scholarly journals Vanderbilt Health Affiliated Network Statin Outreach Service

2020 ◽  
Author(s):  
Christopher Terry ◽  
Erin B. Neal ◽  
Katelynn Daly ◽  
Donna Skupien ◽  
Michelle L. Griffith
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Medical Center ◽  
Tertiary Care ◽  
Primary Care Providers ◽  
Care Group ◽  
Care Providers ◽  
Physician Practices ◽  
Outreach Service ◽  
Academic Center

The Vanderbilt Health Affiliated Network (VHAN) is a collaborative alliance of physicians, health systems, and employers driving a new level of clinical innovation and teamwork to enhance patient care, contain costs, and improve the health of communities in Tennessee and surrounding states. The network includes more than 5,000 clinicians, 60 hospitals, 12 health systems, and hundreds of physician practices and clinics who work together to strengthen communities and improve quality of life across the Southeast through better health. The statin outreach service was piloted in one VHAN practice, the Vanderbilt Medical Group, a large primary care group at Vanderbilt University Medical Center (VUMC). VUMC is a tertiary care academic center. VUMC primary care providers (PCPs) are located in several practice locations, and one location was chosen to pilot this intervention. The PCPs included internal medicine residents and attending physicians. Before this project, there was no clinical pharmacy presence in this practice.

scholarly journals Vanderbilt Health Affiliated Network Statin Outreach Service

2020 ◽  
Author(s):  
Christopher Terry ◽  
Erin B. Neal ◽  
Katelynn Daly ◽  
Donna Skupien ◽  
Michelle L. Griffith
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Medical Center ◽  
Tertiary Care ◽  
Primary Care Providers ◽  
Care Group ◽  
Care Providers ◽  
Physician Practices ◽  
Outreach Service ◽  
Academic Center

The Vanderbilt Health Affiliated Network (VHAN) is a collaborative alliance of physicians, health systems, and employers driving a new level of clinical innovation and teamwork to enhance patient care, contain costs, and improve the health of communities in Tennessee and surrounding states. The network includes more than 5,000 clinicians, 60 hospitals, 12 health systems, and hundreds of physician practices and clinics who work together to strengthen communities and improve quality of life across the Southeast through better health. The statin outreach service was piloted in one VHAN practice, the Vanderbilt Medical Group, a large primary care group at Vanderbilt University Medical Center (VUMC). VUMC is a tertiary care academic center. VUMC primary care providers (PCPs) are located in several practice locations, and one location was chosen to pilot this intervention. The PCPs included internal medicine residents and attending physicians. Before this project, there was no clinical pharmacy presence in this practice.

scholarly journals Shared Care for Adults with Sickle Cell Disease: An Analysis of Care from Eight Health Systems

2019 ◽  
Vol 8 (8) ◽  
pp. 1154
Author(s):  
Arch G. Mainous ◽  
Benjamin Rooks ◽  
Rebecca J. Tanner ◽  
Peter J. Carek ◽  
Vandy Black ◽  
...  
Keyword(s):  
Primary Care ◽  
Sickle Cell Disease ◽  
Health Systems ◽  
Sickle Cell ◽  
Primary Care Providers ◽  
Shared Care ◽  
Care Group ◽  
Care Providers ◽  
Cell Disease ◽  
Lower Likelihood

Adult sickle cell disease (SCD) patients frequently transition from pediatric hematology to adult primary care. We examined healthcare utilization for adult patients with SCD with shared care between hematologists and primary care providers (PCP). We analyzed the OneFlorida Data Trust, a centralized data repository of electronic medical record (EMR) data from eight different health systems in Florida. The number of included adults with SCD was 1147. We examined frequent hospitalizations and emergency department (ED) visits by whether the patient had shared care or single specialty care alone. Most patients were seen by a PCP only (30.4%), followed by both PCP and hematologist (27.5%), neither PCP nor hematologist (23.3%), and hematologist only (18.7%). For patients with shared care versus single specialist care other than hematologist, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.63; 95% CI 0.43–0.90). Similarly, when compared to care from a hematologist only, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.67; 95% CI 0.47–0.95). There was no significant relationship between shared care and ED use. When patients with SCD have both a PCP and hematologist involved in their care there is a benefit in decreased hospitalizations.

scholarly journals 1542. Provider Uptake of Extragenital Screening for Gonorrhea and Chlamydia in Active Duty Air Force Members with Incident HIV Diagnosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S770-S771
Author(s):  
Christian C Lamb ◽  
Joseph Yabes ◽  
Shilpa Hakre ◽  
Jason Okulicz
Keyword(s):  
Primary Care ◽  
Hiv Infection ◽  
Air Force ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Previous History ◽  
Primary Care Providers ◽  
Care Providers ◽  
National Guidelines ◽  
Hiv Diagnosis

Abstract Background The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection. Methods All USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C. Results Patients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone. Table 1 Table 2 Conclusion EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening. Disclosures All Authors: No reported disclosures

Diagnosis of retinal detachments by a tele-ophthalmology screening program

2018 ◽  
Vol 25 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Sarah A McCord ◽  
Mary G Lynch ◽  
April Y Maa
Keyword(s):  
Primary Care ◽  
Screening Program ◽  
Medical Center ◽  
Case Reports ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Eye Care ◽  
Primary Care Clinics ◽  
The Usa

In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.

scholarly journals 864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S523-S524
Author(s):  
Genevieve Allen ◽  
Jamie Riddell
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Hiv Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Academic Medical ◽  
Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p < 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

scholarly journals MP05: Injuries in refugee children presenting to a paediatric emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S41-S42
Author(s):  
E. Zhang ◽  
F. Razik ◽  
S. Ratnapalan
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Tertiary Care ◽  
Primary Care Providers ◽  
Refugee Children ◽  
Medical Attention ◽  
Care Providers ◽  
Ed Visits

Introduction: The number of refugees accepted to Canada grew from 24,600 in 2014 to 46,700 in 2016. Many of these refugees have young families and the number of child refugees has increased accordingly. Although child refugee health care has been in the forefront of media and medical attention recently, there is limited data on injury patterns in this population. Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) collects data on injuries in children presenting to the emergency department (ED). Our objective is to examine the clinical presentations and outcomes of refugee children with injuries presenting to a tertiary care paediatric ED. Methods: Our paediatric hospital has approximately 70,000 ED visits per year of which 13,000 are due to injuries and/or poisonings. The CHIRPP database was accessed to identify children with injuries presenting to our ED from April 2014 to March 2017 with Interim Federal Health Program (IFHP) registration status. All patient charts were reviewed to extract demographic and clinical care information. Results: There were 74 children with 81 ED visits during the study period of whom 19% were transferred from other facilities. Most of them (72%) were males with a mean age of 8.7 years (standard deviation 4.29). There were significant medical histories in 32% of children. The presentation to our ED (greater than 24 hours post-injury) was seen in 25% of visits. Twenty five percent of injured children were seen in our ED. The distribution of Canadian Triage Acuity Score (CTAS) scores 1, 2, 3, 4, and 5 were 0%, 16%, 37%, 46% and 1% respectively. However, subspecialty consultations were required in 69%, 60% and 27% of CTAS 2, 3 and 4 children respectively. Overall, 46% of all patients required subspecialty consults. The top three categories of injuries include fractures (23%), soft tissue injuries (20%) and lacerations (17%). More than half (56%) required diagnostic imaging. Most (89%) were treated in ED and discharged (average length-of-stay 3 hours 55 minutes) and 11% required admissions. 47% of children lacked primary care physicians. Conclusion: Almost half of refugee children with IFHP status require DI testing, sub-specialty consultations and primary care referrals when presenting to our ED with injuries. Follow up arrangements are needed as many do not have access to primary care providers. This demonstrates a need for securing primary care providers early for this vulnerable population.

Project LIFE: A Partnership to Increase Physical Activity in Elders with Multiple Chronic Illnesses

2006 ◽  
Vol 14 (3) ◽  
pp. 324-343 ◽  
Author(s):  
Miriam C. Morey ◽  
Carola Ekelund ◽  
Megan Pearson ◽  
Gail Crowley ◽  
Matthew Peterson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Usual Care ◽  
High Intensity ◽  
Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Significant Group ◽  
Physical Activity Counseling ◽  
Activity Counseling

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group × Time interaction (p= .041) for physical activity frequency and a similar effect for caloric expenditure (p= .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.

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