Prevention In Primary Care Research Articles

Sexually Transmitted Infections and Associated Factors in Southeast Spain: A Retrospective Study from 2000 to 2014.

The World Health Organization estimates that more than one million people acquire a Sexually Transmitted Infection (STI) every day, compromising quality of life, sexual and reproductive health, and the health of newborns and children. It is an objective of this study to identify the factors related to a Sexually Transmitted Infection diagnosis in the province of Granada (Spain), as well as those better predicting the risk of acquiring such infections. In this study, 678 cases were analyzed on a retrospective basis, which were treated at the Centre for Sexually Transmitted Diseases and Sexual Orientation in Granada, between 2000–2014. Descriptive statistics were applied, and by means of binary logistic regression, employing the forward stepwise-likelihood ratio, a predictive model was estimated for the risk of acquiring an STI. Sex, age, occupation, economic crisis period, drug use, number of days in which no condoms were used, number of sexual partners in the last month and in the last year, and number of subsequent visits and new subsequent episodes were associated with an STI diagnosis (p < 0.05). The risk of being diagnosed with an STI increased during the economic crisis period (OR: 1.88; 95%-CI: 1.28–2.76); during the economic crisis and if they were women (OR:2.35, 95%- CI: 1.24–4.44); and if they were women and immigrants (OR: 2.09; 95%- CI:1.22–3.57), while it decreased with age (OR: 0.97, 95%-CI: 0.95–0.98). Identification of the group comprised of immigrant women as an especially vulnerable group regarding the acquisition of an STI in our province reflects the need to incorporate the gender perspective into preventive strategies and STI primary health care.

Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis.

BackgroundThe COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative.ObjectiveThis study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine.MethodsWe conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown.ResultsDeferred care was widespread—48% (n=812) of respondents deferred care—but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care.ConclusionsTemporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services.

Prevención de la conducta suicida en niños y adolescentes en atención primaria

Objetivo: el suicidio es un grave problema de salud pública, con una mayor incidencia en niños y adolescentes. No obstante, es prevenible mediante intervenciones oportunas, por lo cual se considera fundamental encontrar y elegir programas de prevención de suicidio en estos grupos etarios desde la atención primaria en salud. Metodología: se revisó la literatura sobre la prevención del suicidio desde atención primaria en documentos oficiales y artículos en las bases de datos Web of Science, Clinicalkey, PubMed y Science Direct. Se seleccionaron 35 documentos y se organizaron en 4 categorías: familia, entorno, personal de salud y prevención en atención primaria. Resultados: se encontraron programas enfocados en la familia, que ayudan a mejorar la relación padre-hijo e informan a los padres sobre métodos letales y cómo restringir su acceso. Por otro lado, hay documentos en donde se capacita al personal de salud para identificar, diagnosticar y tratar oportunamente las enfermedades mentales o las situaciones que predisponen las conductas suicidas; y así mismo, se interviene a aquellos que están en riesgo o han tenido intentos de suicidio previos. Conclusión: existen múltiples estrategias e intervenciones para reconocer y responder a las señales de advertencia de suicidio. Es importante que el personal de salud de atención primaria identifique y se capacite para el manejo inicial de pacientes con riesgo de suicidio y pueda brindar educación a la red de apoyo del menor sobre las estrategias para afrontar estas conductas.

Mental health policy issues and development in Lithuania

Abstract Background Lithuanian has experienced rapid and relatively successful transition to capitalism and transatlantic-Western values and practices in recent decades. Suicide and legal alcohol consumption rates remain the highest in the EU and OECD, and Lithuania's Positive emotions index score has been consistently amongst the 10 lowest in the world in recent years. Emigration rate is the highest in the EU and OECD, social inequality is amongst the highest in the same groups. Despite a relatively strong economy these changes are not automatically transferred to better social and emotional well-being. Methods This unconventional situation calls for strong and unconventional policy responses in the area of mental health, amongst others. Health impact assessment using theory-based approach and desk research. Results Recent attempts include strategic reorientation towards social and emotional well-being, stronger focus on prevention and promotion and primary care, intensifying efforts to reduce suicide rates, and implementation of strong regulatory measures to reduce alcohol use. Suicide rates have been declining since 2013 but remain high. Effort is made to implement best practices in media reporting, recognition and providing appropriate help for those in suicide crisis, expanding prevention efforts. Conclusions Finally, WHOs “best buys” in alcohol control were implemented since 2017, including steep increases in excise taxes, ban on alcohol advertisement, increase of allowed age, reducing alcohol trading hours and others. This resulted in the steepest decline of legal alcohol consumption in decades. The chosen policy route may be called iterative policy-making, whereby improvements are made along the way, which allows for quicker policy decisions and results. Key messages Mental health policies need to be based on the socio-political context of the specific country. Smaller countries such as Lithuania might benefit form flexible approaches to mental health policies.

EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study.

To provide contemporary data on the implementation of European guideline recommendations for lipid-lowering therapies (LLTs) across different settings and populations and how this impacts low-density lipoprotein cholesterol (LDL-C) goal achievement. An 18 country, cross-sectional, observational study of patients prescribed LLT for primary or secondary prevention in primary or secondary care across Europe. Between June 2017 and November 2018, data were collected at a single visit, including LLT in the preceding 12 months and most recent LDL-C. Primary outcome was the achievement of risk-based 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) LDL-C goal while receiving stabilized LLT; 2019 goal achievement was also assessed. Overall, 5888 patients (3000 primary and 2888 secondary prevention patients) were enrolled; 54% [95% confidence interval (CI) 52-56] achieved their risk-based 2016 goal and 33% (95% CI 32-35) achieved their risk-based 2019 goal. High-intensity statin monotherapy was used in 20% and 38% of very high-risk primary and secondary prevention patients, respectively. Corresponding 2016 goal attainment was 22% and 45% (17% and 22% for 2019 goals) for very high-risk primary and secondary prevention patients, respectively. Use of moderate-high-intensity statins in combination with ezetimibe (9%), or any LLT with PCSK9 inhibitors (1%), was low; corresponding 2016 and 2019 goal attainment was 53% and 20% (ezetimibe combination), and 67% and 58% (PCSK9i combination). Gaps between clinical guidelines and clinical practice for lipid management across Europe persist, which will be exacerbated by the 2019 guidelines. Even with optimized statins, greater utilization of non-statin LLT is likely needed to reduce these gaps for patients at highest risk.

AN ANTIBIOTIC DRUG-INDUCED ALLERGIC REACTION IN A PATIENT WITH MULTIPLE COMORBIDITIES. CLINICAL CASE

Drug induced allergic reactions due to antibiotics rarely occur. Penicillin is the antibiotic class that is mostly commonly associated with drug induced allergic reactions (10 %). They are followed by quinolones (2 %) which will be discussed in this case based review. Fluoroquinolones allergic reactions can either present as an immediate reaction which requires urgent medical attention or a delayed reaction. Among the antibiotics of this class, moxifloxacin has been reported as the drug which is likely to result in occurrence of an allergic reaction. Some of the dermatologic eruptions that could manifest include maculopapular exanthema, urticarial, Steven Johnson Syndrome, fixed drug eruptions and drug rash with eosinophilia and systemic symptoms (DRESS). The diagnosis needs a thorough history and physical examination, skin test, in vitro testing and drug provocation tests. Management includes discontinuation of the provoking agent and administration of antihistamines or corticosteroids depending on the situation.&#x0D; The case of the 75 year old lady who had an allergic reaction following administrations of ciprofloxacin and follow up management plan is described in the article. The case illustrates and urgent necessity of quaternary prevention in primary care to avoid harming patients while choosing the best and safe therapy.

Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China

BackgroundComprehensive primary care practices, through preconception, preventive, curative, and rehabilitative care, have been a global priority in the promotion of health. However, the scope of primary care services has still been in decline in China. Studies on the factors for primary care service scope have centred on human resources and infrastructure; the role of direct government subsidies (DGS) on services scope of primary care facilities were left unanswered. This study aimed to explore the association between the DGS and services scope of primary care facilities in China.MethodsA multi-stage, clustered cross-sectional survey using self-administrated questionnaire was conducted among primary care facilities of 36 districts/counties in China. A total of 770 primary care facilities were surveyed with 757 (98.3%) valid respondents. Of the 757 primary care facilities, 469 (62.0%) provided us detailed information of financial revenue and DGS from 2009 to 2016. Therefore, 469 primary care facilities from 31 counties/districts were included in this study. Sasabuchi-Lind-Mehlum tests and multivariate regression models were used to examine the inverted U-shaped relationship between the DGS and service scope.ResultsOf 469 PCFs, 332 (70.8%) were township health centres. Proportion of annul DGS to FR arose from 26.5% in 2009 to 50.5% in 2016. At the low proportion of DGS to financial revenue, an increase in DGS was associated with an increased service scope of primary care facilities, whereas the proportion of DGS to financial revenue over 42.5% might cause narrowed service scope (P = 0.023, 95% CI 11.59–51.74%); for the basic medical care dimension, the cut point is 42.6%. However, association between DGS and service scope of public health by primary care facilities is statistically insignificant.ConclusionWhile the DGS successfully achieved equalization of basic preventive and public health services, the disproportionate proportion of DGS to financial revenue is associated with narrowed service scope, which might cause underutilization of primary care and distorted incentive structure of primary care. Future improvements of DGS should focus on the incentive of broader basic medical services provision, such as clarifying service scope of primary care facilities and strategic procurement with a performance-based subsidies system to determine resource allocation.

Rapid Diet Assessment Screening Tools for Cardiovascular Disease Risk Reduction Across Healthcare Settings: A Scientific Statement From the American Heart Association.

It is critical that diet quality be assessed and discussed at the point of care with clinicians and other members of the healthcare team to reduce the incidence and improve the management of diet-related chronic disease, especially cardiovascular disease. Dietary screening or counseling is not usually a component of routine medical visits. Moreover, numerous barriers exist to the implementation of screening and counseling, including lack of training and knowledge, lack of time, sense of futility, lack of reimbursement, competing demands during the visit, and absence of validated rapid diet screener tools with coupled clinical decision support to identify actionable modifications for improvement. With more widespread use of electronic health records, there is an enormous unmet opportunity to provide evidence-based clinician-delivered dietary guidance using rapid diet screener tools that must be addressed. In this scientific statement from the American Heart Association, we provide rationale for the widespread adoption of rapid diet screener tools in primary care and relevant specialty care prevention settings, discuss the theory- and practice-based criteria of a rapid diet screener tool that supports valid and feasible diet assessment and counseling in clinical settings, review existing tools, and discuss opportunities and challenges for integrating a rapid diet screener tool into clinician workflows through the electronic health record.

Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease.

Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease.

Embedding "Smart" Disease Coding Within Routine Electronic Medical Record Workflow: Prospective Single-Arm Trial.

BackgroundElectronic medical record (EMR) chronic disease measurement can help direct primary care prevention and treatment strategies and plan health services resource management. Incomplete data and poor consistency of coded disease values within EMR problem lists are widespread issues that limit primary and secondary uses of these data. These issues were shared by the McMaster University Sentinel and Information Collaboration (MUSIC), a primary care practice-based research network (PBRN) located in Hamilton, Ontario, Canada.ObjectiveWe sought to develop and evaluate the effectiveness of new EMR interface tools aimed at improving the quantity and the consistency of disease codes recorded within the disease registry across the MUSIC PBRN.MethodsWe used a single-arm prospective trial design with preintervention and postintervention data analysis to assess the effect of the intervention on disease recording volume and quality. The MUSIC network holds data on over 75,080 patients, 37,212 currently rostered. There were 4 MUSIC network clinician champions involved in gap analysis of the disease coding process and in the iterative design of new interface tools. We leveraged terminology standards and factored EMR workflow and usability into a new interface solution that aimed to optimize code selection volume and quality while minimizing physician time burden. The intervention was integrated as part of usual clinical workflow during routine billing activities.ResultsAfter implementation of the new interface (June 25, 2017), we assessed the disease registry codes at 3 and 6 months (intervention period) to compare their volume and quality to preintervention levels (baseline period). A total of 17,496 International Classification of Diseases, 9th Revision (ICD9) code values were recorded in the disease registry during the 11.5-year (2006 to mid-2017) baseline period. A large gain in disease recording occurred in the intervention period (8516/17,496, 48.67% over baseline), resulting in a total of 26,774 codes. The coding rate increased by a factor of 11.2, averaging 1419 codes per month over the baseline average rate of 127 codes per month. The proportion of preferred ICD9 codes increased by 17.03% in the intervention period (11,007/17,496, 62.91% vs 7417/9278, 79.94%; χ21=819.4; P<.001). A total of 45.03% (4178/9278) of disease codes were entered by way of the new screen prompt tools, with significant increases between quarters (Jul-Sep: 2507/6140, 40.83% vs Oct-Dec: 1671/3148, 53.08%; χ21=126.2; P<.001).ConclusionsThe introduction of clinician co-designed, workflow-embedded disease coding tools is a very effective solution to the issues of poor disease coding and quality in EMRs. The substantial effectiveness in a routine care environment demonstrates usability, and the intervention detail described here should be generalizable to any setting. Significant improvements in problem list coding within primary care EMRs can be realized with minimal disruption to routine clinical workflow.

Role of Primary Care in Suicide Prevention During the COVID-19 Pandemic

Primary care providers have an important role in suicide prevention, knowing that among people who die by suicide, 83% have visited a primary care provider in the prior year, and 50% have visited that provider within 30 days of their death, rather than a psychiatrist. The psychosocial impact of the coronavirus disease 2019 pandemic poses increased risk for suicide and other mental health disorders for months and years ahead. This article focuses on screening tools, identification of the potentially suicidal patient in the primary care setting, and a specific focus on suicide prevention during widespread, devastating events, such as a pandemic.

Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare \u2013 systematic review

IntroductionHealth systems offer access to unscheduled care through numerous routes; however, it is typically provided by general practitioners (GPs), by emergency medicine doctors in in emergency departments (EDs) and by GPs in out-of-hours GP services such as practitioner cooperatives. Unscheduled healthcare constitutes a substantial portion of healthcare delivery. A systematic review was conducted to establish the factors that influence parents’ decision making when seeking unscheduled healthcare for their children. The systematic review question was “What are the factors that influence the decision making of parents and families seeking unscheduled paediatric healthcare?”MethodFive databases (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and four grey literature databases (Proquest, Lenus, OpenGrey, Google Scholar) were searched. The titles and abstracts of 3746 articles were screened and full-text screening was performed on 177 of these articles. Fifty-six papers were selected for inclusion in the review. Data relating to different types of unscheduled health services (namely primary care, the emergency department and out-of-hours services) were extracted from these articles. A narrative approach was used to synthesise the extracted data.ResultsSeveral factors were identified as influencing parental preferences and decision making when seeking unscheduled healthcare for their children. A number of the included studies identified pre-disposing factors such as race, ethnicity and socioeconomic status (SES) as impacting the healthcare-seeking behaviour of parents. Unscheduled healthcare use was often initiated by the parent’s perception that the child’s condition was urgent and their need for reassurance. The choice of unscheduled service was influenced by a myriad of factors such as: waiting times, availability of GP appointments, location of the ED, and the relationship that the parent or caregiver had with their GP.ConclusionPolicy and planning initiatives do not always reflect how patients negotiate the health system as a single entity with numerous entry points. Altering patients’ behaviour through public health initiatives that seek to improve, for instance, health literacy or reducing emergency hospital admissions through preventative primary care requires an understanding of the relative importance of factors that influence behaviour and decision making, and the interactions between these factors.

A computer-guided quality improvement tool for primary health care: cost-effectiveness analysis based on TORPEDO trial data.

To assess the cost-effectiveness of a computer-guided quality improvement intervention for primary health care management of cardiovascular disease (CVD) in people at high risk. Modelled cost-effectiveness analysis of the HealthTracker intervention and usual care for people with high CVD risk, based on TORPEDO trial data on prescribing patterns, changes in intermediate risk factors (low-density lipoprotein cholesterol, systolic blood pressure), and Framingham risk scores. Hypothetical population of people with high CVD risk attending primary health care services in a New South Wales primary health network (PHN) of mean size. HealthTracker, integrated into health care provider electronic health record systems, provides real time decision support, risk communication, a clinical audit tool, and a web portal for performance feedback. Incremental cost-effectiveness ratios (ICERs): difference in costs of the intervention and usual care divided by number of CVD events averted with HealthTracker. The estimated numbers of major CVD events over five years per 1000 patients at high CVD risk were lower in PHNs using HealthTracker, both for patients with prior CVD events (secondary prevention; 259 v 267 with usual care) and for those without prior events (primary prevention; 168 v 176). Medication costs were higher and hospitalisation costs lower with HealthTracker than with usual care for both primary and secondary prevention. The estimated ICER for one averted CVD event was $7406 for primary prevention and $17988 for secondary prevention. Modelled cost-effectiveness analyses provide information that can assist decisions about investing in health care quality improvement interventions. We estimate that HealthTracker could prevent major CVD events for less than $20000 per event averted. Australian New Zealand Clinical Trials Registry, ACTRN 12611000478910.

Organised and opportunistic prevention in primary health care: estimation of missed opportunities by population based health interview surveys in Hungary

BackgroundImprovement of preventive services for adults can be achieved by opportunistic or organised methods in primary care. The unexploited opportunities of these approaches were estimated by our investigation.MethodsData from the Hungarian implementation of European Health Interview Surveys in 2009 (N = 4709) and 2014 (N = 5352) were analysed. Proportion of subjects used interventions in target group (screening for hypertension and diabetes mellitus, and influenza vaccination) within a year were calculated. Taking into consideration recommendations for the frequency of intervention, numbers of missed interventions among patients visited a general practitioner in a year and among patients did not visit a general practitioner in a year were calculated in order to describe missed opportunities that could be utilised by opportunistic or organised approaches. Numbers of missed interventions were estimated for the entire population of the country and for an average-sized general medical practice.ResultsImplementation ratio were 66.8% for blood pressure measurement among subjects above 40 years and free of diagnosed hypertension; 63.5% for checking blood glucose among adults above 45 and overweighed and free of diagnosed diabetes mellitus; and 19.1% for vaccination against seasonal influenza. There were 4.1 million interventions implemented a year in Hungary, most of the (3.8 million) among adults visited general practitioner in a year. The number of missed interventions was 4.5 million a year; mostly (3.4 million) among persons visited general practitioner in a year. For Hungary, the opportunistic and organised missed opportunities were estimated to be 561,098, and 1,150,321 for hypertension screening; 363,270, and 227,543 for diabetes mellitus screening; 2,784,072, and 380,033 for influenza vaccination among the < 60 years old high risk subjects, and 3,029,700 and 494,150 for influenza vaccination among more than 60 years old adults, respectively. By implementing all missed services, the workload in an average-sized general medical practice would be increased by 12–13 opportunistic and 4–5 organised interventions a week.ConclusionsThe studied interventions are much less used than recommended. The opportunistic missed opportunities is prevailing for influenza vaccination, and the organised one is for hypertension screening. The two approaches have similar significance for diabetes mellitus screening.

Design of a cluster-randomized trial of the effectiveness and cost-effectiveness of metformin on prevention of type 2 diabetes among prediabetic Mexican adults (the PRuDENTE initiative of Mexico City)

IntroductionType 2 diabetes (T2D) is a global epidemic, and nations are struggling to implement effective healthcare strategies to reduce the burden. While efficacy studies demonstrate that metformin can reduce incident T2D by half among younger, obese adults with prediabetes, its real-world effectiveness are understudied, and its use for T2D prevention in primary care is low. We describe the design of a pragmatic trial to evaluate the incremental effectiveness of metformin, as an adjunct to a simple lifestyle counseling. MethodsThe “Prevención de la Diabetes con Ejercicio, Nutrición y Tratamiento” [Diabetes Prevention with Exercise, Nutrition and Treatment; PRuDENTE, (Spanish acronym)] is a cluster-randomized trial in Mexico City's public primary healthcare system. The study randomly assigns 51 clinics to deliver one of two interventions for 36 months: 1) lifestyle only; 2) lifestyle plus metformin, to 3060 patients ages 30–65 with impaired fasting glucose and obesity. The primary endpoint is incident T2D (fasting glucose ≥126 mg/dL, or HbA1c ≥6.5%). We will also measure a range of implementation-related process outcomes at the clinic-, clinician- and patient-levels to inform interpretations of effectiveness and enable efforts to refine, adapt, adopt and disseminate the model. We will also estimate the cost-effectiveness of metformin as an adjunct to lifestyle counseling in Mexico. DiscussionFindings from this pragmatic trial will generate new translational knowledge in Mexico and beyond, both with respect to metformin's real-world effectiveness among an ‘at-risk’ population, and uncovering facilitators and barriers to the reach, adoption and implementation of metformin preventive therapy in public primary care settings. Trial registrationThis trial is registered at Clinicaltrials.gov (NCT03194009).

Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India.

Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India.

U.S. task force doesn't recommend for or against primary care prevention

In its most recent recommendation, the U.S. Preventive Services Task Force (USPSTF) last week said there is not enough evidence to recommend either for or against clinicians providing counseling to prevent drug use in young people. In the final recommendation statement, “Primary Care–Based Interventions to Prevent Illicit Drug Use in Children, Adolescents, and Young Adults: US Preventive Services Task Force Recommendation Statement,” published in the Journal of the American Medical Association (JAMA), the task force concluded that “the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults.”

Embedded Mental Health in the United States Marine Corps.

Despite the rich history and progression of mental health assets and their utilization within the Marine Corps, the implementation of these assets has been varied and inconsistent. This article strives to take the lessons learned from the past and improve on them. The goal is to develop a consistent program focused on resiliency and retention, and propose an integrated organized structure across all the Marine Expeditionary Forces (MEF). Review of the literature, current practices, and future recommendations. This article demonstrates that continuing to utilize mental health resources at the Regimental level with a focus on community mental health principles rather than the medical model allows for proximity to members and leadership of their primary command, immediate access to them as their Special Staff Officer, the ability to set the expectation of recovery, resiliency, and readiness, and the capability to implement simple principles of nonmedical recuperation and advisement. Improving on the organizational structure of mental health in the Marine Corps by placing a mental health Special Staff Officer at the MEF level and focusing on the principles of community mental health will shift the focus back to the primary and secondary prevention care efforts across all levels of the Marine Corps and provide clinical and leadership oversight as it relates to the philosophy, role, and implementation of organic mental health Officers.

Integrating an Urgent Care Clinic Into an Academic Family Medicine Practice.

There has been a growth in the demand for convenient, walk-in access in health care across the United States, resulting in primary care practices seeing a shift in services to urgent care centers (UCCs). In order to incorporate the flexibility of a UCC and improve primary care access and preventive care for our regular patients, the University of North Carolina (UNC) Family Medicine Center (FMC) established a UCC within the practice. This report describes that process and the impact of the new UCC on our academic practice. With the support of the UNC health care system, our primary objectives were to provide enhanced access for patients with acute problems, decrease emergency department (ED) utilization, and increase enrollment of new patients for ongoing primary care. As part of our intervention, we asked providers to respond to a series of questions at the end of each visit. These questions, along with data regarding number of visits and revenue, were tracked longitudinally. By the end of our first year, we were treating about 900 patients per month, of which approximately one-third would have otherwise visited the ED. We averaged 115 new patients establishing care per quarter. In addition to the success of this new service line, our primary practice maintained provider continuity and grew at a higher rate than prior to opening the UCC. The opening of urgent care at the UNC FMC provided improved access for our patients, increased the number of patients empaneled in our primary care practice, and provided a new revenue stream.

Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) are at high risk of developing cardiovascular disease (CVD). Inflammation has a pivotal role in the pathogenesis of CVD. RA is an inflammatory joint disease and, compared with the general population, patients with RA have approximately double the risk of atherosclerotic CVD, stroke, heart failure and atrial fibrillation. Although this high risk of CVD has been known for decades, patients with RA receive poorer primary and secondary CVD preventive care than other high-risk patients, and an unmet need exists for improved CVD preventive measures for patients with RA. This Review summarizes the evidence for atherosclerotic CVD in patients with RA and provides a contemporary analysis of what is known and what needs to be further clarified about recommendations for CVD prevention inpatients with RA compared with the general population. The management of traditional CVDrisk factors, including blood pressure, lipids, diabetes mellitus and lifestyle-related risk factors, as well as the effects of inflammation and the use of antirheumatic medication on CVDrisk and risk management in patients with RA are discussed. The main aim is to provide aroadmap of atherosclerotic CVD risk management and prevention for patients with RA.