What should primary care providers know about pediatric skin conditions? A modified Delphi technique for curriculum development

2014 ◽  
Vol 71 (4) ◽  
pp. 656-662 ◽  
Author(s):  
Dana F. Feigenbaum ◽  
Christy K. Boscardin ◽  
Ilona J. Frieden ◽  
Erin F.D. Mathes
Keyword(s):  
Primary Care ◽  
Curriculum Development ◽  
Delphi Technique ◽  
Primary Care Providers ◽  
Care Providers ◽  
Modified Delphi ◽  
Modified Delphi Technique ◽  
Skin Conditions

Medications Used Routinely in Primary Care to be Dose-Adjusted or Avoided in People With Chronic Kidney Disease: Results of a Modified Delphi Study

2020 ◽  
Vol 54 (7) ◽  
pp. 625-632 ◽  
Author(s):  
Leena Taji ◽  
Marisa Battistella ◽  
Allan K. Grill ◽  
Jessie Cunningham ◽  
Brenda L. Hemmelgarn ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Delphi Study ◽  
Dose Adjustment ◽  
Sglt2 Inhibitor ◽  
Primary Care Providers ◽  
Delphi Panel ◽  
Care Providers ◽  
Modified Delphi

Background: Chronic kidney disease (CKD) affects up to 18% of those over the age of 65 years. Potentially inappropriate medication prescribing in people with CKD is common. Objectives: Develop a pragmatic list of medications used in primary care that required dose adjustment or avoidance in people with CKD, using a modified Delphi panel approach, followed by a consensus workshop. Methods: We conducted a comprehensive literature search to identify potential medications. A group of 17 experts participated in a 3-round modified Delphi panel to identify medications for inclusion. A subsequent consensus workshop of 8 experts reviewed this list to prioritize medications for the development of point-of-care knowledge translation materials for primary care. Results: After a comprehensive literature review, 59 medications were included for consideration by the Delphi panel, with a further 10 medications added after the initial round. On completion of the 3 Delphi rounds, 66 unique medications remained, 63 requiring dose adjustment and 16 medications requiring avoidance in one or more estimated glomerular filtration rate categories. The consensus workshop prioritized this list further to 24 medications that must be dose-adjusted or avoided, including baclofen, metformin, and digoxin, as well as the newer SGLT2 inhibitor agents. Conclusion and Relevance: We have developed a concise list of 24 medications commonly used in primary care that should be dose-adjusted or avoided in people with CKD to reduce harm. This list incorporates new and frequently prescribed medications and will inform an updated, easy to access source for primary care providers.

scholarly journals Consensus guidelines on managing Rett syndrome across the lifespan

2020 ◽  
Vol 4 (1) ◽  
pp. e000717
Author(s):  
Cary Fu ◽  
Dallas Armstrong ◽  
Eric Marsh ◽  
David Lieberman ◽  
Kathleen Motil ◽  
...  
Keyword(s):  
Primary Care ◽  
Rett Syndrome ◽  
Health Professionals ◽  
Best Practice ◽  
Neurodevelopmental Disorder ◽  
Primary Care Providers ◽  
Care Providers ◽  
Medical Comorbidities ◽  
Modified Delphi ◽  
Delphi Approach

BackgroundRett syndrome (RTT) is a severe neurodevelopmental disorder with complex medical comorbidities extending beyond the nervous system requiring the attention of health professionals. There is no peer-reviewed, consensus-based therapeutic guidance to care in RTT. The objective was to provide consensus on guidance of best practice for addressing these concerns.MethodsInformed by the literature and using a modified Delphi approach, a consensus process was used to develop guidance for care in RTT by health professionals.ResultsTypical RTT presents early in childhood in a clinically recognisable fashion. Multisystem comorbidities evolve throughout the lifespan requiring coordination of care between primary care and often multiple subspecialty providers. To assist health professionals and families in seeking best practice, a checklist and detailed references for guidance were developed by consensus.ConclusionsThe overall multisystem issues of RTT require primary care providers and other health professionals to manage complex medical comorbidities within the context of the whole individual and family. Given the median life expectancy well into the sixth decade, guidance is provided to health professionals to achieve current best possible outcomes for these special-needs individuals.

scholarly journals Erythematous plaques of the vulvo-perineal region

2021 ◽  
Vol 16 (3) ◽  
pp. 101-103
Author(s):  
Qin Jian Low ◽  
Tzyy Huei Lim ◽  
Shu Ann Hon ◽  
Seng Wee Cheo ◽  
Noranizah Wagino ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Health ◽  
Primary Health Care Providers ◽  
Slow Evolution ◽  
Skin Conditions

Skin conditions are a common reason for consulting primary health care. The public frequently expects their primary health care providers to be able to recognise and treat common skin conditions with confidence. Primary care providers must be able to identify ‘red flag’ skin conditions that require dermatology referral. However, diagnosis is often delayed due to the non-specific clinical presentation, low incidence, slow evolution and long-term history of such lesions. We report the case of a patient with extramammary Paget’s disease that presented to her primary care provider and subsequently underwent a wide local excision.

Analysis of Teledermatology Consults in a County Hospital Setting (Preprint)

2021 ◽  
Author(s):  
Colton Funkhouser ◽  
Martha E Funkhouser ◽  
Jay E Wolverton ◽  
Stephen E Wolverton ◽  
Toby Maurer
Keyword(s):  
Primary Care ◽  
Chart Review ◽  
Hospital Setting ◽  
Primary Care Providers ◽  
County Hospital ◽  
Care Providers ◽  
Seborrheic Keratosis ◽  
Non Melanoma Skin Cancer ◽  
Skin Conditions ◽  
Melanoma Skin

BACKGROUND Teledermatology consults are increasingly used by primary care providers for diagnosis and triage of skin conditions. However, there are few studies that analyze which conditions are most commonly sent for teledermatology consultation and which of those are most often referred for an in-person visit. OBJECTIVE We aim to examine teledermatology consults sent from primary care providers at a county hospital to identify common diagnoses that prompted use of the teledermatology system and determine which diagnoses required an in-person visit after teledermatology evaluation. METHODS A retrospective analysis was conducted based on 450 teledermatology consults from primary care providers at a county health system. Chart review was performed to identify the diagnoses made by the teledermatologist for each consult and which diagnoses prompted an in-person visit after teledermatology evaluation. RESULTS Our analysis captured 471 diagnoses. Seborrheic keratosis was the most frequent diagnosis (10.2%) prompting teledermatology consultation. Some diagnoses, such as non-melanoma skin cancer, actinic keratosis, and alopecia areata required an in-person visit after each teledermatology consult. Others, such as atopic dermatitis and lentigo, did not require an in-person visit and were able to be managed by teledermatology each time. Overall, 39.9% of diagnoses seen via teledermatology were referred for an in-person visit. CONCLUSIONS Teledermatology is valuable in managing many dermatologic conditions that present to primary care, while serving as an effective triage tool for more complex conditions or concern for malignancy. Conditions that required procedural management or involved the scalp also frequently required an in-person referral after TD evaluation. The lowest proportion of referrals for an in-person visit occurred in banal conditions without concern for malignancy.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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