scholarly journals Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing

2019 ◽  
Vol 17 (4) ◽  
pp. 319-325 ◽  
Author(s):  
Michael L. Parchman ◽  
Robert B. Penfold ◽  
Brooke Ike ◽  
David Tauben ◽  
Michael Von Korff ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Management ◽  
Opioid Medication ◽  
Opioid Prescribing

How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

2021 ◽  
Vol 17 (6) ◽  
pp. 499-509
Author(s):  
Elizabeth C. Danielson, PhD ◽  
Christopher A. Harle, PhD ◽  
Sarah M. Downs, MPH ◽  
Laura Militello, MA ◽  
Olena Mazurenko, MD, PhD
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Treatment Decisions ◽  
Healthcare Organizations ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prevention Guideline ◽  
Multistep Process ◽  
Primary Care Clinicians ◽  
Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

Pharmacists on primary care teams: Effect on antihypertensive medication management in patients with type 2 diabetes

2015 ◽  
Vol 55 (3) ◽  
pp. 265-268 ◽  
Author(s):  
Dima Omran ◽  
Sumit R. Majumdar ◽  
Jeffrey A. Johnson ◽  
Ross T. Tsuyuki ◽  
Richard Z. Lewanczuk ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Antihypertensive Medication ◽  
Medication Management ◽  
Primary Care Teams

scholarly journals Drug interactions in the pharmacotherapy of patients included in primary care comprehensive medication management services

2021 ◽  
Vol 12 (2) ◽  
pp. 545
Author(s):  
Hágabo M. SILVA ◽  
Djenane RAMALHO-DE-OLIVEIRA ◽  
Ursula M. MARTINS ◽  
Yone A. NASCIMENTO ◽  
Adriano M. REIS ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Management ◽  
Cross Sectional Study ◽  
Clinical Impact ◽  
Clinical Event ◽  
Cross Sectional ◽  
Indirect Measures ◽  
Clinical Consequences ◽  
Safety Parameters ◽  
Available Information

Objective: A drug interaction (DI) is the clinical event in which the effect or action of one drug is modified by the presence of another. Because of potential harms and low consistency of available information, it is critical to assess the clinical relevance of DI. This study aimed to identify and evaluate the clinical consequences of DI in the pharmacotherapy of patients followed in a primary care Comprehensive Medication Management (CMM) services. Methods: This observational cross-sectional study was based on the analysis of the CMM records all the patients that used at least two medications and attended to at least three CMM consultations from August 2015 to March 2016 (n=88). Potential DI were identified among the medications used in the initial consultation of CMM using Micromedex® Drug-Reax® software. The DI were classified as “monitorable” (when its clinical consequences could be monitored by effectiveness or safety paremeters) or non-monitorable, and their clinical consequences were evaluated by analysis of CMM records. Results: Among the studied population 95.5% of the patients had at least one potential DI in their pharmacotherapy, totaling 493 potential DI. Of all the potential DIs identified, 90.9% were monitorable, and the majority of these monitorable DI presented no clinical consequences (62.7%). For 63.9% of the DI with clinical impact, the pharmacist adopted direct or indirect measures that would favor the resolution or reduction of the clinical impact of DIs. Conclusion: The CMM service facilitates the management of DIs since its decision-making method calls for monitoring of the effectiveness and safety parameters, individualizing the management of DIs according to the patient’s needs and their clinical consequences.

scholarly journals Time of Day is Associated with Opioid Prescribing for Low Back Pain in Primary Care

2018 ◽  
Vol 33 (11) ◽  
pp. 1828-1830 ◽  
Author(s):  
Lindsey M. Philpot ◽  
Bushra A. Khokhar ◽  
Daniel L. Roellinger ◽  
Priya Ramar ◽  
Jon O. Ebbert
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Time Of Day ◽  
Low Back ◽  
Opioid Prescribing

Patient Digital Technologies to Support Primary Care across Disorders: Perspectives from Primary Care Providers, Behavioral Health Consultants, and Nurses (Preprint)

2021 ◽  
Author(s):  
Oleg Zaslavsky ◽  
Frances Chu ◽  
Brenna Renn
Keyword(s):  
Primary Care ◽  
Mobile Apps ◽  
Medication Management ◽  
Primary Care Providers ◽  
Health Conditions ◽  
Care Providers ◽  
Health Promoting Behaviors ◽  
Live Video ◽  
Health Promoting ◽  
Clinical Conditions

BACKGROUND Acceptance of digital health technologies among primary care providers and staff for various clinical conditions has not been explored. OBJECTIVE The purpose of this nationwide study was to determine differences between behavioral health consultants (BHCs), primary care providers (PCPs), and nurses in acceptance of mobile apps, wearables, live video, phone, email, instant chats, text messages, social media, and patient portals to support patient care across clinical conditions. METHODS We surveyed 51 BHCs, 52 PCPs, and 48 nurses embedded in primary care clinics across the United States. We asked respondents to mark technologies they consider appropriate to support patients in: acute and chronic disease, medication management, health-promoting behaviors, sleep, substance use, and common and serious mental health conditions. RESULTS Respondents were geographically dispersed across the nation, although most (82.9%) practiced in urban and suburban settings. Compared to other personnel, a higher proportion of BHCs endorsed live video. Similarly, a higher proportion of nurses endorsed all other technologies. PCPs had the lowest rates of endorsement across technologies. Within clinical contexts, the highest acceptance rates were 81% and 70% for BHCs and PCPs respectively in live video for common mental health conditions, and 75% for nurses in mobile apps for health-promoting behaviors. The lowest (9%) endorsement rate across providers was in social media for medication management. CONCLUSIONS The survey suggests subtle differences in the way clinicians envision using technologies to support patient care. Future work must attend to provider perceptions to ensure the sustainment of services across conditions and patient populations.

scholarly journals Electronic Health Records and Patient Safety

2015 ◽  
Vol 06 (01) ◽  
pp. 136-147 ◽  
Author(s):  
D. Gans ◽  
J. White ◽  
R. Nath ◽  
J. Pohl ◽  
C. Tanner
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Management ◽  
Health Records ◽  
Safety Practices ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices ◽  
Promote Patient Safety

Summary Background: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions: Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. Citation: Tanner C, Gans D, White J, Nath R, Pohl J. Electronic health records and patient safety – co-occurrence of early EHR implementation with patient safety practices in primary care settings. Appl Clin Inf 2015; 6: 136–147http://dx.doi.org/10.4338/ACI-2014-11-RA-0099

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