Integrated Care: Provider referrer perceptions of occupational therapy services for homeless adults in an integrated primary care setting

Work ◽  
2020 ◽  
Vol 65 (2) ◽  
pp. 321-330 ◽  
Author(s):  
M. Beth Merryman ◽  
Caitlin Synovec
Keyword(s):  
Primary Care ◽  
Occupational Therapy ◽  
Integrated Care ◽  
Care Provider ◽  
Care Setting ◽  
Primary Care Setting ◽  
Integrated Primary Care ◽  
Homeless Adults ◽  
Therapy Services

FRI0512 INTEGRATED CARE NETWORK AS A BUILDING STONE FOR SUSTAINABLE AND COMPREHENSIVE CARE FOR PATIENTS WITH ARTHRALGIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 855.1-855
Author(s):  
E. Van Delft ◽  
K. H. Han ◽  
J. Hazes ◽  
D. Lopes Barreto ◽  
A. Weel
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Integrated Care ◽  
Usual Care Group ◽  
Inflammatory Arthritis ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Group ◽  
Care Network ◽  
The Right

Background:Western countries experience an increasing demand for care, particularly for inflammatory arthritis (IA), while the healthcare budget decreases1. The innovative value-based primary care strategy2includes integrated care networks, where primary and secondary care bundle their expertise to improve patient value by providing the right care at the right place.General practitioners (GPs) have difficulties recognising IA, leading up to only 20% IA diagnoses of all newly referred arthralgia patients. However, since IA needs to be treated as early as possible to overcome progression, it is worthwhile to analyse whether integrated care networks have an impact on patient outcomes and cost-effectiveness. Triage by a rheumatologist in a primary care setting is one of the most promising integrated care networks for efficient referrals3.Objectives:To assess the effect of triage by a rheumatologist in a primary care setting in patients suspect for inflammatory arthritis.Methods:The present study follows a cluster randomized controlled trial design. The intervention, triage by a rheumatologist in a local primary care centre, will be compared to usual care. Usual care means that patients are referred to a rheumatology outpatient clinic based on the opinion of the general practitioner.The primary outcome is the frequency of IA diagnoses assessed by a rheumatologist. Patient reported outcome measures (PROMs (EQ-5D)) and costs (work productivity (iPCQ) and healthcare utilization (iMCQ)) were determined at baseline, after three, six and twelve months. The target was to include 267 patients for each study group (power level 0.8). Since this study is still ongoing we can only show first results on the efficiency of referrals.Results:In the period between February 2017 and December 2019 a total of 543 participants were included; 275 in the usual care group and 268 in the triage group. Mean age (51.3 ± 14.6 years) and percentage of men (23.6%) were comparable between groups (page=0.139; psex=0.330).The preliminary data show that the number of referred patients in the triage group is n=28 (10.5%) (Fig. 1). 32 patients (11.9%) were not referred directly but advice was given for additional diagnostics. Since all patients in the usual care group were referred there is a decrease of at least 77.6% in referrals when rheumatologists are participating in the integrated practice units.Preliminary data on diagnosis are available for all referred patients in the triage group and for n=137 (49.8%) in the usual care group at this point. In the triage group n=18 (64.2%) of referred patients were diagnosed with IA (6.7% of the total study population). In the usual care group this was n=52 (38.0%) of the patients yet diagnosed.Conclusion:These preliminary results of an integrated care network are promising. Approximately three-quarters of all patients can be withheld from expensive outpatient care. PROMs data and cost-effectiveness analysis will give clear answers in order to provide evidence whether this integrated care network can be implemented as a standard of care.References:[1] Rijksoverheid. (2018). Bestuurlijk akkoord medisch-specialistische zorg 2019 t/m 2022.https://www.rijksoverheid.nl/.[2] Porter ME, Pabo EA, Lee TH. (2013). Redesigning Primary Care: a strategic vision to improve value by organizing around patients’ needs. Health affairs, 32(3);516-525[3] Akbari A, et al. (2008). Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database Syst Rev, 4,CD005471.Disclosure of Interests:None declared

Crisis Intervention in Integrated Care

2017 ◽  
Author(s):  
Scott A. Simpson ◽  
Robert E. Feinstein
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Crisis Intervention ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Environment ◽  
Intervention Treatment ◽  
Response To Stress ◽  
Life Stressor ◽  
Integrated Team

A crisis occurs when a life stressor overwhelms a person’s ability to cope with a problematic life situation. Crises often become evident in the primary care setting. People in crisis feel distressed and alone; they experience a psychological disorganization that affects their mood and functioning. Most patients can benefit from a brief crisis intervention treatment delivered in an integrated care environment. Behavioral health specialists can lead crisis intervention therapy with the support of the primary care provider, nurses, staff, and a consulting psychiatrist. Crisis intervention treatment includes identifying the life stressor, understanding the patient’s response to stress, assessing the patient’s social system, listing possible solutions to the crisis, and working to implement those solutions. As the crisis resolves, the integrated team provides anticipatory guidance for the patient and primary provider.

scholarly journals Attitudes and perceived barriers to firearm safety anticipatory guidance by pediatricians: a statewide perspective

2021 ◽  
Vol 8 (S1) ◽  
Author(s):  
Bijan Ketabchi ◽  
Michael A. Gittelman ◽  
Hayley Southworth ◽  
Melissa Wervey Arnold ◽  
Sarah A. Denny ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Perceived Barriers ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Safety Education ◽  
Firearm Safety

Abstract Background Firearms are the second leading cause of injury-related death in American children. Safe storage of firearms is associated with a significantly decreased odds of firearm-related death, however more than half of US firearm owners store at least one firearm unlocked or accessible to a minor. While guidance by primary care providers has been shown to improve storage practices, firearm safety counseling occurs infrequently in the primary care setting. The primary objective of this study was to describe pediatricians’ perceived barriers to providing firearm safety education to families in the pediatric primary care setting. Secondary objectives included identifying pediatric provider attitudes and current practices around firearm counseling. Methods This was a cross-sectional survey of pediatric primary care providers in Ohio. Participants were recruited from the Ohio AAP email list over a 3-month period. Only pediatric primary care providers in Ohio were included; subspecialists, residents and non-practicing physicians were excluded. Participants completed an anonymous online survey detailing practice patterns around and barriers to providing firearm safety counseling. Three follow-up emails were sent to pediatricians that failed to initially respond. Response frequencies were calculated using Microsoft Excel. Results Two hundred eighty-nine pediatricians completed the survey and 149 met inclusion criteria for analysis. One hundred seven (72%) respondents agreed that it is the responsibility of the pediatric primary care provider to discuss safe storage. Counseling, however, occurred infrequently with 119 (80%) of respondents performing firearm safety education at fewer than half of well child visits. The most commonly cited barriers to providing counseling were lack of time during office visits, lack of education and few resources to provide to families. A majority, 82 of pediatric providers (55%), agreed they would counsel more if given additional training, with 110 (74%) conveying they would distribute firearm safety devices to families if these were available in their practice. Conclusion Ohio pediatricians agree that it is the responsibility of the primary care provider to discuss firearm safety. However, counseling occurs infrequently in the primary care setting due to a lack of time, provider education and available resources. Improving access to resources for primary care pediatricians will be critical in helping educate families in order to protect their children through improved storage practices.

scholarly journals Telepsychiatry and integrated primary care: setting expectations and creating an effective process for success

mHealth ◽  
2020 ◽  
Vol 6 ◽  
pp. 29-29 ◽  
Author(s):  
Jacqueline Calderone ◽  
Amy Lopez ◽  
Sarah Schwenk ◽  
Joel Yager ◽  
Jay H. Shore
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Integrated Primary Care

scholarly journals 2264 Early findings from a real-world RCT: Acceptance and commitment therapy (ACT) for persistent pain in an integrated primary care setting

2018 ◽  
Vol 2 (S1) ◽  
pp. 81-81
Author(s):  
Kathryn E. Kanzler ◽  
Patricia Robinson ◽  
Mariana Munante ◽  
Donald McGeary ◽  
Jennifer Potter ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Persistent Pain ◽  
Integrated Primary Care ◽  
Treatment As Usual ◽  
Integrated Behavioral Health ◽  
Behavioral Health Provider ◽  
Acceptance And Commitment ◽  
Opioid Medications

OBJECTIVES/SPECIFIC AIMS: This study seeks to test the feasibility and effectiveness of a brief Acceptance and commitment therapy (ACT) treatment for patients with persistent pain in a patient-centered medical home. METHODS/STUDY POPULATION: Participants are recruited via secure messaging, clinic advertisements and clinician referral. Primary care patients age 18 and older with at least 1 pain condition for 12 weeks or more in duration are stratified based on pain severity ratings and randomized into (a) ACT intervention or (b) control group [Enhanced Treatment as Usual (E-TAU)]. Participants in the ACT arm attend 1 individual visit with an integrated behavioral health provider, followed by 3 weekly ACT classes and a booster class 2 months later. E-TAU participants will receive usual care plus patient education handouts informed by cognitive behavioral science. Currently, 17% of our overall goal of 60 patients have completed ACT or enhanced treatment as usual. Average participant age is 49 years old, 70% female, and 70% Hispanic/Latino. Most report multisite pain conditions (e.g., musculoskeletal, fibromyalgia) and 30% are taking opioid medications. Data analysis in this presentation will include early correlational findings from baseline assessments. Upon study completion, we will analyze data using a general linear mixed regression model with repeated measures. RESULTS/ANTICIPATED RESULTS: The overall hypothesis is that brief ACT treatment reduces physical disability in patients with persistent pain when delivered by an integrated behavioral health provider in primary care. By examining a subset of patients on opioid medications, we also anticipate a reduction in opioid misuse behaviors. Additionally, it is anticipated that improvements in patient functioning will be mediated by patient change in pain acceptance and patient engagement in values-consistent behaviors. DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot study will establish preliminary data about the feasibility and effectiveness of addressing persistent pain in a generalizable, “real-world” integrated primary care setting. Data will help support a larger trial in the future. If effective, findings could improve treatment methods and quality of life for patients with persistent pain using a scalable approach.

The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting: effects on patient outcomes

2002 ◽  
Vol 39 (4) ◽  
pp. 441-451 ◽  
Author(s):  
H.J.M Vrijhoef ◽  
J.P.M Diederiks ◽  
C Spreeuwenberg ◽  
B.H.R Wolffenbuttel ◽  
L.J.G.P van Wilderen
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Patient Outcomes ◽  
Care Provider ◽  
Care Setting ◽  
Primary Care Setting ◽  
Nurse Specialist

Delivering Parent Management Training in an Integrated Primary Care Setting: Description and Preliminary Outcome Data

2014 ◽  
Vol 21 (3) ◽  
pp. 296-309 ◽  
Author(s):  
Debbie Gomez ◽  
Ana J. Bridges ◽  
Arthur R. Andrews ◽  
Timothy A. Cavell ◽  
Freddie A. Pastrana ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Management Training ◽  
Outcome Data ◽  
Parent Management Training ◽  
Integrated Primary Care ◽  
Parent Management

Treating Substance Use Disorders in Integrated Care Settings

2017 ◽  
Author(s):  
Patricia Pade ◽  
Laura Martin ◽  
Sophie Collins
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Integrated Care ◽  
Substance Use Disorders ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Assessment Process ◽  
Care Providers ◽  
Care Environment

Addiction and substance use disorders (SUDs) are extremely prevalent and are commonly encountered in the primary care setting. The traditional separation of SUD treatment from mainstream medicine has not been an optimal model of effective patient care. Primary care providers can play a crucial role in the recognition, intervention, and treatment of SUDs. This chapter provides an overview of the assessment process, intervention strategies, and pharmacologic and nonpharmacologic treatments that can be effectively implemented in an integrated care environment or primary care setting for a variety of SUDs. The integration of SUD treatment into integrated care environments holds the promise of improving acceptability to patients, decreasing the stigmatization of SUDs, enhancing satisfaction for providers, and improving outcomes for patients.

Age and Mental Health Status Differences in Medical Service Utilization in an Integrated Primary Care Setting

2004 ◽  
Vol 27 (4) ◽  
pp. 71-82
Author(s):  
David C. Speer ◽  
Larry W. Dupree ◽  
Celestino Vega ◽  
Myra G. Schneider ◽  
Jini M. Hanjian ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Status ◽  
Service Utilization ◽  
Medical Service ◽  
Care Setting ◽  
Primary Care Setting ◽  
Integrated Primary Care ◽  
Medical Service Utilization ◽  
Status Differences

scholarly journals Creating an integrated care model for childhood obesity: a randomized pilot study utilizing telehealth in a community primary care setting

2016 ◽  
Vol 6 (6) ◽  
pp. 380-388 ◽  
Author(s):  
A. Fleischman ◽  
S. E. Hourigan ◽  
H. N. Lyon ◽  
M. G. Landry ◽  
J. Reynolds ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Pilot Study ◽  
Integrated Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Model
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