Specialty Care Physicians Research Articles

Clinician Views of Proactive Tobacco Treatment Programs: A Qualitative Evaluation.

Proactive tobacco treatment programs are an evidence-based strategy to recruit patients who smoke to make supported quit attempts. However, such programs are rarely implemented. We performed a qualitative assessment of clinicians to inform the creation of a proactive outreach program for patients with chronic obstructive pulmonary disease (COPD) who smoke. Informed by the Consolidated Framework for Implementation Research, we conducted semi-structured interviews to assess clinician views of proactive outreach, including barriers, program structure, and the use of technology. Clinicians included primary and specialty care physicians, nurses and advanced practice providers, pharmacists, respiratory therapists, a psychologist, and relevant members of leadership. Interviews were transcribed and analyzed using directed content analysis. Clinicians in all roles identified that proactive outreach could be an effective use of resources to help patients with COPD who smoke quit with several advantages over the current state. Clinicians disagreed on the priority population (e.g., younger patients, sicker patients), and to some extent on whether proactive outreach is a clinical priority. Though they supported that technology could be part of the outreach program, most advocated for multiple avenues (phone calls, drop-in clinic, texting), as these patients were perceived to be low technology utilizers. The primary implementation barriers were competing priorities and cost, as well as unclear billing and staffing models. Clinicians support proactive outreach for patients with COPD, but the optimal way to structure, staff, and fund such programs remains unclear. Health systems should leverage implementation strategies to speed uptake of these potentially life-saving programs.

Identifying trusted local sources and predicting behavior change pathways according to COVID-19 vaccination status: Results of a 2022 statewide survey of Alaskan adults

BackgroundLow rates of COVID-19 vaccination remain a substantial public health challenge. Despite early successes, vaccinations of Alaskans trail the US average, drawing attention to the need for better-designed and targeted vaccine confidence interventions. Our objective was to assess levels of community trust and theory-driven predictors of vaccination status to inform the design of future programs. MethodsWe conducted a cross-sectional, telephone-based survey of 940 Alaskan adults between May and June 2022. Data were collected on vaccination status (including initial vaccination and receipt of booster shots), trust in local community members, demographic characteristics, and thematic questions designed using the Capability, Opportunity, Motivation - Behavior (COM-B) model to examine possible predictors (barriers/facilitators) of vaccination status. FindingsAmong those who are not fully vaccinated and boosted, we observe significantly lower trust placed in many immediate community members, especially health workers (e.g., doctors, nurses, specialty care physicians, health administrators). Firefighters and emergency medical technicians enjoy the most community trust, followed by medical professionals. Among those who received only a primary vaccine series, we find that perceptions of whether close friends are vaccinated, a sense of professional responsibility, and age were the strongest predictors vaccination status. Among the unvaccinated, we find significant predictive power from the same variables, as well as perceptions of whether family members are vaccinated, perceived risks from non-vaccination and whether vaccination is a healthy choice. ConclusionsThese findings will help inform the design and targeting of future vaccine promotion interventions to adult populations in Alaska. Interventions that leverage reflective motivation and social opportunity domains of the COM-B framework may be most effective. Local community members including firefighters and emergency medical technicians, as well as medical professionals may be perceived as the most trustworthy and influential messengers among those who are not fully vaccinated and boosted.

Where Are All the Specialists? Current Challenges of Integrating Specialty Care Into Population-Based Total Cost of Care Payment Models.

The Centers for Medicare & Medicaid Services Innovation Center (CMMI) has set the goal for 100% of traditional Medicare beneficiaries to be part of an accountable care relationship by 2030. Lack of meaningful financial incentives, intolerable or unpredictable risk, infrastructure costs, patient engagement, voluntary participation, and operational complexity have been noted by the provider and health care delivery community as barriers to participation or reasons for exiting programs. In addition, most piloted and implemented population-based total cost of care (PB-TCOC) payment models have focused on the role of the primary care physician being the accountability (that is, attributable) leader of a patient's multifaceted care team as well as acting as the mayor of the "medical neighborhood," leaving the role of specialty care physicians undefined. Successful provider specialist integration into PB-TCOC models includes meaningful participation of specialists in achieving whole-person, high-value care where all providers are financially motivated to participate; there is unambiguous prospective attribution and clearly defined accountability for each participating party throughout the care journey or episode; there is a known care attribution transition accountability plan; there is actionable, transparent, and timely data available with appropriate data development and basic analytic costs covered; and there is advanced payment to the accountable person or entity for management of the care episode that is part of a longitudinal care plan. Payment models should be created to address the 7 challenges raised here if specialists are to be incented to join TCOC models that achieve CMMI's goal.

Assessment of Ophthalmology Teaching and its Impact on the Choice of Future Specialties Among Medical Students of Jazan University.

Ophthalmology is essential for primary and specialty care physicians, as eye complaints are common, accounting for a sizable proportion of general practice consultations and emergency department visits. Fundamental ophthalmology knowledge is also relevant to other specialty fields. Thus, medical schools must provide effective undergraduate curricula to teach students about salient points, visual examination skills, emergency recognition, and referral indications. The International Council of Ophthalmology (ICO) has set guidelines that medical students should imbibe to become proficient in ophthalmology. However, there have been no recent investigationsevaluating undergraduate ophthalmology education at Jazan University's Faculty of Medicine. Therefore, this study aimed to compare the curriculum at Jazan University to the ICO's requirements for undergraduate medical education. An observational cross-sectional study was conducted with both male and female student participantsenrolled in an ophthalmology course at Jazan University's Faculty of Medicine. Following IRB approval, the questionnaire was distributed on social media to assess if Jazan University's undergraduate ophthalmology curriculum complies with ICOstandards. The study included a diverse sample of 322 participants, predominantly consisting of female students (n=178, 55.3%). The participants' ages ranged from 22 to 36 years, with the majority falling within the 24-25 year age range (n=173, 53.7%). Regarding academic performance, (n=117, 36.3%) of participants had a GPA of less than 4, while 66 (20.5%) had a GPA between 4.76 and 5.00. Among the respondents, 31 (9.6%) indicated having no exposure to ophthalmology, while 117 (36.3%) felt they had insufficient exposure. A considerable percentage of participants expressed competence in various areas, such as obtaining ocular history (n=113, 35.1%), testing visual acuity (n=201, 62.4%), and examining extraocular motility (n=201, 62.4%). In total, 98participants (30.4%) expressed an interest in ophthalmology, while the majority (n=224, 69.6%) were not interested. Essential improvements include increasing hands-on clinical experience, small-group learning, exposure across academic years, and early mentorship. Developing competency-based curricula aligned with ICO guidelines could significantly strengthen education. Better training quality and exposure will equip students with the necessary skills, boost confidence, and potentially expand the ophthalmology workforce.

Exploring provider roles, continuity, and mental models in cirrhosis care: A qualitative study.

BACKGROUND: Advanced cirrhosis results in frequent emergency department visits, hospital admissions and readmissions, and a high risk of premature death. We previously identified and compared differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions in care. The aim of this paper is to further explore how challenges to continuity and coordination of care influence how health care providers adapt in their approaches to and development of mental models of cirrhosis care. METHODS: Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling took place over 6 months across Alberta for a total of 19 participants, made up of family physicians (n = 8), specialists (n = 9), and cirrhosis nurse practitioners (n = 2). RESULTS: Lack of continuity in cirrhosis care, particularly informational and management continuity, not only hinders health care providers' ability to develop rich mental models of cirrhosis care but may also determine whether they form a patient-centred or task-based mental model, and whether they develop shared mental models with other providers. CONCLUSIONS: The system barriers and gaps that prevent the level of continuity needed to coordinate care for people with cirrhosis lead providers to create and work under mental models that perpetuate those barriers, in a vicious cycle. Understanding how providers approach cirrhosis care, adapt to the challenges facing them, and develop mental models offers insights into how to break that cycle and improve continuity and coordination.

Performance and usability testing of an automated tool for detection of peripheral artery disease using electronic health records

Peripheral artery disease (PAD) is a common cardiovascular disorder that is frequently underdiagnosed, which can lead to poorer outcomes due to lower rates of medical optimization. We aimed to develop an automated tool to identify undiagnosed PAD and evaluate physician acceptance of a dashboard representation of risk assessment. Data were derived from electronic health records (EHR). We developed and compared traditional risk score models to novel machine learning models. For usability testing, primary and specialty care physicians were recruited and interviewed until thematic saturation. Data from 3168 patients with PAD and 16,863 controls were utilized. Results showed a deep learning model that utilized time engineered features outperformed random forest and traditional logistic regression models (average AUCs 0.96, 0.91 and 0.81, respectively), P < 0.0001. Of interviewed physicians, 75% were receptive to an EHR-based automated PAD model. Feedback emphasized workflow optimization, including integrating risk assessments directly into the EHR, using dashboard designs that minimize clicks, and providing risk assessments for clinically complex patients. In conclusion, we demonstrate that EHR-based machine learning models can accurately detect risk of PAD and that physicians are receptive to automated risk detection for PAD. Future research aims to prospectively validate model performance and impact on patient outcomes.

Hepatitis C Virus Screening: Factors Associated With Test Completion in a Large Academic Health Care System.

In 2012, onetime hepatitis C virus (HCV) screening was recommended for all baby boomers (people born during 1945-1965) in the United States, but only 4.0%-12.9% of baby boomers have ever had a screening ordered by a health care provider. This study examined the HCV screening prevalence among adult patients in a large academic health care system and assessed factors associated with the completion of screening when ordered for baby boomers. We defined HCV screening completion as the completion of an HCV antibody test when it was ordered. We used electronic health records to examine HCV screening completion rates among adults (N = 106 630) from August 1, 2015, through July 31, 2020, by birth cohort. Among baby boomers whose health care provider ordered HCV screening, we examined frequency and percentages of HCV screening completion by sociodemographic and clinical characteristics. We conducted univariate and multivariable logistic regression analyses to assess factors associated with HCV screening completion among baby boomers. During the study period, 73.0% of baby boomers completed HCV screening when it was ordered. HCV completion did not differ by sex or race and ethnicity among baby boomers. Baby boomers with Medicare supplemental health insurance compared with commercial health insurance (adjusted odds ratio [aOR] = 1.87) and those seeing only advanced practice professionals compared with specialty care physicians (aOR = 2.24) were more likely to complete HCV screening when it was ordered. Noncompletion of HCV screening is one of many barriers along the HCV treatment continuum. Our findings suggest a need for interventions targeting systems, health care providers, and patients to increase HCV screening rates in the United States.

Anesthetic Considerations of Intraoperative Submissive Pulmonary Embolism with Thrombus Crossing to the Left Heart via a Patent Foramen Ovale

From the Front Lines| October 2021 Anesthetic Considerations of Intraoperative Submissive Pulmonary Embolism with Thrombus Crossing to the Left Heart via a Patent Foramen Ovale Vignesh Sankar, BS; Vignesh Sankar, BS Search for other works by this author on: This Site PubMed Google Scholar Nazir Noor, MD; Nazir Noor, MD Search for other works by this author on: This Site PubMed Google Scholar Ruben H. Schwartz, DO; Ruben H. Schwartz, DO Search for other works by this author on: This Site PubMed Google Scholar Jason Hoyos, DO, FASA Jason Hoyos, DO, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor October 2021, Vol. 85, 41. https://doi.org/10.1097/01.ASM.0000795128.68970.d8 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Vignesh Sankar, Nazir Noor, Ruben H. Schwartz, Jason Hoyos; Anesthetic Considerations of Intraoperative Submissive Pulmonary Embolism with Thrombus Crossing to the Left Heart via a Patent Foramen Ovale. ASA Monitor 2021; 85:41 doi: https://doi.org/10.1097/01.ASM.0000795128.68970.d8 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Topics: intraoperative care, left side of heart, patent foramen ovale, pulmonary embolism, thrombus Mount Sinai Medical Center-Miami Beach is Florida's largest private, nonprofit teaching hospital focused on providing high-quality care to the diverse community of South Florida through teaching, research, and community advocacy. Established in 1949, our system includes 4,000 employees across 11 medical campuses, 672 beds, 26 operating suites, and 650 specialty care physicians with an additional 160 physicians trained every year. In such a large protocol-driven, multidimensional hospital center, the process of optimizing patient outcomes in surgery can be lost due to challenges in efficiency and coordination. Here, we demonstrate an example of how proper coordination and multidisciplinary discussion led to the best patient outcome in a high-risk surgical case. A 43-year-old male with a PMHx of atrial fibrillation, hypertension, high cholesterol, and type II diabetes mellitus presented to our institution with shortness of breath. He described the onset as sudden, constant, and moderate in severity. However, the patient denied any... You do not currently have access to this content.

Eliciting and Understanding Primary Care and Specialist Mental Models of Cirrhosis Care: A Cognitive Task Analysis Study.

Background Gaps in coordination and transitions of care for liver cirrhosis contribute to high rates of hospital readmissions and inadequate quality of care. Understanding the differences in the mental models held by specialty and primary care physicians may help to identify the root causes of problems in the coordination of cirrhosis care. Aim To compare and identify differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions. Methods Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling to select family physicians (n = 8), specialists (n = 9), and cirrhosis-dedicated nurse practitioners (n = 2) across Alberta. Results Family physicians do not maintain rich mental models of cirrhosis care. They see cirrhosis patients relatively infrequently, rebuilding their mental models when required (knowledge on demand). They have reactive and patient-need-focused, rather than proactive and system-of-care, mental models. Specialists' mental models are rich but vary widely between patient-centered and task-centered and in the degree to which they incorporate responsibility for addressing system gaps. Nurse practitioners hold patient-centered mental models like specialists but take responsibility for addressing gaps in the system. Conclusions Improving the coordination of cirrhosis care will require infrastructure to design care pathways and work processes that will support family physicians' knowledge-on-demand needs, facilitate primary care-specialist relationships, and deliberately work toward building a shared mental model of responsibilities for addressing medical care and social determinants of health.

US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019.

Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care. Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001-2010, vs post-ACA, 2011-2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P < .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P < .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P < .001), but not post-ACA (P = .22). We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.

DELINEATINGACCESS TO SPECIALTY HEALTHCARE IN ZIMBABWE A CROSS-SECTIONAL STUDY TO INFORMEVIDENCE-BASED PUBLIC HEALTH POLICY AND PRACTICE

The study investigated the determinants of access and utilization of specialty healthcare services in the case of public referral hospitals in Zimbabwe using the period post-independence in 1980s to 2018. This becomes an exciting period for the study as it presents the rise and fall of Zimbabwe’s healthcare system. Although there are many specialists offering specialty healthcare, the study limited its focus on specialty care physicians operating at public health facilities. The study objectives were to identify the socio-economic and health behavioural determinants that could influence access to and utilization of specialty healthcare amongst different groupings in Zimbabwe. The study specifically examined the influence of household income, insurance, health information/ education, distance to the nearest health centre, waiting time and dual practice as a variable of interest on access to specialty care. The study utilized cross-sectional household data collected through a survey from April to October 2019. Out of the 40 selected districts from a cluster of 63 existing administrative health districts, 1000 households were randomly selected using one stage cluster sampling (probability sampling design). The study used the Logistic regression model to identify the determinants of access to and utilisation of specialty healthcare based on 653 households that had reported sickness of a member within the last twelve months before the survey. The study tested the hypotheses that dual practice does not affect the supply capacity at public hospitals hence does not reduce access and utilisation of specialty healthcare household income does not increase the demand for specialized healthcare services and that the distance to the nearest health facility does not reduce the probability of seeking of specialty healthcare services. The Logistic regression results revealed that distance to the nearest health care facility, household income, health insurance coverage, presence of dual practice and waiting time all had a significant statistical relationship with access and utilization (demand) for specialty healthcare at public health institutions. However, the study found out that health information had negative effect though an insignificant variable. Distance to the nearest health facility and waiting time was found to negatively affect access (demand) to specialty healthcare whereas household income, dual practice and insurance coverage were found to positively influence access and utilization of specialty healthcare at public health institutions. The study established that, as there is an increase in income and insurance coverage, access and utilization of specialty care also increased. More households in Zimbabwe (71%) are not medically insured. The study found that the provision of specialty healthcare services is too centralized thereby patients are compelled to travel long distancesto metropolitan facilities where specialty health services are more concentrated. The study further established that dual practice affects the supply capacity in public hospitals. The constraining arrangement of management and teaching services at main teaching hospitals affects the supply of specialty services. Households tend to wait longer to consult specialists at public hospitals due to poorly regulated dual practice that induces long waiting times. Given the study findings, the study recommends health policy planners to adopt a balanced centralized and decentralized modelon access to specialty care, differentiating higher and lower tier specialty care facilities to address the geographic accessibility and availability dimensions and revisiting management of training and structuring of specialty teaching services. Other major recommendations of the study include the review of supply-side policies used to enhance access to specialty healthcare services. The policies may target at implementing a public sector ‘National Health Insurance Fund’, driven by the government of Zimbabwe offering realistic, acceptable and affordable premiums for vulnerable groups and expanding the scope of participation in developing the policy regulating dual practice. The study also recommends the creation of Special Economic Zones (SEZ) for Specialty health riding on the existing Government framework on SEZs. The adoption of Strategic Specialty care Partnerships (SSCPs) can enhance access and institutional capacities in dealing with the expensive response to Non Communicable Diseases, which are the main drivers for households to seek specialty care. Zimbabwe through its national health authority needs to ‘Reframe the Health Agenda’ on specialty care thus initiate a national health action plan that will continue to drive to evidence-based health policy and practice.

A skills network approach to physicians’ competence in shared decision making

BackgroundMeasurement of physicians’ competence in shared decision making (SDM) remains challenging with frequent disagreement between assessment methods.ObjectiveTo conceptualize and measure physicians’ SDM competence as an organized network of behavioural skills and to determine whether processing patient‐reported data according to this model can be used to predict observer‐rated competence.DesignSecondary analysis of an observational study.Setting and participantsPrimary and specialty outpatient care physicians and consecutively recruited adult patients with a chronic condition who faced a treatment decision with multiple acceptable choices.MeasuresNetwork parameters constructed from patients’ assessment of physicians’ SDM skills as measured by the 9‐item Shared Decision Making Questionnaire (SDM‐Q‐9) and observer‐rated SDM competence of physicians measured by three widely used observer‐rated instruments.Results29 physicians (12 female, 17 male; mean age 50.3 years) recruited 310 patients (59.4% female, 40.6% male; mean age 54.0 years) facing a decision mainly regarding type 2 diabetes (36.4%), chronic back pain (32.8%) or depressive disorder (26.8%). Although most investigated skills were interrelated, elicitation of the patient's treatment preferences showed the strongest associations with the other skills. Network parameters of this skill were also decisive in predicting observer‐rated competence. Correlation between predicted competence scores and observer‐rated measurements ranged from 0.710 to 0.785.ConclusionsConceptualizing physicians’ SDM competence as a network of interacting skills enables the measurement of observer‐rated competence using patient‐reported data. In addition to theoretical implications for defining and training medical competences, the findings open a new way to measure physicians’ SDM competence under routine conditions.

Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012-2016.

Total health expenditure in China has grown considerably since a new round of health system reform was enacted in 2009. Researchers have shown that strengthening primary healthcare may be an option for countries to solve the rapid expansion of their medical expenditures. This study was designed to explore the association between the strength of primary healthcare and medical expenditures, in the context of the hospital-oriented healthcare system in China. A longitudinal ecological study was conducted using a 5-year panel dataset of 27 provinces in mainland China. The linear mixed effects regression model was used to assess the effects of primary healthcare-related metrics on medical expenditures, controlling for the provincial level specialty care physician supply and socio-economic parameters. All of the three primary healthcare-related metrics showed negative associations with the two medical expenditure parameters. Primary care physicians per 10,000 population was significantly associated with the per capita hospital medical expenditures (p < 0.05), and the percentage of public health expenditure in total health expenditure was significantly associated with both per capita total medical expenditure and per capita hospital medical expenditures (p < 0.01 for both). Our study found negative associations between the primary healthcare capacity and medical expenditure in the context of hospital-oriented healthcare systems in China, adding to the previous evidence that primary healthcare may play a positive role in reducing medical expenditure. Policies on increasing the primary care physician supply and the public share of total health expenditure should be conducted to strengthen the primary healthcare system. With the gradual advance of medical reform and the policy inclination to primary healthcare, this will play a more important role in controlling the rapid growth of medical expenditure.

Non-vitamin K antagonist oral anticoagulant (NOAC) use and dosing in Canadian practice: Insights from the optimising pharmacotherapy in the management approach to lowering risk in atrial fibrillation (OPTIMAL AF) Programme.

To estimate the rate of non-vitamin K oral anticoagulant (NOAC) dosing that is lower- and higher-than-recommended and to describe the reasons for NOAC dose discordance with Health Canada prescribing information. The OPTIMAL AF Programme was an observational cohort quality assessment initiative in which primary and specialty care physicians in eight provinces provided a snapshot of their anticoagulated non-valvular atrial fibrillation (NVAF) patients through either an electronic medical record (EMR) system or standardised, paper-based data collection methods. Data on 1681 NVAF patients receiving oral anticoagulation (OAC) for stroke prevention was provided by 102 physicians. A NOAC was prescribed in 1379 patients (8%). The standard recommended dose was prescribed in 849 (76%) and reduced dose in 264 (24%). Concordance of the reduced dose with Health Canada prescribing information occurred in 154 patients (58%). The standard dose was concordant in 805 (95%). The main reasons for the use of discordant reduced doses were age of 80years or more, elevated creatinine, prior bleeding or dose recommended by specialist. The vast majority of Canadian patients meeting the Canadian Cardiovascular Society (CCS) guideline recommendations for OAC to decrease AF-related stroke risk were receiving product monograph-concordant NOAC dosing (85%). Nonetheless, this highlights the fact that an important proportion of patients were prescribed doses that are discordant and opportunities remain to improve NOAC dosing to optimise stroke prevention.

Association of primary care physician supply with maternal and child health in China: a national panel dataset, 2012\u20132017

BackgroundThe Chinese government has been strengthening the primary care system since the launch of the New Healthcare System Reform in 2009. Among all endeavors, the most obvious and significant improvement lays in maternal and child health. This study was designed to explore the association of primary care physician supply with maternal and child health outcomes in China, and provide policy suggestions to the law makers.MethodsSix-year panel dataset of 31 provinces in China from 2012 to 2017 was used to conduct the longitudinal ecological study. Linear fixed effects regression model was applied to explore the association of primary care physician supply with the metrics of maternal and child health outcomes while controlling for specialty care physician supply and socio-economic covariates. Stratified analysis was used to test whether this association varies across different regions in China.ResultsThe number of primary care physicians per 10,000 population increased from 15.56 (95% CI: 13.66 to 17.47) to 16.08 (95% CI: 13.86 to 18.29) from 2012 to 2017. The increase of one primary care physician per 10,000 population was associated with 5.26 reduction in maternal mortality per 100,000 live births (95% CI: − 6.745 to − 3.774), 0.106% (95% CI: − 0.189 to − 0.023) decrease in low birth weight, and 0.419 decline (95% CI: − 0.564 to − 0.273) in perinatal mortality per 1000 live births while other variables were held constant. The association was particularly prominent in the less-developed western China compared to the developed eastern and central China.ConclusionThe sufficient supply of primary care physician was associated with improved maternal and child health outcomes in China, especially in the less-developed western region. Policies on effective and proportional allocation of resources should be made and conducted to strengthen primary care system and eliminate geographical disparities.

Treatment Outcomes of Hepatitis C-Infected Patients in Specialty Clinic vs. Primary Care Physician Clinic: A Comparative Analysis.

Background Oral direct-acting antivirals (DAAs) provide an exceptional opportunity to treat hepatitis C virus (HCV) infection. Goals We compared the treatment outcomes between specialty and primary care physician (PCP) clinics for patients treated with DAAs. Methods We performed a retrospective analysis of patients treated for HCV in our PCP clinics and specialty; liver and gastroenterology clinics and gastroenterology clinics. We used the two-sided t-test and the chi-square test to compare the means of continuous and categorical variables, respectively. Results Data from a total of 377 patients was analyzed (PCP clinic: n = 185 and specialty clinic: n = 192). There was no significant difference between age, race, and gender. Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores were comparable at baseline. Greater than 90% of the patients achieved sustained virological response (SVR) with no difference between the groups. Conclusions Uncomplicated patients can be treated for hepatitis C by their PCPs with DAAs with similar treatment outcomes to specialty clinics. There should be explicit guidelines on patient eligibility for treatment by PCPs vs. specialists.

Management of atherogenic dyslipidemia according to current treatment guidelines: DESPEGA study in real clinical practice

Studies in patients with dyslipidemia have revealed that, despite guideline recommendations, treatment remains unchanged even when therapeutic goals are not achieved. Our objective was to determine the degree to which primary care (PC) and specialty care (SC) physicians adhere to clinical guidelines for the management of atherogenic dyslipidemia (AD). This was an observational, descriptive, cross-sectional study. Physicians working in the Spanish Health System completed an electronic questionnaire comprising 24 items organized into three blocks: clinical guidelines, adherence to clinical guidelines, and other issues in the management of AD. The questions were formulated with closed polytomous or categorized responses. Adherence to guidelines, in terms of treatment, was assessed according to physicians’ responses to six patient profiles. Absolute and relative frequencies (qualitative variables), central tendency and dispersion (quantitative variables) were calculated. In total, 980 physicians (88.5% PC) participated in the study; 77.3% used guidelines in their routine clinical practice, with the most used being the Spanish SEMERGEN (73.8%) and the European Society of Cardiology/European Atherosclerosis Society guidelines (41.2%). A total of 83% adhered to guideline recommendations in more than four of the six profiles proposed, 26.2% adhered to the SEMERGEN definition of AD, 66.6% combined all lipoprotein ratios to diagnose AD, and > 60% used non-high-density lipoprotein cholesterol (HDL-C) to diagnose patients with AD at high cardiovascular risk. In total, 99.0% prescribed a fibrate to reduce triglyceride levels, 47.4% to increase HDL-C levels and 40.2% to reduce small, dense low-density lipoprotein cholesterol particles. Since adherence to clinical guidelines improves both the quality of care and health outcomes, greater adherence to and satisfaction with clinical guidelines for the management of AD may contribute to improvements in and optimization of the management of patients with AD in the Spanish health system.

Career Regret Among Physician Assistants: A Comparative Survey of Primary and Specialty Care Careers

Purpose: This study investigated if career regret varies among physician assistants (PAs) practicing in primary and specialty care fields. This information may assist practicing and aspiring physician assistants when selecting or changing their career path. Methods: A survey was emailed to 5,000 primary and specialty care physician assistants. Items indicating career regret were compared between primary and specialty care groups. Results: Eight hundred and thrity-four (16.7%) completed surveys were received back. Career regret is similar between primary and specialty care physician assistants, with low reports from both groups. No statistical significance was found between primary care and specialty care groups with regards to career regret or student loan debt. The primary care group noted a less sustainable work/ life balance and higher perceived burnout. Specialty care physician assistants reported higher annual gross income. Regret and disappointment correlated highly with burnout. Conclusions: Physician assistants and prospective physician assistants should carefully consider their career path as regret and disappointment correlated highly with burnout.

PCV103 - MANAGEMENT OF ATHEROGENIC DYSLIPIDEMIA IN REAL CLINICAL PRACTICE WITHIN THE SPANISH HEALTH SYSTEM ACCORDING TO CURRENT TREATMENT GUIDELINES: DESPEGA STUDY

Previous studies conducted in patients with dyslipidemia managed in Spanish Health System (SHS) revealed that, despite guidelines recommendations, even when therapeutic goal is not achieved, treatment remains unchanged even though the availability of alternatives approaches. Atherogenic dyslipidemia (AD) is a specific type of dyslipidemia characterized by the simultaneous presence of several lipid abnormalities, that confers a greater risk of CV disease compared with general population. We aim to determine the degree of adherence of primary care (PC) and specialty care (SC) physicians to clinical guidelines for the management of AD. Observational, descriptive, cross-sectional study. PC and SC physicians working in the SHS and experienced (≥5 years) completed an electronic questionnaire. To assess physicians’ adherence to guidelines, answers about which treatment should be provided for 6 different patient profiles were analyzed: 3 corresponded with AD patients and 3 with dyslipidemia patients. A partial adherence index was calculated as the percentage of adherent physicians for each individual patient profile. Absolute and relative frequencies were calculated. 980 physicians (88.55% PC) with a mean experience of 24.90 years participated in the study. Most of them (77.32%) reported that they use guidelines in their clinical practice. The Spanish SEMERGEN (73.84%) and the European ESC/EAS guide (41.22%) are the most used. Based on physicians’ treatment prescription for each patients’ profiles, 83% of physicians adhered to the guideline recommendations in more than 4 of the 6 profiles proposed (31.12% four, 37.14% five and 14.69% six profiles). 81.24% and 98.04% of physicians were satisfied with the results obtained from using the guidelines and considered that they were useful, respectively. The greater adherence to and satisfaction with clinical guidelines for the management of AD described in the study may contribute to improve and optimize the management of patients with AD in SHS.

Integrating Tracker Data Into Clinical Care

Background: Adding physical activity to a weekly routine has been shown to contribute to both delaying onset and improving management of existing chronic conditions. With physicians a highly trusted source of advice and care, the physical activity recommendations received from doctors may be adhered to more than other sources, especially when advice is tailored to patients’ specific physical conditions and limitations in increasing activity levels. Yet a survey by Smith et al found that fewer than 50% of clinicians were able to provide specific guidance on physical activity. This issue may stem from physicians rarely having objective physical activity data to inform their counseling. Objective: We aimed to understand physician perceptions of the potential benefits and challenges of integrating trackers in a clinical setting to provide tailored counseling to patients on increasing physical activity. Methods: Our study consisted of two phases: an online survey and in-depth, key-informant interviews. We recruited 60 clinicians to complete a 50-question survey and recruited fourteen primary and specialty care physicians for 15-20 minute in-person or phone interviews. Results from the survey were tabulated through Google Forms, while the interviews were recorded and then analyzed for emerging themes. Results: Fifty-seven percent of the fourteen interviewed physicians reported that objective data would be useful in counseling their patients on physical activity. Three-quarters (77%) believed that advice based on an objective data display would be actionable for the patients. Of the 60 clinicians who completed the online survey, only 14% believe their patients are adhering to their physical activity recommendations. More than half (57%) of respondents believe that objective data collected from a tracker would be useful in counseling patients. However, when asked how likely they would be to recommend a tracker to a patient, 43% replied they would recommend a tracker to help motivate patients to make a lifestyle change. From the interviews and the survey, the majority of physicians believed that their biggest barrier is limited time for reviewing data, yet they also expressed strong interest in well-designed displays with a small number of data points highlighting physical activity since the patients' last visit. Conclusions: The majority of physicians in our study believed that integrating tracker data into clinical settings would improve their ability to make personalized recommendations to patients, but also noted that significant barriers exist, most notably time. Future research is needed to 1) create and test condensed tracker data displays to determine physician willingness to view and use them, 2) evaluate the impact of the displays on physicians' ability to provide tailored advice to patients, and 3) evaluate the impact of tailored advice on increases in patients' physical activity levels.