Evaluation of an Interdisciplinary Controlled Substance Review Committee on Opioid Prescribing in a Community Health Center

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1840-1846 ◽  
Author(s):  
Holly C Bourgeois ◽  
Rachel C Proteau ◽  
Cassandra V Vielma ◽  
Daniel M Hartung ◽  
Adriane N Irwin
Keyword(s):  
Primary Care ◽  
Health Center ◽  
Community Health Center ◽  
Primary Care Providers ◽  
Patient Specific ◽  
Future Research ◽  
Care Providers ◽  
Opioid Dose ◽  
Opioid Prescribing ◽  
Controlled Substance

Abstract Objective To describe recommendations made by an interdisciplinary controlled substance committee and acceptance by primary care providers. Design Retrospective cohort study. Setting Multisite federally qualified health center using an interdisciplinary committee to provide patient-specific recommendations to prescribers with patients using prescription opioids and other controlled substances. Subjects Patients prescribed long-term opioids. Methods We identified and characterized committee recommendations to prescribers between January 1, 2013, and December 31, 2016. We manually reviewed electronic medical records to determine if recommendations were accepted at eight months. The primary outcome was the overall acceptance rate of recommendations. Secondary outcomes were the acceptance of recommendations to reduce opioid doses and change in opioid dose from baseline. Results The committee made 337 recommendations for 94 patients. Of those, 169 recommendations (50.1%) were accepted within eight months. The most common recommendation was to change opioid prescribing (N = 53, 56.4%), but recommendations varied. For patients with a recommendation to change opioid prescribing, this was accepted in 31 of 53 patients (58.5%). Overall, opioid doses decreased from 60 morphine equivalents per day (interquartile range [IQR] = 27.5–135, range = 5–1,260) at baseline to 40 morphine equivalents per day (IQR = 15–105, range = 0–1,260) at eight months (P < 0.001). Conclusions An interdisciplinary committee was well positioned to offer primary care providers with nonopioid options to manage chronic nonmalignant pain and provide support in reducing opioid doses. About half of recommendations were accepted by primary care providers. Future research should focus on strategies to improve the utility of this approach and its impact on clinical outcomes.

scholarly journals Barriers to weight loss among community health center patients: qualitative insights from primary care providers

BMC Obesity ◽  
2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Rebecca C. Woodruff ◽  
Gillian L. Schauer ◽  
Ann R. Addison ◽  
Ajay Gehlot ◽  
Michelle C. Kegler
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Community Health ◽  
Health Center ◽  
Community Health Center ◽  
Primary Care Providers ◽  
Care Providers

scholarly journals Federally Qualified Health Centers Minimize the Impact of Loss of Frequency and Independence of Movement in Older Adult Patients through Access to Transportation Services

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Krystal Elaine Knight
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Health Center ◽  
Older Adult ◽  
Case Reports ◽  
Community Health Center ◽  
Primary Care Providers ◽  
Adult Patients ◽  
Care Providers ◽  
The Impact

Loss of mobility in older adults (65 and older) is associated with falling, loss of independence, and mortality. This paper, which to the author's knowledge is the first of its kind, summarizes findings of Federally Qualified Health Center (FQHC) case reports and how FQHCs minimize the impacts of mobility loss in older adult patients (who would not receive primary services without these transportation programs) by providing access to primary care services through transportation programs. This paper features the transportation programs of four FQHCs located in both urban and rural United States areas: LifeLong Medical Care (Oakland, CA); Hudson Headwaters Health Network (Queensbury, NY); North End Community Health Center (Boston, MA); Aaron E. Henry Community Health Services Center, Inc. (Clarksdale, MS). This paper is beneficial to primary care providers and public health officials in outlining how transportation may be used to minimize the effects of mobility loss in older adult patients.

Use of seven types of medical jargon by male and female primary care providers at a university health center

2021 ◽  
Author(s):  
Ann Neville Miller ◽  
Ajay Bharathan ◽  
Venkata Naga Sreelalitapriya Duvuuri ◽  
Vanessa Navas ◽  
Lisvet Luceno ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Male And Female ◽  
Medical Jargon

Culturally Relevant Online Cancer Education Supports Tribal Primary Care Providers to Reduce Their Cancer Risk and Share Information About Cancer

2021 ◽  
pp. 152483992110278
Author(s):  
Katie Cueva ◽  
Melany Cueva ◽  
Laura Revels ◽  
Michelle Hensel ◽  
Mark Dignan
Keyword(s):  
Primary Care ◽  
Cancer Risk ◽  
Culturally Relevant ◽  
Cancer Education ◽  
Primary Care Providers ◽  
Future Research ◽  
Cancer Information ◽  
Care Providers ◽  
Share Information

Background Culturally relevant education is an opportunity to reduce health disparities, and online learning is an emerging avenue for health promotion. In 2014–2019, a team based at the Alaska Native Tribal Health Consortium developed, implemented, and evaluated culturally relevant online cancer education modules with, and for, Alaska’s tribal primary care providers. The project was guided by Indigenous Ways of Knowing and the principles of community-based participatory action research and was evaluated in alignment with empowerment theory. About 265 unique learners completed 1,898 end-of-module evaluation surveys between March 2015 and August 2019, and 13 people completed a follow-up survey up to 28 months post module completion. Key Findings Learners described the modules as culturally respectful and informative and reported feeling more knowledgeable and comfortable talking about cancer as a result of the modules. About 98% of the learners planned to reduce their cancer risk because of the modules, and all follow-up survey respondents had reduced their risk, including by quitting smoking, getting screened for cancer, eating healthier, and exercising more. About 98% of the learners planned to share information with their patients, families, friends, and community members because of the modules, with all follow-up survey respondents indicating that they had shared information about cancer from the modules. Implications for Practice and Further Research Culturally relevant online modules have the capacity for positive behavioral change and relatively high correlations between intent and behavior change. Future research could determine which aspects of the modules catalyzed reduced cancer risk and increased dissemination of cancer information.

scholarly journals Protocol for a Systematic Review of the Effectiveness of Provider-targeted Interventions to Improve Opioid Prescribing in Primary Care

2021 ◽  
Author(s):  
Pallavi Prathivadi ◽  
Natalie Connell ◽  
Louisa Picco ◽  
Karleen F Giannitrapani ◽  
Hong-nei Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Primary Care Providers ◽  
Cochrane Library ◽  
Narrative Synthesis ◽  
Care Providers ◽  
Strict Adherence ◽  
Targeted Interventions ◽  
Opioid Prescribing ◽  
Wide Range

Abstract Background: Improving primary care opioid prescribing is a public health priority in many western nations. Governments, policymakers and key stakeholders are intervening on multiple levels to address patient, prescriber and systems factors contributing to opioid over-prescription in primary care. Many opioid prescribing interventions specifically target primary care providers (PCPs); however, the overall effectiveness of these interventions is not known. Identifying effective components of PCP-targeted behaviour change interventions may help inform scalability and translation of prescribing interventions across countries and varying primary healthcare settings. The aim of this systematic review is to assess the effectiveness of provider-targeted interventions to improve opioid prescribing in primary care. This protocol reports the methods of the proposed narrative synthesis review that will be guided by the Theoretical Domains Framework (TDF). Methods: The study will follow Cochrane methods for conducting a narrative synthesis. Reporting is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols. The review will conduct searches in PubMed, EMBASE, PsychInfo, CINAHL, and the Cochrane Library databases for studies published in the English language from 2010 onwards. Reference lists of accepted articles will be also screened for additional studies meeting inclusion. Any opioid prescribing behaviour will be measured as an outcome. Intervention components will be mapped to domains of the TDF. No geographic limits will be applied. All stages of screening and data extraction will involve a dual review with gold standard adjudication. The Cochrane Risk of Bias tool will be used to evaluate quality and risk. Discussion: This review is being conducted in strict adherence to Cochrane principles. The protocol was submitted for registration to Prospero prior to publication for transparency and to avoid duplication of research. Formal ethics approval is not required for this research. The findings of this review will inform the delivery and implementation of PCP targeted opioid prescribing interventions. Findings will be disseminated to a wide range of stakeholders involved in quality improvement, prescribing interventions, education and training; professional groups, policymakers, researchers and PCPs.Systematic review registration: Submitted to Prospero 22 December 2020; pending registration

Reduction in Schedule II opioid prescribing by primary care providers, orthopedic and general surgeons, and pain management specialists following the implementation of a State House Bill and an Institutional Controlled Substance Task Force

2021 ◽  
Vol 17 (2) ◽  
pp. 155-167
Author(s):  
Lisa B. E. Shields, MD ◽  
Timothy A. Johnson, BS ◽  
Michael W. Daniels, MS ◽  
Alisha Bell, MSN, RN, CPN ◽  
Diane M. Siemens, PharmD ◽  
...  
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Primary Care Providers ◽  
The United States ◽  
Prescription Opioid ◽  
Evidence Based ◽  
Care Providers ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
General Surgeons

Objective: Prescription opioid misuse represents a social and economic challenge in the United States. We evaluated Schedule II opioid prescribing practices by primary care providers (PCPs), orthopedic and general surgeons, and pain management specialists.Design: Prospective evaluation of prescribing practices of PCPs, orthopedic and general surgeons, and pain management specialists over 5 years (October 1, 2014-September 30, 2019) in an outpatient setting.Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards at our institution. Results: There were significantly more PCPs, orthopedic and general surgeons, and pain management specialists with a significantly increased number who prescribed Schedule II opioids, whereas there was a simultaneous significant decline in the average number of Schedule II opioid prescriptions per provider, Schedule II opioid pills prescribed per provider, and Schedule II opioid pills prescribed per patient by providers. The average number of Schedule II opioid prescriptions with a quantity 90 and Opana/Oxycontin prescriptions per PCP, orthopedic surgeon, and pain management specialist significantly decreased. The total morphine milligram equivalent (MME)/day of Schedule II opioids ordered by PCPs, orthopedic and general surgeons, and pain management specialists significantly declined. The ages of the providers remained consistent throughout the study. Conclusions: This study reports the implementation of federal and state regulations and institutional evidence-based guidelines into primary care and medical specialty practices to reduce the number of Schedule II opioids prescribed. Further research is warranted to determine alternative therapies to Schedule II opioids that may alleviate a patient’s pain without initiating or exacerbating a potentially lethal opioid addiction.

scholarly journals HIV Screening and the Affordable Care Act

2016 ◽  
Vol 11 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Greg Carter ◽  
Christopher Owens ◽  
Hsien-Chang Lin
Keyword(s):  
Primary Care ◽  
Affordable Care Act ◽  
Health Care Disparities ◽  
Primary Care Providers ◽  
Future Research ◽  
Hiv Screening ◽  
Health Providers ◽  
Care Providers ◽  
Increased Risk ◽  
The Affordable Care Act

Men continue to bear disproportionate accounts of HIV diagnoses. The Patient Protection and Affordable Care act aims to address health care disparities by recommending preventative services, including HIV screening, expanding community health centers, and increasing the healthcare workforce. This study examined the decision making of physician and primary care health providers to provide HIV screenings. A quasi-experimental design was used to estimate the effects of the Affordable Care Act on provider-initiated HIV screening. The National Ambulatory Medical Care Survey was used to examine HIV screening characteristic from two time periods: 2009 and 2012. Logistic regression indicated that patient and provider characteristics were associated with likelihood of being prescribed HIV screening. Non-Hispanic Black men were more likely to be prescribed HIV screening compared to non-Hispanic White men (odds ratio [OR] = 12.33, 95% confidence interval [CI; 4.42, 34.46]). Men who see primary care providers were more likely to be prescribed HIV screening compared to men not seeing a primary care provider (OR = 5.94, 95% CI [2.15, 16.39]). Men between the ages of 19 and 22 were more likely to be prescribed HIV screening compared to men between the ages of 15 and 18 (OR = 6.59, 95% CI [2.16, 20.14]). Men between the ages of 23 and 25 were more likely to be prescribed HIV screening compared with men between the ages of 15 and 18 (OR = 10.13, 95% CI [3.34, 30.69]). Health education programs identifying men at increased risk for contracting HIV may account for the increased screening rates in certain populations. Future research should examine age disparities surrounding adolescent and young men HIV screening.

scholarly journals Effect of a Digital Precision Public Health Intervention for Care Coordination During Covid-19 Pandemic in Australia: A Real World Study

2021 ◽  
Author(s):  
Andre Q Andrade ◽  
Jean-Pierre Calabretto ◽  
Nicole L Pratt ◽  
Lisa M Kalisch-Ellett ◽  
Vanessa T LeBlanc ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Continuity Of Care ◽  
Care Coordination ◽  
Real World ◽  
Primary Care Providers ◽  
Patient Specific ◽  
Specific Information ◽  
Care Providers ◽  
Precision Public Health

Abstract Background: Emergencies disproportionally affect vulnerable populations. The COVID-19 pandemic affected older patients with co-morbidities both directly due to more severe infection and indirectly by affecting care provision. To promote continuity of care, public health professionals require tools to quickly and precisely coordinate with primary care providers. This study evaluated whether digital interventions powered by current existing infrastructure are more effective than conventional interventions in promoting primary care appointments during the COVID-19 pandemic. Methods: We developed a digital intervention delivered by secure messaging and compared it to a post delivered intervention to promote continuity of care for vulnerable veterans during COVID-19 in a real world, non-randomised, interventional study. The study was implemented as part of the Veterans’ MATES program, an Australian Government Department of Veterans’ Affairs program to promote improvements in health care for veterans. The intervention provided patient specific information to general practitioners (GPs) to support continuity of care, alongside mailed education to veterans. The intervention key messages were to maintain regular contact with care providers and to continue to adhere to health plans. The intervention took place in April 2020, during the first weeks of COVID-19 social distancing rules in Australia. The main outcome was time to first appointment with the primary general practitioner (GP) measured using a Cox proportional hazards model.Results: GPs received digital messaging for 51,052 veterans and post messaging for 26,859 veterans. The proportion of patients seeing their primary GP during the three months following intervention was higher in the digital group (77.8%) than the post group (61.5%) (p<0.01). Being in the digital group was associated with earlier appointments. Conclusion: Current infrastructure coupled with innovative solutions is effective in promoting care coordination at scale during national emergencies, opening up new perspectives for precision public health initiatives.

scholarly journals First, Do No Harm: Understanding Primary Care Providers’ Perception of Risks Associated With Discussing Weight With Pediatric Patients

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110409
Author(s):  
Katie A. Loth ◽  
Jocelyn Lebow ◽  
Marc James Abrigo Uy ◽  
Samantha M. Ngaw ◽  
Dianne Neumark-Sztainer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Unintended Consequences ◽  
Future Research ◽  
Care Providers ◽  
Perceived Risks ◽  
Negative Impacts ◽  
Pediatric Weight Management

Many health care providers struggle with if- and how-to discuss weight with their pediatric patients. This study used one-on-one interviews with primary care providers (n = 20) to better understand their: (1) perception of risks associated with talking about weight with pediatric patients, (2) commitment to adhering to best practices of pediatric weight management, and (3) approaches to mitigate perceived risks. Providers felt concerned that discussing weight with children during clinic visits may have unintended negative impacts. Despite perceived risks, providers continued regular BMI screening and weight-focused conversations, but took care with regard to language and approach with the goal of mitigating perceived risks. Findings suggest that pediatric primary care providers perceive that engaging in weight-related discussions with their patients has the potential to lead to negative, unintended consequences. Future research is needed to understand if weight-focused conversations should be avoided altogether or if there are approaches that can effectively mitigate risks.

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