Primary Care Physicians For Patients Research Articles

Demographics and clinical characteristics of patients of prescribing psychologists, psychiatrists, and primary care physicians.

To describe the characteristics of patients receiving psychotropic medication from prescribing psychologists, psychiatrists, and primary care physicians. This descriptive study was conducted using private insurance claims of patients from New Mexico and Louisiana receiving psychotropic medications (anticonvulsants, antidepressants, antipsychotics, hypotensive agents, anxiolytics/sedatives/hypnotics, and stimulants) from 2004 to 2021 (N = 307,478). Patient characteristics were captured during the 6 months prior to their first psychotropic medication using administrative information, diagnosis and procedure codes, and medication data. Logistic regression models estimated the associations of patient characteristics with prescriber type. Additional logistic regression models estimated the association of prescriber type with medication classes prescribed. Patients were most likely to see specialists (psychologists or psychiatrists) if they had bipolar disorder (average marginal effect and 95% CI 0.214 [0.196, 0.231]), schizophrenia/psychotic disorders (0.118 [0.097, 0.138]), or had 1-4 visits of psychotherapy (0.267 [0.258, 0.026]). Specialist patients were most likely to see a prescribing psychologist if they had 1-4 visits of psychotherapy (0.196 [0.183, 0.210]) or had insomnia (0.309 [0.203, 0.415]). Prescribing psychologists were more likely to prescribe antidepressants (0.028 [0.011, 0.045]) and less likely to prescribe antipsychotics (-0.016 [-0.020, -0.012]) than psychiatrists. Primary care physicians were less likely to prescribe all psychotropic medications except antidepressants (0.011 [0.002, 0.019]) and anxiolytics (0.074 [0.067, 0.080]). Prescribing psychologists treat patients who are more similar to those of psychiatrists than patients of primary care physicians; they are less likely to prescribe antipsychotics and more likely to prescribe antidepressants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

An Approach for Providing Drug Information to Primary Care Physicians of Patients Undergoing Nephrectomy Using Information Forms Created by Urologists and Pharmacists

An Approach for Providing Drug Information to Primary Care Physicians of Patients Undergoing Nephrectomy Using Information Forms Created by Urologists and Pharmacists

Performance on Patient Experience Measures of Former Chief Medical Residents as Physician Exemplars Chosen by the Profession

Physicians' knowledge about each other's quality is central to clinical decision-making, but such information is not well understood and is rarely harnessed to identify exemplars for disseminating best practices or quality improvement. One exception is chief medical resident selection, which is typically based on interpersonal, teaching, and clinical skills. To compare care for patients of primary care physicians (PCPs) who were former chiefs with care for patients of nonchief PCPs. Using 2010 to 2018 Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data (response rate, 47.6%), Medicare claims for random 20% samples of fee-for-service beneficiaries, and medical board data from 4 large US states, we compared care for patients of former chief PCPs with care for patients of nonchief PCPs in the same practice using linear regression. Data were analyzed from August 2020 to January 2023. Receiving the plurality of primary care office visits from a former chief PCP. Composite of 12 patient experience items as primary outcome and 4 spending and utilization measures as secondary outcomes. The CAHPS samples included 4493 patients with former chief PCPs and 41 278 patients with nonchief PCPs. The 2 groups were similar in age (mean [SD], 73.1 [10.3] years vs 73.2 [10.3] years), sex (56.8% vs 56.8% female), race and ethnicity (1.2% vs 1.0% American Indian or Alaska Native, 1.3% vs 1.9% Asian or Pacific Islander, 4.8% vs. 5.6% Hispanic, 7.3% vs 6.6% non-Hispanic Black, and 81.5% vs. 80.0% non-Hispanic White), and other characteristics. The Medicare claims for random 20% samples included 289 728 patients with former chief PCPs and 2 954 120 patients with nonchief PCPs. Patients of former chief PCPs rated their care experiences significantly better than patients of nonchief PCPs (adjusted difference in composite, 1.6 percentage points; 95% CI, 0.4-2.8; effect size of 0.30 standard deviations (SD) of the physician-level distribution of performance; P = .01), including markedly higher ratings of physician-specific communication and interpersonal skills typically emphasized in chief selection. Differences were large for patients of racial and ethnic minority groups (1.16 SD), dual-eligible patients (0.81 SD), and those with less education (0.44 SD) but did not vary significantly across groups. Differences in spending and utilization were minimal overall. In this study, patients of PCPs who were former chief medical residents reported better care experiences than patients of other PCPs in the same practice, especially for physician-specific items. The study results suggest that the profession possesses information about physician quality, motivating the development and study of strategies for harnessing such information to select and repurpose exemplars for quality improvement.

Physician-Peer Relationships and Patient Experiences With Specialist Care

Peer relationships may motivate physicians to aspire to high professional standards but have not been a major focus of quality improvement efforts. To determine whether peer relationships between primary care physicians (PCPs) and specialists formed during training motivate improved specialist care for patients. In this quasi-experimental study, difference-in-differences analysis was used to estimate differences in experiences with specialist care reported by patients of the same PCP for specialists who did vs did not co-train with the PCP, controlling for any differences in patient ratings of the same specialists in the absence of co-training ties. Specialist visits resulting from PCP referrals from 2016 to 2019 in a large health system were analyzed, including a subset of undirected referrals in which PCPs did not specify a specialist. Data were collected from January 2016 to December 2019 and analyzed from March 2020 to October 2022. The exposure was PCP-specialist overlap in training (medical school or postgraduate medical) at the same institution for at least 1 year (co-training). Composite patient experience rating of specialist care constructed from Press Ganey's Medical Practice Survey. Of 9920 specialist visits for 8655 patients (62.9% female; mean age, 57.4 years) with 502 specialists in 13 specialties, 3.1% (306) involved PCP-specialist dyads with a co-training tie. Co-training ties between PCPs and specialists were associated with a 9.0 percentage point higher adjusted composite patient rating of specialist care (95% CI, 5.6-12.4 percentage points; P < .001), analogous to improvement from the median to the 91st percentile of specialist performance. This association was stronger for PCP-specialist dyads with full temporal overlap in training (same class or cohort) and consistently strong for 9 of 10 patient experience items, including clarity of communication and engagement in shared decision-making. In secondary analyses of objective markers of altered specialist practice in an expanded sample of visits not limited by the availability of patient experience data, co-training was associated with changes in medication prescribing, suggesting behavioral changes beyond interpersonal communication. Patient characteristics varied minimally by co-training status of PCP-specialist dyads. Results were similar in analyses restricted to undirected referrals (in which PCPs did not specify a specialist). Concordance between PCPs and specialists in physician age, sex, medical school graduation year, and training institution (without requiring temporal overlap) was not associated with better care experiences. In this quasi-experimental study, PCP-specialist co-training elicited changes in specialist care that substantially improved patient experiences, suggesting potential gains from strategies encouraging the formation of stronger physician-peer relationships.

The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services.

Few studies have determined whether clinician usage of a community health information exchange (HIE) directly improves patient care transitions. We hypothesized that lookup in the HIE by primary care physicians of patients recently released from the hospital would increase the time until hospital reuse. We identified a retrospective cohort of 8,216 hospital inpatients aged over 18 years that were discharged from January 1, 2021 through November 30, 2021 using the Paso del Norte Health Information Exchange, in El Paso County, Texas. All patients had a primary care physician visit within 30 days after hospital discharge, and we identified patients that were looked up in the HIE close to that visit. Of the cohort, 2,627 were rehospitalized and 3,809 visited an emergency department (ED) during the follow-up window. The remaining 1,780 patients were controls. We conducted survival analysis, censoring at the second ED or inpatient visit or end of the study window (January 31, 2022). The model was adjusted by ethnicity, gender, insurance, and age. Lookup in the HIE was significantly associated with reducing the likelihood of visiting the ED by 53% and being rehospitalized by 61%. Lookup in the HIE was associated with an increased median time to use of the ED after inpatient discharge from 99 to 238 patient days. Ethnicity, insurance, gender, and age were also significant predictors of hospital reuse. Increased utilization of community HIEs by primary care physicians on behalf of their recently discharged patients may dramatically increase the time until inpatient or ED reuse.

Anxiety and sleep disorders

Anxiety disorders are widespread among patients of primary care physicians and are the cause of increased morbidity and access to healthcare. Anxiety is a reaction of the body to the effects of stress and is manifested by the development of psychovegetative syndrome. In the general population, 5 to 7% of people have clinically significant anxiety, and in the practice of primary care physicians, these disorders are detected in every fourth patient. Anxiety disorder contributes to the development of psychogenic somatic pathology and/or negatively affects the course of background disease. Most patients with anxiety disorders suffer from various sleep disorders. In general practice, the frequency of sleep disorders reaches 73%. Chronic sleep disorder can act as a stressor that contributes to the development of pathophysiological changes in the body and increases anxiety. The above determines the need for early detection of sleep disorders and its timely treatment. The current treatment strategy for patients with sleep disorders involves an individualized approach to insomnia therapy. The existing arsenal of drugs used to treat sleep disorders allows this principle to be applied taking into account concomitant diseases (including anxiety disorders). The choice of product is also determined by good tolerability, efficacy and high safety profile. The optimal drug that answers the above requirements is doxylamine succinate, which allows you to effectively stop both anxiety symptoms and sleep disorders. Due to its high safety profile, doxylamine succinate can be used in the treatment of insomnia in pregnant women. The release form determines the convenience of use and the possibility of selecting an individual dose of the drug.

A quantitative study of shoulder pain management by primary care physicians in Qatar

Background: Patients with shoulder pain are mainly managed in primary care. There have been studies in other countries which suggested low confidence among general practitioners in diagnosing and managing shoulder pain, with frequent use of investigations. No comparable studies are available in Qatar. We conducted this study to understand the variations of practice amongst primary care physicians in patients with shoulder pain. We also aimed to assess the association between practice decisions and selected characteristics of physicians, such as their grade and musculoskeletal training or qualification. We hope our study will improve our knowledge of this subject and provide empirical evidence if a gap exists between practice and best evidence. Methods: We conducted an online cross-sectional survey of all primary care physicians working within 27 health centers under the PHCC. Participation in this survey was voluntary and online survey responses were anonymous. The survey questionnaire included questions on participant characteristics and clinical scenarios describing the two most common shoulder pain presentations in primary care i.e., Rotator cuff tendinopathy and adhesive capsulitis. The response options for both scenarios were listed under categories of diagnosis, investigations, clinical management and referrals. Results: 28% of physicians responded to email request with three quarters being male. Most of the responders were consultants and had more than 10 years of clinical experience. About one in five physicians reported to have musculoskeletal experience or qualifications. 73% of responders felt a CME session will be useful. In the first scenario, 49% felt confident about the RCT diagnosing with 31% who didn’t feel any investigation was required. From responders who chose to investigate, a nearly equal number selected plain shoulder radiography (71%) and Ultrasound scan (70%). For AdhC scenario, 64% of responders felt confident about the diagnosis. However, 78% chose investigation; the most common investigations were USS (65%), plain shoulder radiography (62%) and Blood test (58%). In both scenarios, USS was selected mainly to confirm diagnosis while shoulder radiography was considered to exclude other diagnosis. The most recommended treatment for both presentations was analgesia (RCT 86%, AdhC 82%) followed by physiotherapy (RCT 84%, AdhC 82%). 56% opted to refer RCT to secondary care compared to 62% for the AdhC. Association analysis revealed that junior grade responders were more likely to refer patient to specialist (RCT scenario, p=0.022) and relied more frequently on shoulder radiography (AdhC Scenario, p=0.022). Association analysis of previous MSK experience showed a statistically significant tendency to request blood tests and shoulder radiography by physicians with previous MSK experience (p= 0.022). Conclusion: This survey in Qatar identifies a reliance on frequent use of investigations in the management of common shoulder pain presentations. A tendency to choose early referral to secondary care was also noted especially amongst junior grade physicians. We hope with more experience and CME training they may feel more confident in their decision making and less inclined to refer in future. However, the low response rate to the survey means that caution needs to be exercised in generalising the findings due to potential non-response bias. Key words. Shoulder pain management, Primary care, Qatar.

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

BackgroundSome jurisdictions restrict primary care physicians’ daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily.MethodsPopulation-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians’ daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician.ResultsPeople with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily.ConclusionsPeople with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.

An experiment on referrals in health care

Abstract How referral fees affect primary care physicians’ behavior is not well understood. We conduct a behavioral experiment on referral fees in which subjects take on the role of physicians. An illustrative theoretical model guides our experimental design and the formulation of behavioral hypotheses for heterogeneously altruistic physician-types. We exogenously vary the level of referral fees paid by specialists to primary care physicians and study the impact of these fees on primary care physicians’ diagnostic effort and referrals. In a separate experimental task, we evaluate primary care physicians’ altruism. In line with our model, introducing medium-sized referral fees significantly increases referrals made by barely altruistic primary care physicians of patients who need specialist treatment, when compared to the baseline without referral fees. High referral fees significantly increase referrals irrespective of physicians’ level of altruism. Surprisingly, diagnostic effort is not significantly affected by referral fees. Implications for economic efficiency are discussed.

Primary care management of patients with pain complaints and the influence of physician training in mechanical diagnosis and therapy

Chronic pain affects 20% of the adult population, and pain-related consultations comprise a significant amount of all primary care visits. The purpose of this study was to describe health care utilization by primary care physicians for patients with a consultation for pain and to compare subsequent health care utilization and costs for a physician trained in the McKenzie method, or mechanical diagnosis and therapy (MDT), with a group of physicians that were not trained in MDT. This study was a single-center retrospective quality and cost metrics data analysis performed at a community regional health-care system; patients seen by primary care physicians for a consultation for pain had subsequent health care utilization and costs compared for a physician trained in MDT with a group of 19 physicians who were not trained in MDT. A total of 22,907 continuously eligible patients were seen during the 12-month period for a pain-related complaint; 1282 patients (6%) were seen by the physician trained in MDT, and 21,625 patients (94%) were seen by the group of physicians that were not trained in MDT (n = 19). The patients seen by the physician trained in MDT had a decreased likelihood of medication use including both opioids and non-opioid pain pills, diagnostic imaging, electromyography/nerve conduction velocity testing, specialty referrals, injections (joint and spinal injections), surgeries, emergency room visits, and inpatient admissions. Also, patients who were seen by the physician trained in MDT cost significantly less to the system ($3481 per member per year versus $4852, p < 0.001), despite being older and having more medical problems and pain complaints. Although further research is necessary to either support or refute these findings, these results may have important implications for health policy decisions for designing optimal primary care models and consideration of MDT in primary care.

Safety, Efficacy, and Effectiveness of Delabeling in Patients with Multiple Drug Allergy Labels

Patients with multiple drug allergy labels (MDALs) present a challenging barrier to patient care. To assess the efficacy, safety, and effectiveness of removing MDALs in a single clinic visit. Retrospective chart review was performed from October 1, 2014, to October 31, 2018, on patients with MDALs who had electronic health record (EHR) allergy label to 2 or more drugs and who were delabeled to 1 or more drug. Our primary outcome was the number of allergy labels tested and removed, at a single or multiple visits. Postvisit surveys were administered to patients, their pharmacies, and primary care physicians for patients delabeled following an EHR transition from November 2, 2017, to October 31, 2018 (n= 184). Among 536 patients meeting inclusion criteria, 916 of 943 (97.1%) tested allergy labels were removed from the EHR. Most patients, 461 of 536 (86.0%), were tested, challenged, and delabeled in a single visit, to 1 or more drug, although 134 of 536 (25%) still had evidence of 1 or more label at 1 year. In surveys, 90 of 171 (52.6%) responding pharmacies and 122 of 168 (72.6%) primary care physicians contacted had removed drug labels from the EHR as a result of the recommendations from the patient's drug allergy evaluation. Overall, 91 of 142 (64.1%) MDAL patient survey respondents were willing to take the drugs to which they had been delabeled. Patients with MDALs can be safely delabeled to multiple drugs in 1 visit; however, effectiveness barriers were identified. Reinforcement of drug allergy label removal information to patients, pharmacies, and primary care providers presents a targeted area for improvement.

Usefulness of Lung Ultrasound Examinations Performed by Primary Care Physicians in Patients With Suspected COVID-19.

ObjectivesIn patients with suspected coronavirus disease 2019 (COVID‐19) consulting primary care (PC) centers, clinical criteria may not be sensitive enough to detect many cases in which complications first occur. We intended to assess whether lung ultrasound (LUS) examinations performed by PC physicians are a useful tool to detect lung injury and may help in decisions about hospital referral.MethodsThis study included 61 patients with moderate symptoms suggesting COVID‐19 who were evaluated with LUS by PC physicians and then referred to a hospital during the current pandemic peak in Madrid. We analyzed association of a simple self‐designed LUS severity scale (grade 0, normal; grade 1, multiple separated B‐lines, pleural irregularity, or both; and grade 2, coalescent B‐lines, consolidations, pleural effusion, or a combination thereof) with the main outcome indicating adequacy of hospital referral, and also with chest x‐ray (CXR) findings.ResultsThe proposed LUS severity scale was significantly associated with the main outcome of appropriate referral (P = 0.001): the higher the scale, the higher the percentage of adequate referrals. The LUS scale was also associated with a CXR severity scale (P = 0.034). The presence of coalescent B‐lines was the only independent LUS finding significantly associated with the appropriate‐referral outcome (P =0 .008) and also with a higher probability of hospital admission (P = 0.02) and with several CXR findings.ConclusionsThis study supports the use of LUS in PC as a tool to assess patients with suspected COVID‐19. Its use can reduce uncertainty during clinical evaluations of moderate patients, facilitate early detection of lung involvement, allow early appropriate referral, and avoid unnecessary referral.

Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study

BackgroundRectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC.MethodsResults of all FITs requested in primary care for symptomatic patients in the Örebro region during 2015 were retrieved. Data on each patient’s history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden.ResultsA total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1–13.4) and negative predictive value 99.7% (95% CI 99.2–100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6–10.9) and 100% (95% CI 99.6–100).ConclusionThe diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.

Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial

BackgroundOptimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCPs) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge.MethodsStage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years.ResultsFrom November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups. Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival.ConclusionThese results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD.Trial registrationThis study was registered on June 29, 2009 in clinicaltrials.gov (NCT00929760) and adheres to CONSORT 2010 guidelines.

Antihypertensive therapy in men and women in real clinical practice according to the National register

Hypertension is one of the most important risk factors for cardiovascular diseases (CVD) in the world, including Russia. Current Guidelines for the management of arterial hypertension do not include different theatment strategies for men and women. Gender and age analysis of antihypertensive treatmen in men and women could reveal unreasonable and non - optimal treatment in each group. The purpose of this study was to identify the gender features of antihypertensive therapy used by primary care physicians in patients with hypertension. Materials and methods. The study is based on the Arterial Hypertension Registry established in 2012. The methodology of it has been described previously [1]. Medical data from outpatient cards were entered by doctors of 53 city primary care medical centers and 5 cardiology clinics from 22 regions of the Russian Federation. The study included the data of 33 564 patients from 18 years and older with diagnosis of arterial hypertension. Gender, age, height, body weight, smoking status, office blood pressure (BP), laboratory and instrumental examination methods, diagnosed cardiovascular and cerebrovascular diseases and comorbidities in accordance with the International Classification of Diseases of the 10th revision [ICD-10], as well as the treatment (antihypertensive and lipid - lowering therapy) were listed. Results and conclusion. Gender differences in the prescription antihypertensive therapy (AHT) in men and women with hypertension were revealed. Apparently, one of the reasons for these differences is the earlier and more frequent development of cardiovascular and cerebrovascular complications of hypertension in men than in women. Beta - blockers (BB) and angiotensin - converting enzyme inhibitors (ACEi) are more often prescribed to men with hypertension and with coronary artery disease (CAD), myocardial infarction (MI) and chronic heart failure (CHF). Women with hypertension are more often prescribed angiotensin receptor blockers (ARB), thiazide and thiazide - like diuretics. The study also showed non - optimal treatment of patients with hypertension. Insufficient prescription of medication which could improve the prognosis of the disease (ACE inhibitors /ARB, BB, mineralocorticoid receptor antagonist) have been identified in patients with hypertension and CAD, MI, CHF. It is noteworthy that in the some outpatient cards of patients with AH there is no record of AHT prescription: at a young age - in 9.6%, at old age in 15.1% of cards. Despite the fact of high and very high cardiovascular risk of the majority of patients, lipid - lowering therapy (statins) was prescribed insufficiently. The most statin administration was observed in hypertensive patients with coronary artery disease (50.1%) and myocardial infarction (62.7%).

Underutilization of primary medical care among men presenting for fertility evaluation

A growing body of evidence demonstrates an association between male infertility and significant medical comorbidities including cardiovascular disease, cancer, and even mortality. As such, it is essential that men with subfertility establish and maintain a relationship with a primary care physician (PCP). We sought to determine the proportion of young men presenting for fertility evaluation who reported an established relationship with a PCP. Retrospective, cross-sectional study. We retrospectively examined all men presenting for initial male infertility consultation at a tertiary care center with a single reproductive urologist between 2000 and 2018. All men were asked to provide the name of their PCP at the time of initial visit. Descriptive statistics and multivariable regression were utilized to characterize the proportion of men with a PCP at the time of evaluation and associations between PCP status, patient age, and comorbidity. Among 4,127 men presenting for initial fertility consultation, 1,324 had PCP data recorded. Of these, 480 (36.3%) did not have an established PCP at the time of evaluation. Men with a PCP were older than those without - median age 35 years (interquartile range [IQR] 23-40) versus 34 years (IQR 31-38), p<0.001. A smaller proportion of men with a PCP had elevated blood pressure (46.2% versus 56.8%, p=0.03), however a similar proportion of men in both groups were obese (21.7% versus 24.6%, p=0.31). Among 513 men who had a documented visit with an internal medicine physician within our tertiary care network prior to initial fertility consultation, 184 (35.9%) had not seen an internal medicine physician in over a year. Over one-third of men presenting for fertility evaluation did not have an established PCP, and among those who did, a sizable proportion had not seen their PCP in the previous year. Given the strong link between male infertility and medical comorbidities, reproductive urologists are uniquely positioned to encourage and facilitate the critical relationship between men with subfertility and primary care physicians.

Primary care patients' use of conventional and complementary medicine for chronic low back pain.

PurposeTo investigate among primary care patients and their physicians in western Switzerland the prevalence of use, perceived usefulness, and communication about common treatments for chronic or recurrent low back pain (crLBP) including complementary medicine (CM).Patients and methodsA cross-sectional cluster observational study involving 499 crLBP patients visiting 45 primary care physicians (PCPs) was conducted from November 1, 2015, to May 31, 2016. Patients and primary care physicians completed questionnaires about lifetime use and usefulness of 30 crLBP therapies. We conducted multivariate analyses of factors associated with therapy use, including sociodemographic variables, pain duration, insurance coverage, and primary care physicians’ characteristics.ResultsThe five most frequent modalities used at least once by patients were physiotherapy (81.8%), osteopathic treatment (63.4%), exercise therapy (53.4%), opioids (52.5%), and therapeutic massage (50.8%). For their PCPs, the five most useful therapies were physiotherapy, osteopathic treatment, yoga, meditation, and manual therapy. In multivariate analysis, the use of physiotherapy was significantly associated with longer pain duration; osteopathic treatment was associated with age under 75 years, female gender, higher education, and CM insurance coverage. Exercise therapy was associated with non-smoking and longer pain duration. Smokers were more likely and patients of PCPs with CM training were less likely to have used opioids. During their lifetime, 86.6% of the participants had used at least one CM therapy to manage their crLBP, with a mean of 3.3 (SD=2.9) therapies used per participant; 46.1% of participants reported that their PCP did not enquire about CM use. Among CM users, 64.7% informed their PCP about it.ConclusionPatients with crLBP use a variety of treatments, including self-prescribed and unreimbursed therapies, most frequently physiotherapy and osteopathy. The results suggest that PCPs should systematically discuss with their patients the treatments they tried to manage crLBP, including CM.

Treatment Intensification With Insulin Pumps and Other Technologies in Patients With Type 2 Diabetes: Results of a Physician Survey in the United States.

An online survey was conducted to assess the perspectives and use of diabetes technologies by a sample of U.S. primary care physicians (PCPs) and endocrinologists to optimize intensive insulin therapy in patients with type 2 diabetes. Overall, endocrinologists reported using diabetes technologies more frequently than PCPs for patients with type 2 diabetes requiring basal-bolus insulin therapy. PCPs and endocrinologists who were highly focused on diabetes management with insulin therapy reported using insulin delivery devices (insulin pumps and wearable tube-free patches) when patients are not achieving their A1C target while taking basal plus three or more prandial injections of insulin daily.

Medication adherence, costs, and ER visits of nurse practitioner and primary care physician patients: Evidence from three cohorts of Medicare beneficiaries.

To compare medication adherence, cost, and utilization in Medicare beneficiaries attributed to nurse practitioners (NP) and primary care physicians (PCP). Medicare Part A, B, and D claims and beneficiary summary file data, years 2009-2013. We used propensity score-weighted analyses combined with logistic regression and generalized estimating equations to test differences in good medication adherence (proportion of days covered (PDC >0.8); office-based and specialty care costs; and ER visits. Beneficiaries with prescription claims for anti-diabetics, renin-angiotensin system antagonists (RASA), or statins. There were no differences in good medication adherence (PDC >0.8) between NP and PCP attributed beneficiaries taking anti-diabetics or RASA. Beneficiaries taking statins had a slightly higher probability of good adherence when attributed to PCPs (74.6% vs 75.5%; P<0.05). NP attributed beneficiaries had lower office-based and specialty care costs and were less likely to experience an ER visit across all three medication cohorts (P<0.01). Examining the impact of NP and PCP provided care on outcomes beyond the primary care setting is important to the Medicare program in general but will also help practices seeking to meet benchmarks under alternative payment models that incentivize higher quality and lower costs.

Appropriateness of magnetic resonance imaging requested by primary care physicians for patients with knee pain.

To evaluate the appropriateness of magnetic resonance imaging (MRI) of the knee requested by primary care physicians. Retrospective observational study. Six primary care centres in the Elche Department of Health of the Valencian Community, Spain. Three hundred patients with knee pain who were prescribed MRI. Data were collected from the electronic clinical history, which allowed us to assess the appropriateness and inappropriateness of the MRI requests for the knee based on the American College of Radiology (ACR) criteria. A multivariate logistic regression model was used to identify factors associated with an inappropriate request. About 45% (41-49%) of knee MRI prescriptions were assessed as inappropriate. The frequency was higher in female patients (odds ratio, OR = 1.96; P = 0.03). A history of knee trauma and urgent use of MRI were associated with a lower frequency of inappropriate requests (OR = 0.14, P < 0.001 and OR = 0.32, P = 0.03, respectively). In 82% of cases, the request for MRI was deemed inappropriate because it was used as the initial imaging test. The availability of a previous radiograph of the knee significantly reduced the rate of inappropriate requests (OR = 0.05, P < 0.001); only 47% of the patients had a previous radiograph. The percentage of inappropriate knee MRI prescriptions is high. Protocols should be put in place to improve the appropriateness of MRI requests by promoting understanding of the appropriate use of MRI among primary care physicians.