less strong. Conclusions Most providers recommended guideline-endorsed colorectal cancer screening. However, patient refusal for sigmoidoscopy was common. Results indicate that multiple levels of intervention, including patient and provider education and systems strategies, may help increase prevalence.