scholarly journals Effect of Closure of a Local Safety-Net Hospital on Primary Care Physicians' Perceptions of Their Role in Patient Care

2011 ◽  
Vol 9 (6) ◽  
pp. 496-503 ◽  
Author(s):  
K. O. Walker ◽  
R. Clarke ◽  
G. Ryan ◽  
A. F. Brown
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Primary Care Physicians ◽  
Safety Net ◽  
Safety Net Hospital ◽  
Local Safety

scholarly journals Patient-Care Questions that Physicians Are Unable to Answer

2007 ◽  
Vol 14 (4) ◽  
pp. 407-414 ◽  
Author(s):  
John W. Ely ◽  
Jerome A. Osheroff ◽  
Saverio M. Maviglia ◽  
Marcy E. Rosenbaum
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Primary Care Physicians ◽  
Clinical Information ◽  
Clinical Findings ◽  
Information Resources ◽  
Clinical Information Systems ◽  
Unanswered Question ◽  
Test Results ◽  
Clinical Questions

Abstract Objective: To describe the characteristics of unanswered clinical questions and propose interventions that could improve the chance of finding answers. Design: In a previous study, investigators observed primary care physicians in their offices and recorded questions that arose during patient care. Questions that were pursued by the physician, but remained unanswered, were grouped into generic types. In the present study, investigators attempted to answer these questions and developed recommendations aimed at improving the success rate of finding answers. Measurements: Frequency of unanswered question types and recommendations to increase the chance of finding answers. Results: In an earlier study, 48 physicians asked 1062 questions during 192 half-day office observations. Physicians could not find answers to 237 (41%) of the 585 questions they pursued. The present study grouped the unanswered questions into 19 generic types. Three types accounted for 128 (54%) of the unanswered questions: (1) “Undiagnosed finding” questions asked about the management of abnormal clinical findings, such as symptoms, signs, and test results (What is the approach to finding X?); (2) “Conditional” questions contained qualifying conditions that were appended to otherwise simple questions (What is the management of X, given Y? where “given Y” is the qualifying condition that makes the question difficult.); and (3) “Compound” questions asked about the association between two highly specific elements (Can X cause Y?). The study identified strategies to improve clinical information retrieval, listed below. Conclusion: To improve the chance of finding answers, physicians should change their search strategies by rephrasing their questions and searching more clinically oriented resources. Authors of clinical information resources should anticipate questions that may arise in practice, and clinical information systems should provide clearer and more explicit answers.

scholarly journals Factors affecting the rates of adherence to surveillance recommendations for incidental pancreatic cystic lesions in a large urban safety net hospital

2020 ◽  
Vol 7 (1) ◽  
pp. e000430
Author(s):  
Andrew Canakis ◽  
Asaf Maoz ◽  
Jaroslaw N Tkacz ◽  
Christopher Huang
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Safety Net ◽  
Multivariate Logistic Regression Model ◽  
Cystic Lesions ◽  
Factors Affecting ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Access To Primary Care

BackgroundPancreatic cystic lesions (PCLs) are a heterogenous group of lesions with varying degrees of malignant potential. PCLs are often incidentally detected on imaging. Management for patients without an immediate indication for resection or tissue sampling entails radiographic surveillance to assess for features concerning for malignant transformation. This study aims to determine the rates of adherence to surveillance recommendations for incidental PCLs, and identify factors associated with adherence or loss of follow-up.MethodsWe conducted a single-centre retrospective study of patients at a tertiary safety net hospital with incidentally discovered asymptomatic PCLs. Follow-up was defined as having undergone repeat imaging as recommended in the radiology report. Data were analysed using logistic regression.ResultsWithin our cohort (n=172), 123 (71.5%) subjects completed follow-up imaging. Attending a gastroenterology appointment was most strongly associated with completing follow-up for PCLs and remained significant (p=0.001) in a multivariate logistic regression model. Subjects without a documented primary care provider were less likely to have follow-up (p=0.028). Larger cyst size was associated with completion of follow-up in univariate only (p=0.067).ConclusionWe found that follow-up of an incidentally discovered PCLs was completed in the majority of our subjects. Incomplete follow-up for PCLs occurred in up to one in three to four patients in our cohort. Access to primary care and utilisation of subspecialty gastroenterology care are associated with completion of follow-up for PCLs. If validated, our findings can guide potential interventions to improve follow-up rates for PCLs.

scholarly journals Implementation and Evaluation of a Military–Civilian Partnership to Train Mental Health Specialists

2019 ◽  
Vol 184 (7-8) ◽  
pp. e184-e190
Author(s):  
Scott A Simpson ◽  
Matthew Goodwin ◽  
Christian Thurstone
Keyword(s):  
Mental Health ◽  
Patient Care ◽  
Small Sample Size ◽  
Safety Net ◽  
Small Sample ◽  
Training Experience ◽  
Training Environment ◽  
Army Reserve ◽  
Safety Net Hospital ◽  
The Military

Abstract Introduction Mental health specialists (MHS, or 68X) play a central role in meeting the growing demand for combat stress care among Service Members. Partnering with civilian institutions may enhance the MHS training experience beyond Advanced Individual Training (AIT). Methods We describe a novel military–civilian collaboration to train U.S. Army Reserve MHS’s in the psychiatric emergency service (PES) of a public, safety-net hospital. Details of implementation are described. The training rotation was evaluated after 1 year through a comprehensive chart abstraction of patients seen as well as surveys of MHS’s and civilian partners. Results The roles of MHS and physician officers in this rotation are described. Over 9 days in the PES, the MHS team evaluated 26 patients. MHS’s described a high-quality training environment (83% rated very good or excellent) in which they frequently saw high-risk patients relevant to military practice. Experience with a certain patient presentation was correlated with comfort assessing and managing that presentation (p < 0.01). Many civilian staff (40%) felt the PES operated better with the presence of the Army team and 50% of civilians agreed their impression of the U.S. Army Reserve improved as a result of the partnership. Hundred percent of specialists and 80% of civilians reported very good to excellent rapport between military and civilian staff. Two civilian respondents (11%) expressed concern that the military team’s presence impeded patient care. Conclusion This is the first military–civilian training collaboration for behavioral health specialists, who have already completed AIT. This program provided well-received and mission-relevant training for MHS’s without notable adverse effects on patient care or team functioning in a civilian environment. Our findings are based on a small sample size, and no other such programs exist against which to compare these results. We propose that such educational partnerships, which have long been effective for other clinical specialists, may benefit the military, civilian communities, and the country.

scholarly journals 3220 Can you read me now? Clinician variations in managing and responding to secure messages from patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 59-59
Author(s):  
Joy Li-Yueh Lee ◽  
Michael Weiner ◽  
Marianne Matthias
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Safety Net ◽  
Patient Centeredness ◽  
Cognitive Approach ◽  
Electronic Communications ◽  
Secure Messaging ◽  
Safety Net Hospital ◽  
Primary Care Clinicians

OBJECTIVES/SPECIFIC AIMS: To identify areas of variation in primary care clinician responses to secure messaging and to assess the quality of secure messages by clinicians. METHODS/STUDY POPULATION: This mixed-methods study included twenty one primary care clinicians from a Midwestern safety net hospital and Veterans Affairs medical center. Participants were presented with five short clinical vignettes and corresponding secure messages from hypothetical patients and asked to compose responses. Participants were interviewed about their cognitive approach to the responses as well as perspectives on quality of care as related to electronic communications. RESULTS/ANTICIPATED RESULTS: Every participant recalled having patients who misused secure messaging for urgent issues, suggesting the need for more patient education and the possible adverse consequences of overlooked messages. The study also uncovered key differences in several areas, include clinician timeliness, message management, the circumstances in which they would use messaging, and the content of the messages (including patient-centeredness). While participants agreed that messages about clinical issues should not be resolved via secure messaging, there was a lack of consensus regarding emotionally charged messages and messages dealing with medication adjustments. Some participants spoke of the need for more guidance in knowing when best to use secure messaging. “Sometimes,” one physician said, “it feels like we’re just making up [rules for secure messaging].” Although clinician responses were uniformly respectful, the patient-centeredness varied in the use of jargon and social talk, as well as clarity for patients. DISCUSSION/SIGNIFICANCE OF IMPACT: This study revealed variations in provider approaches to secure messaging, and the content of responses. These variations reflect lack of consensus about how care is delivered via secure messaging, and reveal the need for clinician guidance. They also suggest possible negative patient consequences if secure messaging is used ineffectively. The extent to which variations are undesirable remains unknown. Future work will explore the consequences of such variations.

scholarly journals Improving After-Clinic Work Workflow in a Family Medicine Residency

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Nguyen V ◽  
◽  
Jaqua E ◽  
Oh A ◽  
Altamirano M ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Patient Care ◽  
Primary Care Physicians ◽  
Training Session ◽  
P Value ◽  
Post Intervention ◽  
Family Medicine Residency ◽  
Resident Physicians ◽  
Family Medicine Residents

Introduction: The broad range of patients and diagnoses addressed by primary care physicians lends to a larger after-work clinic load. The resulting after-clinic work, including various in-basket tasks, can be a substantial burden to physicians, and potentially leading to burnout. The goal of this study is to generate a standardized workflow to improve physician after-clinic work efficiency and patient care. Methods: A nine-question pre- and post-intervention survey about afterclinic work management was administered to family medicine residents at a multi-specialty FQHC in California. The intervention was done in June 2020 and included a twenty-minute training session explaining how to implement a standardized in-basket management flowchart in a family medicine residency clinic. Results: Pre- and post-intervention data were analyzed using nonindependent paired sample t-tests. The survey was sent to all 40 family medicine residents. Pre- and post-intervention survey response rate was 77.5% and 97.5% respectively. The result of the nine questions post intervention were statistically significant (p value of <0.001). The standardized flowchart addressed adequate supervision of resident physicians’ patient care. Conclusion: The post-intervention results showed that having a clear and standardized flowchart enhanced the overall knowledge and understanding by the resident physicians in how to management the in-basket workflow. With increased patient access via telehealth and enhanced electronic medical records, it is essential to have effective teaching and supervision of resident physician after-clinic work. Successful teaching of after-clinic work will improve work-life balance and the overall success of the new primary care physician.

scholarly journals A financial incentive program to improve appointment attendance at a safety-net hospital-based primary care hepatitis C treatment program

PLoS ONE ◽  
2020 ◽  
Vol 15 (2) ◽  
pp. e0228767 ◽  
Author(s):  
Kristen S. Lee ◽  
Lisa Quintiliani ◽  
Alexandra Heinz ◽  
Natrina L. Johnson ◽  
Ziming Xuan ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Treatment Program ◽  
Financial Incentive ◽  
Safety Net ◽  
Hepatitis C Treatment ◽  
Appointment Attendance ◽  
Incentive Program ◽  
Safety Net Hospital

scholarly journals Patient care complexity as perceived by primary care physicians.

2015 ◽  
Vol 33 (2) ◽  
pp. 137-145 ◽  
Author(s):  
Jill K. Mount ◽  
R. Michael Massanari ◽  
Jay Teachman
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Primary Care Physicians
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