Use Of Primary Care Providers Research Articles

Primary care use and depression screening among young adults with sickle cell disease during their final year of pediatric hematology care.

Depression may contribute to transition risk among young adults with sickle cell disease (SCD). It is unclear if they receive depression screening because primary care providers (PCPs) routinely perform this screening, but PCP use declines with age. This retrospective study of young adults with SCD during their final year of pediatric hematology care identified 51 (91%) had PCPs. Among those with hospital system PCPs, 20% saw their PCP and 50% of those were screened for depression by the PCP. This suggests young adults with SCD may not receive depression screening or see PCPs, leading to potential missed opportunities for intervention.

Using Appreciative Inquiry to Improve Cultural Humility in Primary Healthcare

Primary care providers (PCPs) care for a more diverse population than ever before. PCPs must practice cultural humility to address inequities in health outcomes. The project aimed to introduce Appreciative Inquiry (AI) as a method to begin conversations surrounding cultural humility and raise awareness about its importance. Nurse practitioners working in primary care in both rural and urban settings participated. Results indicated that AI did impact PCP understanding and use of cultural humility in practice.

EVALUATION OF COGNITION IN PRIMARY CARE (CPC): A PILOT STUDY TO INCREASE EARLY DETECTION AND MANAGEMENT OF DEMENTIA

Abstract Despite evidence that early detection of mild cognitive impairment and dementia leads to improved patient care, these conditions remain under-diagnosed in primary care. To address this gap at University of Washington Medicine, we have developed and pilot-tested a program to increase cognitive evaluations and improve dementia care by primary care providers (PCPs). The Cognition in Primary Care (CPC) program was designed utilizing stakeholder-selected components of the GSA KAER (Kickstart-Assess-Evaluate and Refer) Model and Toolkit (2020 Edition), developed by the Gerontological Society of America (GSA). In this presentation we will describe evaluation of the CPC Program including (a) education training; (b) use of assessment tools integrated within the electronic health record (e.g. potentially harmful medications, depressive symptoms, alcohol use, sleep apnea, etc.); (c) practice recommendations such as dedicated evaluation appointments, diagnoses and referrals, and (d) PCP use of community resources for post-diagnosis support. A total of 66 PCPs participated in the series of 3 CME educational seminars. Over 93% of participants reported the content to be highly relevant and expected to incorporate it into their practice; commitments to use specific tools were made. Analysis is underway to determine impact of the program by comparing the above metrics before and after the training as well as between trained and untrained PCPs. Results from this evaluation will inform modifications to increase utilization of the CPC Model within UW Medicine, will be used to package the program to share with other primary care systems, and will guide future enhancements to the GSA KAER Toolkit.

Primary Care Provider Use and Depression Screening Among Transitioning Adolescents and Young Adults with Sickle Cell Disease

Background Sickle cell disease (SCD) is a red blood cell disorder that impacts approximately 100,000 Americans. Adolescents and young adults (AYAs) with SCD face many barriers to successful transition from pediatric to adult care, including high rates of being uninsured, limited access to adult hematology and primary care providers (PCPs), and high rates of depression. Compared to people with SCD in other age groups, AYAs also have more healthcare costs, hospital visits, and greater rates of mortality. In other chronically ill populations, PCP use and well-managed depression are associated with improved outcomes. However, little is known about the prevalence of PCP use and how PCP use relates to mental health care and acute care use in this population near their transition. Thus, the objective of this study was to describe PCP use among transitioning AYAs with SCD and determine if being seen by a PCP in the year prior to transition was associated with receipt of depression screening and care and with decreased acute care utilization. Methods This was a single-site, retrospective review of electronic medical records (EMR) of AYAs 18-21 years old with SCD (any genotype) at Nationwide Children's Hospital (NCH) who had their last pediatric hematology clinic visit between 2015-2019. Patients were excluded if they had ever received a bone marrow transplant or were incarcerated at the time of transition. Demographics, PCP use, depression screening using the validated patient health questionnaire-9 (PHQ-9), and acute care utilization (emergency room and/or hospitalization visits) during their last year of pediatric care were abstracted. Data were analyzed in SPSS. Pearson's correlations and chi-square tests were used to determine significant associations between target variables. Results The final sample (N=56) included 32 (57%) females with mean age of 20.52 (SD=1.27). Of these, 55 (98%) were African/African American/Black, 1 (2%) was Arab; 37 (66%) had Medicaid insurance, 18 (32%) had private or commercial insurance, and 1 (2%) had military insurance. Overall, 51 (91%) patients had a PCP listed in their EMR, 30 (59%) had their PCP through NCH and 7 (23%) of these 30 had visited their PCP at least once in the year prior to their transition. Of the 30 with NCH PCP's, having ≥1 PCP visit in the year prior to transition was significantly associated with completing the PHQ-9 (p<0.01) and receiving a referral to psychiatry or therapy (p<0.01) compared to not having had a PCP visit. Patients who saw an NCH PCP in their final year of pediatric care had a mean of 5 acute care visits (SD= 3) compared to 6 visits (SD=8) among those without a visit to their PCP in their final year, this difference was not significant (p=0.440). Discussion Our results suggest that many AYAs with SCD are not receiving primary care in the year prior to transition to adult care. We also identified that those with a PCP visit may be more likely to receive depression screening and referral for mental health care than those without a PCP visit. These findings suggest that PCPs may play a crucial role in depression diagnosis and management for transitioning AYAs with SCD, which is critical to address due to the impact that undiagnosed and/or untreated depression can have on transition and SCD outcomes. Thus, increasing access to PCPs who can provide essential preventive primary care and mental health screenings may have the potential to impact successful SCD transition. Our study was limited by its retrospective nature and small sample size and because PCP care that may have been provided outside of NCH setting could not be evaluated. Additional studies, with larger samples and across multiple centers, are warranted to better understand PCP use, depression diagnosis and management, and how visits with a PCP can augment and optimize management of SCD.

Association Between Primary Care Provider Status and Preventive Health Care Among People Who Inject Drugs

Introduction: People who inject drugs (PWID) are at increased risk for preventable, communicable infections, such as hepatitis B. Preventive care, such as hepatitis B vaccination, is often delivered through primary care providers (PCPs). However, PWID may not have access to PCPs and, therefore, may receive preventive care through other sites. We aimed to characterize PCP and preventive care use among PWID in Maine. Methods: This is a cross-sectional study of PWID hospitalized with infections associated with injection drug use in Maine from January 2019 to May 2020. Descriptive analyses were used to identify characteristics of participants, rates of screening, and vaccination of participants with and without PCPs. Logistic regression analyses were performed to explore the relationship between PCP status and delivery of preventive services for PWID. Hepatitis B vaccination was an outcome of interest. Results: Of 101 participants, 68 (67%) had a PCP. Overall rates of hepatitis C (93%) and HIV (85%) screening were high and did not differ based on PCP status. More participants with PCPs had previously received a hepatitis B vaccination (62% of those with PCPs, 33% of those without PCPs; P = .006). Only half of those with PCPs recalled receiving a hepatitis B vaccination through a PCP office. Having a PCP was predictive of having received the hepatitis B vaccination (adjusted odds ratio, 3.59; 95% CI, 1.27-7.58; P = .014). Conclusions: Many PWID in Maine engage with PCPs and preventive care. Results from this study call for enhanced delivery of preventive services and linkages to care for PWID.

Assessing the use of a clinical decision support tool for pain management in primary care.

ObjectiveGiven time constraints, poorly organized information, and complex patients, primary care providers (PCPs) can benefit from clinical decision support (CDS) tools that aggregate and synthesize problem-specific patient information. First, this article describes the design and functionality of a CDS tool for chronic noncancer pain in primary care. Second, we report on the retrospective analysis of real-world usage of the tool in the context of a pragmatic trial.Materials and methodsThe tool known as OneSheet was developed using user-centered principles and built in the Epic electronic health record (EHR) of 2 health systems. For each relevant patient, OneSheet presents pertinent information in a single EHR view to assist PCPs in completing guideline-recommended opioid risk mitigation tasks, review previous and current patient treatments, view patient-reported pain, physical function, and pain-related goals.ResultsOverall, 69 PCPs accessed OneSheet 2411 times (since November 2020). PCP use of OneSheet varied significantly by provider and was highly skewed (site 1: median accesses per provider: 17 [interquartile range (IQR) 9–32]; site 2: median: 8 [IQR 5–16]). Seven “power users” accounted for 70% of the overall access instances across both sites. OneSheet has been accessed an average of 20 times weekly between the 2 sites.DiscussionModest OneSheet use was observed relative to the number of eligible patients seen with chronic pain.ConclusionsOrganizations implementing CDS tools are likely to see considerable provider-level variation in usage, suggesting that CDS tools may vary in their utility across PCPs, even for the same condition, because of differences in provider and care team workflows.

257 Factors Associated with Primary Care Provider (PCP) Use Among Home Dialysis Patients

OBJECTIVES/GOALS: Patients utilizing dialysis receive fewer primary care services, especially during the time of initiation of dialysis. This project aims to identify clinical or demographic factors that are associated with either initiation or continuity of PCP use after initiating home dialysis. METHODS/STUDY POPULATION: Using Medicare claims data from the United States Renal Data System (USRDS), we analyzed PCP use for patients aged 67 years or older. We included patients who initiated either peritoneal or home-hemodialysis between 2008-2014. Patients were followed for 2 years: 1 year before and after home dialysis initiation. We used a multivariable logistic model to control for various demographic and clinical factors believed to be confounders and to ascertain factors (i.e. age, race/ethnicity, area of residence, comorbidities, frailty scores) associated with initiation of PCP use or continuity of PCP use. RESULTS/ANTICIPATED RESULTS: Among the 9,854 patients analyzed, 68% of patients used PCP after dialysis initiation. 85% of patients who used PCP before dialysis continued PCP use after home dialysis initiation. Only 29% of patients who had not used PCP before dialysis initiated PCP use after. Employment (vs. unemployment) and use of home-hemodialysis (vs peritoneal) were associated with lower odds of PCP continuity of care. Diabetes and pre-dialysis nephrology care were associated with greater odds of PCP continuity of care. Black race (vs White) and high frailty scores were associated with lower odds of PCP initiation. Those with cardiovascular disease, residence in the South (vs the Northeast), and residence in more urban areas (vs low urban) were associated with greater odds of PCP initiation. DISCUSSION/SIGNIFICANCE: This study highlights the prevalence of PCP use, as well as the factors and subgroups that are associated with lower PCP use among patients receiving home dialysis. These findings will guide future research, interventions and policies in order to improve our understanding of the barriers to PCP use in that population.

COPD Readmissions and Hospital Primary Care Physicians

The Centers for Medicare &amp; Medicaid Services (CMS) collects data on hospital 30-day Chronic Obstructive Pulmonary Disease (COPD) readmission rates to reduce preventable readmissions and prevent wasteful use of Medicare dollars. Hospitals have begun exploring different strategies to reduce their COPD-related 30-day readmissions. One key strategy has been the use of primary care providers (PCPs). This study examined the association between the percentage of PCPs at the hospital and Medicare COPD 30-day readmissions from 2014 to 2019. Results demonstrate a slight positive association between PCP percentage and COPD 30-day readmission. Further, hospitals in rural areas and those in less competitive environments are also associated with increased COPD readmission rates; yet, hospitals that are part of a system, provide medical education, or are larger, tend to have lower readmission rates.

Silver Linings Around the Increased Use of Telehealth After the Emergence of COVID-19: Perspectives From Primary Care Physicians.

Introduction/Objectives:With the emergence of COVID-19, the transition from in-person care to widespread use of telehealth raised many well-described challenges for primary care providers (PCP). The purpose of this study was to improve understanding of how this increased use of telehealth impacted PCPs in positive ways, and specifically focus on any “silver linings” of using telehealth.Methods:We interviewed PCPs working at a large Midwestern academic medical center between June and July 2020 and asked for perspectives about the use of telehealth during the pandemic. Verbatim transcripts were coded and analyzed using deductive dominant thematic analysis that allowed for categorization of data and identification of emergent themes.Results:PCPs noted 3 main benefits of using telehealth: (1) demonstrated remote care was feasible, (2) patients expressed gratitude; and (3) payers fully reimbursed for telehealth visits. PCPs also described “silver linings” they perceived for patients: (1) easier access to care, (2) more convenient follow-up care, and (3) ability to get quick specialty referrals.Conclusions:Study participants offered encouraging feedback regarding the potential for telehealth to offer a convenient and patient-centric alternative to in-person care. As a healthcare delivery mode, telehealth can remove personal and social barriers to care for many patients, but reimbursement parity and more evidence is needed to inform best practices for ongoing telehealth use in primary care. With the continuing use of telehealth, it will be important to monitor health outcomes as well as consider how these modalities may need to be adapted to mitigate potential care disparities.

Diabetes and the use of primary care provider services in rural, remote and metropolitan Australia

Public health agencies around the world are concerned about an ever-increasing burden of type 2 diabetes and related disability. Access to primary care providers (PCPs) can support early diagnosis and management. However, there is limited literature on how frequently older people with diabetes access PCPs, and their levels of access in rural Australia relative to metropolitan areas. In this research, patterns of PCP use among those with diagnosed diabetes and those without diagnosed diabetes (referred to as 'healthy' individuals) were compared using a large survey of more than 230 000 people aged 45 years and older from New South Wales, Australia. A published model to study the PCP access patterns of a group of individuals with diabetes risk was used. Annual visits to PCPs among people aged 45 years or more with diabetes in rural areas, while higher than for healthy rural residents, were significantly lower than their metropolitan counterparts, mirroring similar disparities in PCP use across the rural-urban divide in the healthy population. Similar patterns were present in the high-risk population. Nevertheless, people with diabetes visited PCPs around four times a year, which is around the recommended number of annual visits, although some groups (eg those with comorbidities) may need more visits. Patterns of PCP use among rural residents, while significantly less frequent than their metropolitan counterparts, are at the recommended level for people with diabetes.

A pilot study of the functionality and clinician acceptance of a clinical decision support tool to improve primary care of opioid use disorder

ObjectiveMost Americans with opioid use disorder (OUD) do not receive indicated medical care. A clinical decision support (CDS) tool for primary care providers (PCPs) could address this treatment gap. Our primary objective was to build OUD-CDS tool and demonstrate its functionality and accuracy. Secondary objectives were to achieve high use and approval rates and improve PCP confidence in diagnosing and treating OUD.MethodsA convenience sample of 55 PCPs participated. Buprenorphine-waivered PCPs (n = 8) were assigned to the intervention. Non-waivered PCPs (n = 47) were randomized to intervention (n = 24) or control (n = 23). Intervention PCPs received access to the OUD-CDS, which alerted them to patients at potentially increased risk for OUD or overdose and guided diagnosis and treatment. Control PCPs provided care as usual.ResultsThe OUD-CDS was functional and accurate following extensive multi-phased testing. PCPs used the OUD-CDS in 5% of encounters with at-risk patients, far less than the goal of 60%. OUD screening confidence increased for all intervention PCPs and OUD diagnosis increased for non-waivered intervention PCPs. Most PCPs (65%) would recommend the OUD-CDS and found it helpful with screening for OUD and discussing and prescribing OUD medications.DiscussionPCPs generally liked the OUD-CDS, but use rates were low, suggesting the need to modify CDS design, implementation strategies and integration with existing primary care workflows.ConclusionThe OUD-CDS tool was functional and accurate, but PCP use rates were low. Despite low use, the OUD-CDS improved confidence in OUD screening, diagnosis and use of buprenorphine.NIH Trial registration NCT03559179. Date of registration: 06/18/2018. URL: https://clinicaltrials.gov/ct2/show/NCT03559179

The Effect of Government-Uninsured Optometric Services on the Use of Primary Care Providers.

IntroductionEye care in many countries is provided by optometrists, ophthalmologists, primary care providers (PCPs, including family physicians and pediatricians) and emergency department (ED) physicians. In the province of Prince Edward Island (PEI), Canada, optometric services are not government-insured, while services provided by other eye care providers are government-insured. Clinics of optometrists, PCPs and ED physicians are widely distributed across the island. Clinics of ophthalmologists however are concentrated in the capital city Charlottetown.PurposeTo investigate if more patients visited government-insured PCPs and EDs for eye care when local optometric services are government-uninsured and government-insured ophthalmologists are potentially distant.MethodsFrom PEI physician billing database, we identified all patients with an ocular diagnosis from 2010–2012 using International Classification of Diseases, 9th Revision (ICD-9) codes. The utilization of government-insured PCPs and EDs in five geographical regions was assessed utilizing patients’ residential postal code. Of the five regions, Prince was the region farthest from the capital Charlottetown.ResultsCompared to utilization of government-insured PCPs for ocular diagnoses in Charlottetown (13.5% in 2010, 95% confidence interval [CI] 12.9–14.0%), the utilization in Prince (22.4% in 2010, 95% CI 21.7–23.1%) was nearly double (p<0.05). The utilization of ED physicians for ocular diagnoses was similarly double in Prince (8.8%, 95% CI 8.3–9.3%) versus Charlottetown (4.1%, 95% CI 3.8–4.5%). The utilization of ophthalmologists however was significantly lower in Prince (43%, 95% CI 41.4–42.9%) versus Charlottetown (56.3%, 95% CI 55.6–57.1%). Similar trends remained throughout 2010–2012.ConclusionWhen optometric services are government-uninsured and government-insured ophthalmologist services are geographically distant, ocular patients utilized PCPs and ED physicians more frequently. Due to different levels of training and available equipment for eye examinations among PCPs, ED physicians and optometrists, the quality of eye care and cost-effectiveness of increased use of PCPs and ED physicians for ocular management warrant further investigation.Trial RegistrationNot applicable.

Abstract P685: Primary Care Utilization for Primary Prevention Continues to Be Lacking in Patients With Stroke

Introduction: Primary care plays an essential role in stroke prevention. Yet still, for many stroke patients, a relationship with a primary care provider (PCP) is not established until after stroke. Our goal was to determine if lack of PCP and the consequential differences in management affects stroke severity. Methods: Data was obtained from our Institutional Review Board approved stroke admission database from 2017 to November 2019 of all stroke subtypes (ischemic stroke, transient ischemic attack, subarachnoid and intracerebral hemorrhages). Non-parametric Mann Whitney t-test and regression analysis was used to identify significant differences in medications, stroke risk factors and stroke severity. Results: A total of 559 patients were included, median age 67 (interquartile range (IQR) 58-76), 49% woman, 32% established care with a PCP, 36% on medications for diabetes mellitus (DM), 42% hyperlipidemia, 66% anti-hypertensives, 39% anti-platelet agents, and 10% anticoagulation. More patients with PCP were taking anti-hypertensive medications (80% versus (vs) 60%, p value &lt; 0.0001), DM medications (56% vs 30%, p value &lt; 0.0001), anti-platelet agents (46% vs 35%, p value = 0.0149), and medications for hyperlipidemia (49% vs 39%, p value = 0.0426). Admission NIHSS was lower in patients with a PCP median 6 (IQR 3-11) vs median 9 (IQR 4 -15), p value= 0.0016, and median hemoglobin A1c was higher in patients with a PCP 8 (IQR 5.7- 9.3) vs patients without a PCP prior to their stroke 6 (IQR 5.4 - 8.5), p value= 0.0002. Admitting systolic blood pressure was similar 155 (137-177) vs 152 (134-171). After correcting for age and gender, regression analysis demonstrated a significant association between whether a patient had PCP and antihypertensive medication use (odds ratio (OR) 2.413, 95% confidence interval 1.511 - 3.914) and hemoglobin A1c (OR 1.122, 95% CI 1.037 - 1.215). Also, patients with a PCP were more likely to have a lower NIHSS on admission (OR 0.9679, 95% CI 0.9423 - 0.9930). Conclusions: These result show that patients not followed by a PCP prior to stroke are less likely to be on medications for primary prevention of stroke, contributing to an increased stroke severity on admission. More research is needed to identify barriers to patients establishing care with PCP.

Challenges to Detecting and Addressing Intimate Partner Violence Among Roma Women in Spain: Perspectives of Primary Care Providers.

The objective of this study is to identify challenges and facilitators for detecting and addressing cases of intimate partner violence (IPV) against Roma women, from the perspectives of health personnel and representatives of Roma organizations, and to compare both perspectives. A total of 28 semi-structured interviews were carried out between November 2014 and February 2015 in different Spanish cities. A thematic analysis was carried out, guided by Aday and Andersen's model regarding barriers to access to health services. Both groups signaled the following as principal challenges: (a) consideration of IPV as a private problem among the Roma population, (b) little use of primary care providers for prevention, (c) distrust of Roma women toward primary care professionals as resources for seeking help, (d) the inexistence of Roma professionals in health services, (e) health professionals' lack of cultural sensitivity related to Roma people, and (f) the focus of health protocols for action against IPV on filing a police report. Potential facilitating factors included Roma women's trust in nurses, social workers, and pediatricians and ethnic heterogeneity. There is need to promote action to address the identified challenges through a health equity approach that includes greater training and awareness raising among health professionals about Roma culture and the specific needs of Roma women.

Offering eConsult to Family Physicians With Patients on a Pain Clinic Wait List: An Outreach Exercise.

Wait times for many chronic pain programs in Canada range from 6 months to 2 years. This project sought to determine the interest of primary care providers (PCPs) in using an electronic consult system for patient(s) waiting for a pain consultation. This cross-sectional study was conducted at the pain clinic of a Canadian tertiary academic health sciences center. Participants were PCPs who had submitted a referral to this clinic. Referrals received between April 1, 2012, and March 31, 2014, were reviewed to determine their appropriateness for eConsult, and a letter providing information about eConsult and encouraging its use was sent to the referring PCP. Of the 585 referrals that were reviewed, 227 were appropriate for eConsult. Fifty-one (26%) of the 194 PCP responses received were positive. Technologies like eConsult may help address the growing demand for specialist advice. In addition to facilitating response to specific questions, the bidirectional nature of eConsult permits its use for educating PCPs about chronic pain treatment. Given that almost one third of responding PCPs indicated an interest in eConsult, its potential reach is vast. Additional study is needed to understand barriers to PCP acceptance and use of eConsult and the uptake of advice given.

Patterns of primary healthcare use among female exotic dancers in Baltimore, Maryland

ABSTRACTFemale exotic dancers (FEDs) are often exposed to violence-, sex- and drug-related occupational harms and are precluded from employer-based health insurance. We examined access to primary health-care resources, correlates of use, and service needs among a sample of new FEDs (N = 117) working in 22 exotic dance clubs (EDCs) in Baltimore, MD. Self-administered surveys were completed between May and October 2014. Health care measures were aggregated and described, and correlates of use were evaluated using Fisher Exact and Poisson regression with robust variance, adjusting for race/ethnicity. The majority of dancers reported having health insurance (80%), a primary care provider (PCP) (68%), and having visited a PCP (74%). Among dancers with insurance, all were covered by Medicaid. Multivariable regression models demonstrated that having a regular PCP was associated with recent PCP use (adjusted prevalence ratio 1.5; 95% confidence interval: 1.1, 2.1). Despite a high level of health-care coverage and recent visits to PCP, dancers frequently sought services at the emergency department and reported needs for medical care, including mental health support services and drug treatment. Findings highlight that basic access to primary health care is available and used but may not be fully meeting dancers’ complex needs.

Measuring Relationships between Doctor Densities and Patient Visits: A Dog’s Breakfast of Small Area Health Geographies

A number of small area geographies are used in Australia to investigate primary care relevant outcomes/behaviours and to manage the supply of Primary Care Providers (PCP) that influence these outcomes. However, very little research exists on the choice of a small area geography suitable for these purposes. We evaluated a large basket of Australian small area geographies to determine which geography is optimal for investigating relationships between PCP supply and the use of PCP services. We used linked data to evaluate the relationship between PCP supply and the likelihood of a patient visiting a PCP, after adjusting for individual level covariates. PCP supply was measured at different geographies including Local Government Areas (LGAs), Primary Health Networks (PHNs), Statistical Areas-1/2/3 and Remoteness Areas. Overall, the strongest relationships between PCP density and PCP use were found when LGAs were used to measure PCP density. Large geographies such as PHNs also detected strong relationships while custom built geographies such as Primary Care Service Areas were not significantly better than the rest. Existing geographies such as LGAs may be suitable for investigating the effect of PCP supply at state or national scales.

Facilitating primary care provider use in a patient-centered medical home intervention study for chronic hemodialysis patients.

Patients with chronic kidney disease have a high disease burand may benefit from primary care services and care coord A medical home model with direct access to primary care services is one approach that may address this need, yet has not been examined. As a substudy of the Patient-Centered Outcomes Research Institute (PCORI) patient-centered medical home for kidney disease (PCMH-KD) health system intervention study, we examined the uptake of free primary care physician (PCP) services. The PCORI PCMH-KD study was an initial step toward integrating PCPs, a nurse coordinator, a pharmacist, and community health workers (CHWs) within the health care delivery team. Adult chronic hemodialysis (CHD) at two urban dialysis centers were enrolled in the intervention. We examined trends and factors associated with the use of the PCMH-KD PCP among two groups of patients based on their report of having a regular physician for at least six months (established-PCP) or not (no-PCP). Of the 173 enrolled patients, 91 (53%) patients had at least one visit with the PCMH-KD PCP. The rate of visits was higher in those in the no-PCP group compared with those in the established-PCP group (62% vs. 41%, respectively). Having more visits with the CHW was positively associated with having a visit with the PCMH-KD PCPs for both groups. Embedded CHWs within the care team played a role in facilithe uptake of PCMH-KD PCP. Lessons from this health system intervention can inform future approaches on the integration of PCPs and care coordination for CHD patients.

Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial.

To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales. Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review. One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6-27.7) and 18.8 (95% CI, 1.9-35.7) percentage points, respectively. A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.

Primary Care Provider Use Rates of a Clinical Decision Support Tool and Change in Diabetes Performance Measures

Primary Care Provider Use Rates of a Clinical Decision Support Tool and Change in Diabetes Performance Measures