Is Accelerated Partner Therapy partner notification for sexually transmissible infections acceptable and feasible in general practice?

Sexual Health ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 17 ◽  
Author(s):  
Thomas Shackleton ◽  
Lorna Sutcliffe ◽  
Claudia Estcourt
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Partner Notification ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Sex Partners ◽  
Care Providers ◽  
Practice Nurses ◽  
Limited Effectiveness ◽  
Sexually Transmissible Infections

Background: Partner notification in primary care is problematic and of limited effectiveness despite enthusiasm from primary care providers to engage with sexually transmissible infection (STI) management. Innovative partner notification strategies must be relevant to the primary care context. The aim of the present study was to explore the opinions of general practitioners (GP) and practice nurses on the acceptability and feasibility of a new form of partner notification developed in the specialist setting known as Accelerated Partner Therapy (APT), for sex partners of those diagnosed with a bacterial STI in general practice. APT is defined as partner notification strategies that reduce time for sex partners to be treated, and include partner assessment by appropriately qualified health care professionals and here involve telephone and community pharmacy assessment. Methods: Semi-structured qualitative interviews were conducted with a purposive sample of GP and practice nurses in East London, UK. Results: All participants appreciated the importance of partner notification in STI management and felt that APT would improve their practice. They supported prioritising antibiotic provision for the sex partners with provision for future comprehensive STI screening. Although both models were acceptable and feasible, the majority preferred the sexual health clinic telephone assessment over the pharmacy model. Conclusions: GP and practice nurses welcome new strategies for partner notification and believe APT could provide rapid and convenient treatment of sex partners in general practice. This supports further evaluation of APT models as a partner notification strategy in primary care.

scholarly journals Safety Events and Privilege Utilization Rates in Advanced Practice Physical Therapy Compared to Traditional Primary Care: An Observational Study

2019 ◽  
Author(s):  
Lance M Mabry ◽  
Jeffrey P Notestine ◽  
Josef H Moore ◽  
Chris M Bleakley ◽  
Jeffrey B Taylor
Keyword(s):  
Primary Care ◽  
Physical Therapy ◽  
Diagnostic Imaging ◽  
Primary Care Providers ◽  
The United States ◽  
Health Clinic ◽  
Advanced Practice ◽  
Care Providers ◽  
Dry Needling ◽  
Clinical Procedures

Abstract Introduction The general practitioner shortage in the United States coupled with a growing number of Americans living with disability has fueled speculation of non-physician providers assuming a greater role in musculoskeletal healthcare. Previous physician shortages have been similarly addressed, and expanding physical therapy (PT) scope of practice may best serve to fill this need. Resistance to expanding PT practice focuses on patient safety as PTs assume the roles traditionally performed by primary care providers. While studies have shown advanced practice PT to be safe, none have compared safety events in advanced practice PT compared to primary care to determine if there are increased patient risks. Therefore, the purpose of our study is to examine the rate of safety events and utilization of services in an advanced practice PT clinic compared to a primary care clinic. A secondary aim of our study was to report safety events associated with spinal manipulation and dry needling procedures. Materials and Methods Productivity and safety data were retrospectively collected from Malcolm Grow Medical Center from 2015 to 2017 for the Family Health Clinic (FHC) and an advanced practice Physical Therapy Clinic (PTC). Chi-square tests for independence, risk ratios (RR) and 95% confidence intervals (95%) were used to compare the relationship between the frequency of (1) patient encounters and clinical procedures and (2) clinical procedures and safety events. Results Seventy-five percent (12/16) of safety events reported in the PTC were defined as near misses compared to 50% (28/56) within the FHC (RR 1.5; 95% CIs: 1.0 to 2.2). Safety events were more likely to reach patients in the FHC compared to the PTC (RR 1.9; 95% CIs: 0.8 to 4.7). Safety events associated with minor harm to patients was n = 4 and n = 3 in the FHC and PTC respectively. No sentinel events, intentional harm events, nor actual events with more than minor harm were reported in either clinic. Significant relationships indicated that prescriptions, laboratory studies, imaging studies and referrals, were all more likely to be ordered in the FHC than the PTC (p < 0.01). The PTC ordered one diagnostic imaging study for every 37 encounters compared to one in every 5 encounters in the FHC. The PTC similarly referred one patient to another healthcare provider for every 52 encounters, fewer than the one per every 3 encounters in the FHC. There was a significant relationship between encounters and diagnoses, indicating a higher number of diagnoses per encounter in the FHC, though the difference of 0.31 diagnoses per encounter may not be clinically meaningful (p < 0.01). A total of 1,818 thrust manipulations and 2,910 dry needling procedures were completed without any reported safety events. Conclusion These results suggest advanced practice PT has a similar safety profile to primary care. The authority to order musculoskeletal imaging and refer to other clinicians were among the most commonly utilized privileges and may be of primary importance when establishing an advanced practice PT clinic. These results support research showing advanced practice PT may lead to reductions in specialty referrals, diagnostic imaging, and pharmaceutical interventions.

scholarly journals 1184 Evaluation Of A Novel Sleep Medicine Educational Program For The Primary Care Provider

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A452-A452
Author(s):  
R Lang ◽  
B T Keenan ◽  
E Kneeland-Szanto ◽  
I M Rosen
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Sleep Medicine ◽  
Educational Activity ◽  
Care Providers ◽  
Self Directed Learning ◽  
Sleep Study ◽  
Practice Nurses ◽  
Post Test ◽  
Kirkpatrick’S Model

Abstract Introduction Inadequate exposure to and insufficient training in sleep medicine across the medical education continuum contributes to a lack of patient access to sleep care. We created a self-directed learning curriculum in sleep medicine aimed at practicing primary care providers. Methods In this pilot study, primary care providers, including physicians (PCP) and advanced practice nurses (APP-N), were invited to complete 3 application (app)-based core sleep educational modules in exchange for free continuing education and maintenance of certification credits. The modules were case-based and fully autonomous. Individuals had access to discussion boards moderated by a board-certified sleep physician and were given the option to complete two additional modules on advanced sleep topics. We assessed participants’ opinions on the course and any effect on behavior, measured as change in the number of sleep-related orders. Results Nineteen providers (12 PCP, 7 APP-N) completed the 3 required core modules. Five participants completed at least one additional module. A total of 94.4% reported they would recommend this curriculum to a colleague. Fifteen participants had prior experience with online courses; 93.3% noted that the sleep online modules provided a similar or better experience. Upon completion, 77.8% of learners anticipated this educational activity would contribute to either a great degree or completely to improvements in the health outcomes of their patients. All participants achieved the post-test score of 80% required to receive 1 CME/CNE credit per module completed. The number of sleep consultations or sleep study orders in the 4 months after course completion increased by 24.2% on average compared to the 4 months prior to the course (p=0.0157). Conclusion Based on Kirkpatrick’s model, this novel, app-based curriculum met levels 1-3 (positive reaction, knowledge transfer, and impact on behavior). Larger, longer-term studies are needed to assess the benefits of increasing knowledge in sleep medicine on patient care (Kirkpatrick Level 4). Support Funded by NIH NHLBI 5-R25-HL-120874-04

Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management

2020 ◽  
Vol 44 (3) ◽  
pp. 451
Author(s):  
Victar Hsieh ◽  
Glenn Paull ◽  
Barbara Hawkshaw
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Integrated Care ◽  
Significant Proportion ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Model ◽  
Care Project ◽  
Effective Delivery

ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.

scholarly journals How well are U.S. primary care providers assessing whether their male patients have male sex partners?

2018 ◽  
Vol 107 ◽  
pp. 75-80 ◽  
Author(s):  
Pollyanna R.G. Chávez ◽  
Laura G. Wesolowski ◽  
Philip J. Peters ◽  
Christopher H. Johnson ◽  
Muazzam Nasrullah ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Sex Partners ◽  
Care Providers ◽  
Male Patients ◽  
Male Sex

scholarly journals The many faces of depression in primary care

2009 ◽  
Vol 18 (1) ◽  
pp. 155-164 ◽  
Author(s):  
Kathy Hegadoren ◽  
Colleen Norris ◽  
Gerri Lasiuk ◽  
Denise Guerreiro Vieira da Silva ◽  
Kaitlin Chivers-Wilson
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Primary Care Providers ◽  
Care Providers ◽  
Experienced Nurses ◽  
Practice Nurses ◽  
Client Population ◽  
Pervasive Health ◽  
The Many ◽  
The Individual

Depression is a serious global health problem. It creates a huge economic burden on society and on families and has serious and pervasive health impacts on the individual and their families. Specialized psychiatric services are often scarce and thus the bulk of care delivery for depression has fallen to primary care providers, including advanced practice nurses and experienced nurses who work in under-serviced regions. These health professionals require advanced knowledge about the many faces that depression can display. This article reviews some of the faces of depression seen by primary care providers in their practices. Considering depression as a heterogeneous spectrum disorder requires attention to both the details of the clinical presentation, as well as contextual factors. Recommendations around engagement and potential interventions will also be discussed, in terms of the client population as well as for the practitioner who may be isolated by geography or discipline.

scholarly journals Prevalence Rates of Self-Care Behaviors and Related Factors in a Rural Hypertension Population: A Questionnaire Survey

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Huanhuan Hu ◽  
Gang Li ◽  
Takashi Arao
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Physical Exercise ◽  
Self Care ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Health Practitioner ◽  
Care Providers ◽  
Hypertensive Patients ◽  
Diabetes Status

The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97). Older participants (OR, 1.80; 95% CI 1.08–2.99) were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01). Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients.

scholarly journals Hepatitis C Treatment at a Rural Navajo Health Clinic Using Project ECHO

2020 ◽  
Vol 20 (2) ◽  
pp. 133-155
Author(s):  
Anna R Nance ◽  
Lori S Saiki ◽  
Elizabeth G Kuchler ◽  
Conni DeBlieck ◽  
Susan Forster-Cox
Keyword(s):  
Primary Care ◽  
Chronic Hepatitis ◽  
Quality Improvement ◽  
Hepatitis C ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Care Providers ◽  
Hepatitis C Treatment ◽  
Improvement Project ◽  
Project Echo

Purpose: Hepatitis C incidence is higher among American Indian/Alaskan Native populations than any other racial or ethnic group in the United States. Chronic Hepatitis C complications include cirrhosis of the liver, end stage liver disease, and hepatocellular cancer. Direct acting antiviral treatment taken orally results in > 90% cure, yet rural primary care providers lack the training and confidence to treat and monitor patients with chronic Hepatitis C. Rural patients are reluctant to travel to urban areas for Hepatitis C treatment. Project ECHO is an innovative tele-mentoring program where specialists mentor primary care providers via videoconferencing to treat diseases they would otherwise be unable to manage. The purpose of this quality improvement project was to increase Hepatitis C treatment at a rural Navajo health clinic through partnership with Project ECHO specialists. Methods: This quality improvement project was guided by Lippitt’s Phases of Change Theory. The systematic process plan included a protocol for roles and expectations of all members of the healthcare team, a documentation and communication plan, and a tracking system for monitoring patient progress through the plan of care. Outcomes were analyzed by descriptive statistics. Findings: Following partnership with Project ECHO, six patients (31.6%) consented to receiving Hepatitis C treatment at the rural Navajo health clinic. All six were contacted by outreach staff at multiple points during the project. Five (26.3%) completed the full course of drug therapy. Four (21.1%) completed follow-up lab work, of which three (15.8%) had a documented cure by sustained virologic response. Conclusions: Hepatitis C care via Project ECHO-rural clinic partnership was affordable, feasible and not excessively time consuming for a facility with substantial patient outreach resources. Key words: Rural health clinic, Hepatitis C, Project ECHO, tele-mentoring, Native American

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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