Comparing Primary Health-Care Service Delivery Disruptions Across Disasters

Objective: The aim of this study was to compare primary care appointment disruptions around Hurricanes Ike (2008) and Harvey (2017) and identify patterns that indicate differing continuity of primary care or care systems across events. Methods: Primary care appointment records covering 5 wk before and after each storm were identified for Veterans Health Affairs (VA) facilities in the greater Houston and surrounding areas and a comparison group of VA facilities located elsewhere. Appointment disposition percentages were compared within and across storm events to assess care disruptions. Results: For Hurricane Harvey, 14% of primary care appointments were completed during the week of landfall (vs 33% for Hurricane Ike and 69% in comparison clinics), and 49% were completed the following week (vs 58% for Hurricane Ike and 71% for comparison clinics). By the second week after Hurricane Ike and third week after Harvey, the scheduled appointment completion percentage returned to prestorm levels of approximately 60%. Conclusions: There were greater and more persistent care disruptions for Hurricane Harvey relative to Hurricane Ike. As catastrophic emergencies including major natural disasters and infectious disease pandemics become a more recognized threat to primary and preventive care delivery, health-care systems should consider implementing strategies to monitor and ensure primary care appointment continuity.

Improving Advance Care Planning Documentation Using Reminders to Patients and Physicians: A Longitudinal Study in Primary Care

Objective: Documenting advance care planning (ACP) in primary care requires multiple triggers. New Medicare codes make it easier for providers to bill for these encounters. This study examines the use of patient and provider reminders to trigger advance care planning discussions in a primary care practice. Secondary outcome was billing of new ACP billing codes. Methods: Patients 75 years and older scheduled for a primary care appointment were screened for recent ACP documentation in their chart. If none was found, an electronic or mail message was sent to the patient, and an electronic message to their provider, about the need to have discussion at the upcoming visit. Chart review was performed 3 months after the visit to determine if new ACP discussion was documented in the chart. Results: In the 3 months after the reminder had been sent to patients and providers, new ACP documentation or billing was found in 28.8% of the patients. Most new documentation was health care decision maker (75.6% of new documentation) with new DNR orders placed for 32.3% of these patients. The new Medicare billing code was filled 10 times (7.8%). Conclusion: Reminders sent to both patients and providers can increase documentation of ACP during primary care visits, but rarely triggers a full ACP conversation.

Characterization and Comparison of Primary Care Appointment Utilization Patterns Among Military Health System Beneficiaries

Introduction The role of primary care in the United States is vitally important to improving health outcomes, minimizing waste, and controlling cost. The Military Health System is tasked with both caring for its beneficiaries and ensuring the medical readiness of active duty service members, who often have needs unique to those in the civilian population. Balancing the number of individuals assigned to a primary care clinician with the clinician’s capacity to meet their medical needs and anticipated appointment demand is a fundamental cornerstone of effective primary care clinic management in any setting. Materials and methods Using the Military Health System Data Repository, this cross-sectional study utilized descriptive statistics and Poisson regression to describe crude and adjusted primary care appointment utilization trends among Military Health System beneficiaries during fiscal year 2016. Results The primary care appointment utilization rate of the study population was 3.3 visits per person-year. The youngest and oldest age groups, women, active duty, and those enrolled to Army clinics had the highest utilization rates within each of the respective covariates. Active duty women had the highest utilization of any group in the data set, with a crude rate of 4.7 visits per person-year. Conclusions Primary care utilization trends are different among different demographic subgroups within the Military Health System (MHS). Unmet demand, patient acuity, clinician continuity, robustness of team support, and other important factors that influence appointment utilization were not incorporated in this study. Superficially, these data suggest that the MHS enrollment target of 1,100–1,300 patients per full-time primary care clinician is roughly appropriate, though this should be interpreted with caution given the limitations.

Communication between patients and primary care physicians after behavioural weight loss: an observational study

Primary care physicians can play a key role in supporting patients after behavioural weight loss, though little is known about communication between patients and physicians during this time. Adults (n=139) in a behavioural weight loss trial (delivered outside of primary care) who attended a primary care appointment after an initial weight loss period were surveyed to assess weight-related communication at their most recent appointment. Most participants (78%) reported discussing weight with their physician. Participants who discussed weight, compared to those who did not, lost more weight, had higher blood pressure, and were more likely to be male. Most (89%) reported that their physician was supportive of their weight loss, but only a few participants (6.9%) reported that their physician gave feedback on medical parameters. Areas for improvement identified include physicians providing universal support for modest weight changes and providing interpretation of medical measurements that changed due to weight loss.