Primary careThe Research Articles

Face-to-Face Relationships Still Matter in a Digital Age: A Call for a 5th C in the Core Tenets of Primary Care.

We primary care clinicians, scholars, and leaders ascribe value to Barbara Starfield's core tenets of primary care-the 4 Cs: first contact, comprehensiveness, coordination, and continuity. In today's era of rapid technological advancements and dwindling resources, what are the implications for face-to-face interactions of patient-clinician relationships? We propose adding a 5th C: "Contiguity." Contiguity-or physical proximity and presence-is a key dimension that not only enables the necessary technical aspects of a physical exam but also authenticates the most human aspects of a relationship and occurs specifically when we are physically vulnerable and responsible for the other before us. This, in turn, may best enable us to bridge difference and nurture trust with our patients. We measure what we value and, thus, naming Contiguity as a core tenet assures that we will not lose sight of this keystone in a patient's relationship with their personal physician.

Urinary Incontinence in Primary Care-The Gap Between Recommendations and Real World.

Routine screening for urinary incontinence (UI) by primary care providers (PCPs) is recommended. We aimed to describe the rate of incident UI diagnosed at annual PCP visits, the prevalence of UI in a large primary care population, and estimate the rate of screening for UI during primary care preventive and annual wellness visits. Secondary aims were to describe PCP knowledge and behavior as they relate to UI screening and diagnosis. The electronic health record was used to abstract the number of adult female patients seen by PCPs within a regional health system with a diagnosis of UI before our study period and with a new diagnosis over a 2-year period. Additional new diagnoses and screening practices were found on chart review of an additional 824 representative charts. Primary care providers within the health system were surveyed about their screening practices and knowledge about UI. There were 192,053 women primary care patients seen over 2 years. A total of 5.7% had a UI diagnosis preceding the study period and 3.4% had a UI diagnosis during the study period. A total of 42% of PCPs reported that they screen for UI at least half the time and none were completely satisfied with their ability to screen for UI. Sixteen percent of annual wellness visits had any documentation of screening for UI. In a large primary care population, screening for and detection of UI in women was low.

Improving the Reporting of Primary Care Research: Consensus Reporting Items for Studies in Primary Care-the CRISP Statement.

Primary care (PC) is a unique clinical specialty and research discipline with its own perspectives and methods. Research in this field uses varied research methods and study designs to investigate myriad topics. The diversity of PC presents challenges for reporting, and despite the proliferation of reporting guidelines, none focuses specifically on the needs of PC. The Consensus Reporting Items for Studies in Primary Care (CRISP) Checklist guides reporting of PC research to include the information needed by the diverse PC community, including practitioners, patients, and communities. CRISP complements current guidelines to enhance the reporting, dissemination, and application of PC research findings and results. Prior CRISP studies documented opportunities to improve research reporting in this field. Our surveys of the international, interdisciplinary, and interprofessional PC community identified essential items to include in PC research reports. A 2-round Delphi study identified a consensus list of items considered necessary. The CRISP Checklist contains 24 items that describe the research team, patients, study participants, health conditions, clinical encounters, care teams, interventions, study measures, settings of care, and implementation of findings/results in PC. Not every item applies to every study design or topic. The CRISP guidelines inform the design and reporting of (1) studies done by PC researchers, (2) studies done by other investigators in PC populations and settings, and (3) studies intended for application in PC practice. Improved reporting of the context of the clinical services and the process of research is critical to interpreting study findings/results and applying them to diverse populations and varied settings in PC.Annals "Online First" article.

Systematic urine drug testing for detecting and managing opioid misuse among chronic noncancer pain patients in primary care-The HARMS Program: A retrospective chart review of 77 patients.

The prevalence of opioid abuse has reached an epidemic level. National guidelines recommend safer opioid prescribing practices, including potentially monitoring patients with urine drug testing (UDT). There is limited research evidence sur-rounding the use of UDT in the context of chronic noncancer pain (CNCP). We evaluated the efficacy of systematic, randomized UDT to detect and manage opioid misuse among patients with CNCP in primary care. The Marathon Family Health Team (MFHT) designed and implemented a clinic-wide, randomized UDT program called the HARMS (High-yield Approach to Risk Mitigation and Safety) Program. This retrospective chart review includes 77 CNCP patients being pre-scribed opioids, who were initially stratified by their prescriber as "low-risk." Each month, 10 percent of patients were selected for a random UDT with double testing (immunoassay and liquid chromatography-mass spectrometry). The pri-mary outcome measure was UDT leading to a change in management plan. Of the 77 patients in the study, 55 (71 per-cent) completed at least one UDT during the 12-month study period. Overall, 22 patients had aberrant results. UDT led directly to changes in management in 15 of those patients. Four of those 15 patients were escalated to an addictions program, two were tapered from opioids with informed discussion, and nine were escalated to the high-risk monitoring stream. The results of this study show that in low-risk CNCP patients prescribed opioids, applying systematic UDT in a primary care setting is effective for detecting high risk behaviors and addiction, and altering management. Further re-search is needed with larger numbers using a prospective study design.

Delayed diagnosis in primary care-The main cause of sarcoma litigation in the United Kingdom.

Poor awareness and knowledge of lumps and bumps can impact on patient outcomes and survival. Late referrals or false reassurance may lead to litigation proceedings. The aim of this study was to identify the litigation cost in sarcoma care and identify areas for improvement. Orthopaedic litigation between 1995-2010 in England and Wales was obtained from the National Health Service Litigation Authority. Litigation specifically relating to sarcoma in the extremities was identified. Causation, compensation fee, cost of legal defense, and compensation were analyzed. There were 52 litigation claims. Negligence was proven in 71% (n = 37) of cases. The total cost was £4.4 million (mean of £84,000/case). The mean compensation award was £92,000 (range £650-£978,000) and the mean defense cost was £22,000 (range £0-£102,000). Delayed diagnosis accounted for 89% of cases (n = 48). Negligence following diagnosis was infrequent; inappropriate treatment (n = 2), failure to recognize complications of surgery (n = 2), intra-operative problems (n = 1), failure to refer to a specialist unit after a "whoops procedure" (n = 1). Once the patient is within the specialist sarcoma unit, there is a very low rate of litigation. Efforts to reduce litigation in sarcoma treatment should focus on early diagnosis and raising awareness of sarcomas. J. Surg. Oncol. 2016;113:361-363. © 2016 Wiley Periodicals, Inc.

Table of Contents

AbstractCMS May Stop Maine Medicaid from Limiting Methadone TreatmentRimrock CEO Seeks to Draw from Experience in Primary CareThe LetterIC&RC and NAADAC Support ATTC Workforce RecommendationsCRC Celebrates Recovery Month with Expansion in PennsylvaniaRat Study Finds Intermittent Drinking Leads to Heavier UseNames in the NewsComing up

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

1167 T important role of general practitioners in prescribing antidepressant medications and treating depression has been documented. However, the extent to which general practitioners are prescribing other types of psychotropic medications has received less emphasis. This study used data from August 2006 to July 2007 from the National Prescription Audit (NPA) Plus database of IMS to examine this question. IMS collects transaction information each month from approximately 36,000 retail pharmacies, representing about 70% of all retail pharmacies, which when weighted represent all prescriptions filled in retail outlets in the United States. Using a separate sample of retail pharmacy transactions that includes the physician’s Drug Enforcement Administration number, IMS assigns physician specialty information to obtain an estimate of the total number of prescriptions filled in retail pharmacies by medical specialty. As shown Figure 1, of the 472 million prescriptions for psychotropic medications, 59% were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and nonphysician providers. General practitioners wrote prescriptions for 65% of the anxiolytics in the sample, 62% of the antidepressants, 52% of the stimulants, 37% of the antipsychotics, and 22% of the antimania medications. Conversely, psychiatrists and addiction specialists wrote prescriptions for 66% of the antimania medications, 49% of the antipsychotics, 34% of the stimulants, 21% of the antidepressants, and 13% of the anxiolytics. Pediatricians were included as general practitioners and wrote 25% of all stimulant prescriptions but only 3% of all other types of psychotropic medications (data not shown). Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment. However, concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment. Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

The Good Appraisal Toolkit for Primary Care Chambers Ruth et al The Good Appraisal Toolkit for Primary Care 189pp Radcliffe Publishing 9781857756029 1857756029.

The principles and frameworks demonstrated in this book could be used in many other healthcare settings. The text is divided neatly into nine chapters and addresses practical issues such as being an effective appraiser, developing and demonstrating competence, linking appraisal with career development, and evaluation of the appraisal process. The comprehensive approach to all aspects of appraisal makes this a must-have book for all health professionals and managers undertaking appraisals. It should also appeal to clinical governance leads and individuals being appraised. There are excellent tips on how to prepare for appraisals and how to link this with reflection, lifelong learning, career direction, and so on. The book is well referenced and contains an appendix with useful examples for the appraiser.

The challenge for primary careThe challenge for primary care Nigel Starey Radcliffe Medical Press 320 £35.00 1 85775 569 3 1857755693

The challenge for primary careThe challenge for primary care Nigel Starey Radcliffe Medical Press 320 £35.00 1 85775 569 3 1857755693

The guide to mental health for nurses in primary careThe guide to mental health for nurses in primary care Elizabeth Armstrong The Guide to Mental Health for Nurses in Primary Care Radcliffe Medical Press 159pp £17.95 1 85775 435 2 1857754352

The guide to mental health for nurses in primary careThe guide to mental health for nurses in primary care Elizabeth Armstrong The Guide to Mental Health for Nurses in Primary Care Radcliffe Medical Press 159pp £17.95 1 85775 435 2 1857754352

Systematic review of near patient test evaluations in primary care

Objective: To identify and qualitatively synthesise the findings from all studies that have examined the performance and effect of near patient tests in the primary care setting.Design: Systematic review of...

Primary care: core values Patient centred primary care

This is the second in a series of six articles reflecting on the core values that will underpin the development of primary care The importance and primacy of the clinician-Fpatient...

CORRESPONDENCEThe PPACounselling in Primary CareThe real issues and ClevelandCollege debateCommunity Care Inquiry

CORRESPONDENCEThe PPACounselling in Primary CareThe real issues and ClevelandCollege debateCommunity Care Inquiry

Somatization and the recognition of depression and anxiety in primary care.

The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety. The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.

Social work and primary care--the need for increased collaboration: discussion paper.

Social work and primary care--the need for increased collaboration: discussion paper.

Summary Address: PRIMARY CARE‐THE PROBLEM AND THE PROSPECT

Annals of the New York Academy of SciencesVolume 310, Issue 1 p. 265-274 Full Access Summary Address: PRIMARY CARE-THE PROBLEM AND THE PROSPECT Cecil G. Sheps, Cecil G. Sheps School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27514Search for more papers by this author Cecil G. Sheps, Cecil G. Sheps School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27514Search for more papers by this author First published: June 1978 https://doi.org/10.1111/j.1749-6632.1978.tb22086.xCitations: 5AboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume310, Issue1Primary Health Care in Industrialized NationsJune 1978Pages 265-274 RelatedInformation RecommendedA Multiple‐Levels‐of‐Analysis Perspective on ResilienceDANTE CICCHETTI, JENNIFER A. BLENDER, Annals of the New York Academy of SciencesCompetence and Resilience in DevelopmentANN S. MASTEN, JELENA OBRADOVIĆ, Annals of the New York Academy of SciencesAdvances in primary immunodeficiency diseases in Latin America: epidemiology, research, and perspectivesPaolo Ruggero Errante, José Luis Franco, Francisco Javier Espinosa-Rosales, Ricardo Sorensen, Antonio Condino-Neto, Annals of the New York Academy of SciencesControl of Human Herpes Virus Type 8–Associated Diseases by NK CellsMARIA C. SIRIANNI, MASSIMO CAMPAGNA, DONATO SCARAMUZZI, MAURIZIO CARBONARI, ELENA TOSCHI, ILARIA BACIGALUPO, PAOLO MONINI, BARBARA ENSOLI, Annals of the New York Academy of SciencesHealthy Aging for CaregiversTINA WU, KAREN LO, Annals of the New York Academy of Sciences

CORTICOSTEROID ARTHROPATHY AND TENDON RUPTURE

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