Optimal measures for primary care physician encounters after stroke and association with survival: a data linkage study

2021 ◽  
Author(s):  
David Ung ◽  
Yun Wang ◽  
Vijaya Sundararajan ◽  
Derrick Lopez ◽  
Monique F. Kilkenny ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Cox Regression ◽  
Information Criterion ◽  
Median Number ◽  
Care Physician ◽  
Composite Measure ◽  
Optimal Care ◽  
Clinical Registry

Background and Purpose: Primary care physicians provide ongoing management after stroke. However, little is known about how best to measure physician encounters with reference to longer term outcomes. We aimed to compare methods for measuring regularity and continuity of primary care physician encounters, based on survival following stroke using linked healthcare data. Methods: Data from the Australian Stroke Clinical Registry (2010-2014) were linked with Australian Medicare claims from 2009 2016. Physician encounters were ascertained within 18 months of discharge for stroke. We calculated three separate measures of continuity of encounters (consistency of visits with primary physician) and three for regularity of encounters (distribution of service utilization over time). Indices were compared based on 1-year survival using multivariable Cox regression models. The best performing measures of regularity and continuity, based on model fit, were combined into a composite ‘optimal care’ variable. Results: Among 10,728 registrants (43% female, 69% aged ≥65 years), the median number of encounters was 17. The measures most associated with survival (hazard ratio [95% confidence interval], Akaike information criterion [AIC], Bayesian information criterion [BIC]) were the: Continuity of Care Index (COCI, as a measure of continuity; 0.88 [0.76 1.02], p=0.099, AIC=13746, BIC=13855) and our persistence measure of regularity (encounter at least every 6 months; 0.80 [0.67 0.95], p=0.011, AIC=13742, BIC=13852). Our composite measure, persistent plus COCI ≥80% (24% of registrants; 0.80 [0.68 0.94], p=0.008, AIC=13742, BIC=13851), performed marginally better than our persistence measure alone. Conclusions: Our persistence measure of regularity or composite measure may be useful when measuring physician encounters following stroke.

The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 284-290
Author(s):  
Paul C. Young ◽  
Yu Shyr ◽  
M. Anthony Schork
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Chronic Illness ◽  
Medical Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease. Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital. Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease. Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness. Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness. Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.

Health Literacy in Primary Care: Reflections and Suggestions for Physicians, Researchers, and Administrators

2021 ◽  
pp. 155982762110412
Author(s):  
Anne Sprogell ◽  
Allison R. Casola ◽  
Amy Cunningham
Keyword(s):  
Primary Care ◽  
Health Literacy ◽  
Primary Care Physician ◽  
Healthcare System ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Health Records ◽  
The Past ◽  
Personal Bias ◽  
Concept Of Health

As the healthcare system evolves, it is becoming more complicated for physicians and patients. Patients might have had one doctor in the past, but now are likely to regularly see several specialists along with their primary care physician. Patients can access their health records online, which increases transparency and accountability, but adds more information they have to interpret. This is the concept of health literacy—the ability to obtain, process, and act upon information regarding one’s health. This article will characterize health literacy in primary care and provide three areas that primary care physicians and researchers can direct their focus in order to increase health literacy among patients: community engagement, trainee education, and examination of personal bias.

scholarly journals Medical Cannabis for the Primary Care Physician

2019 ◽  
Vol 10 ◽  
pp. 215013271988483 ◽  
Author(s):  
Deepika Slawek ◽  
Senthil Raj Meenrajan ◽  
Marika Rose Alois ◽  
Paige Comstock Barker ◽  
Irene Mison Estores ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Efficacy And Safety ◽  
Medical Cannabis ◽  
Number Of Patients

Medical cannabis use is common in the United States and increasingly more socially acceptable. As more patients seek out and acquire medical cannabis, primary care physicians will be faced with a growing number of patients seeking information on the indications, efficacy, and safety of medical cannabis. We present a case of a patient with several chronic health conditions who asks her primary care provider whether she should try medical cannabis. We provide a review of the pharmacology of medical cannabis, the state of evidence regarding the efficacy of medical cannabis, variations in the types of medical cannabis, and safety monitoring considerations for the primary care physician.

Smartphone-based tele-electrocardiography support for primary care physicians reduces the pain-to-treatment time in acute coronary syndrome

2017 ◽  
Vol 24 (8) ◽  
pp. 540-546 ◽  
Author(s):  
Vivek Chauhan ◽  
Prakash C Negi ◽  
Sujeet Raina ◽  
Sunil Raina ◽  
Mukul Bhatnagar ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Coronary Syndrome ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Intervention Group ◽  
Care Physician ◽  
Medical College Hospital ◽  
College Hospital ◽  
Medical College ◽  
Coronary Syndrome

Background The Himachal Pradesh state acute coronary syndrome registry recorded a median delay of 13 h between the time of onset of pain to the time of making the diagnosis and giving treatment for acute coronary syndrome. We conducted a pilot study on providing 24-h tele-electrocardiography (Tele-ECG) services in the district Kangra of Himachal Pradesh, with the aim to reduce the time taken for diagnosis of acute coronary syndrome. Methods The intervention group for the study included eight rural community health centres, each with one to three primary care physicians, who were all unskilled in electrocardiogram interpretation. We provided them with 24-h Tele-ECG support. The primary care physicians used their smartphones to transmit the electrocardiogram image to the command centre, which was then read by the skilled specialist physicians in our medical college hospital and the report sent back within five minutes of having received the electrocardiogram. Antiplatelets were given by the primary care physician to patients diagnosed with acute coronary syndrome, who was then transported to the medical college hospital. The urban sub-divisional hospitals ( n = 6) formed the control group for the study. These hospitals had five to fifteen unskilled primary care physicians and one to two skilled specialist physicians; no intervention was done in this group. A pilot was run from February 2015–January 2016. Results We received 819 Tele-ECG consultations within the intervention group; 157 cases of acute coronary syndrome were confirmed and transferred to our medical college hospital facility. Similarly, we admitted 177 cases of acute coronary syndrome at the medical college hospital, who were first attended to by the primary care physician in the control group. Aspirin was administered to 91% and 58% of patients with acute coronary syndrome in the intervention and the control groups, respectively ( p < 0.0001). The median hospital-to-aspirin time (h) in the intervention and the control groups was 0.7 ± 1.45 h and 3.5 ± 10 h, respectively ( p < 0.0001). In the intervention group, 72% of the ST elevation myocardial infarction patients were diagnosed within 12 h by the primary care physician using Tele-ECG support. Interpretation and conclusions Smartphone-based Tele-ECG support for primary care physicians reduced the hospital-to-aspirin time in acute coronary syndrome significantly ( p < 0.0001). This is an effective low cost strategy and is easily replicable anywhere in the world.

Depression as a Systemic Illness

2018 ◽  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Collaborative Care ◽  
Primary Care Physicians ◽  
Depressive Disorders ◽  
Developed Countries ◽  
Care Physician ◽  
World Health ◽  
Mental Health Training ◽  
The World

Depression has been declared by the World Health Organization in March of 2017 to be the illness with the greatest burden of disease in the world. This volume attempts to examine the current state of our understanding of depressive disorders, from the animal models, allostatie load, patterns of recurrence, effects on other illnesses, for example, cancer, neurological, cardiovascular, wound healing, etc. It is from this perspective that the editors declare that depression is a systemic illness, not just a mental disorder. Therefore, primary care physicians need to know how to diagnose, treat, and refer when necessary for the non-complicated, non-refractory forms of depression. From this perspective models of mental health training for the primary care physician are reviewed. Then a new model, the medical model, a step beyond collaborative care is described. Non complicated depressive illness needs to be addressed by the primary care physician much as they do asthma, diabetes, hyptertension, and congestive heart failure. Even collaborative care models are unable as the number of psychiatrists is too few even in developed countries, let alone in developing ones to work with primary care. Medical schools and residency training programs need to incorporate curriculum and clinical experiences to accommodate developing expertise to diagnose, treat, and refer when necessary in this most common medical malady. Finally, a modified electronic medical record is proposed as a collaborating agent for the primary care physician.

Likelihood of Normal ABI Increases With Physiologic Testing Referrals From Rural Primary Care Physicians

2019 ◽  
Vol 43 (3) ◽  
pp. 123-127
Author(s):  
Robert P. Scissons ◽  
Abraham Ettaher ◽  
Sophia Afridi
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Bypass Graft ◽  
Ankle Brachial Index ◽  
Care Physician ◽  
Health Care Facilities ◽  
Rural Primary Care ◽  
And Gender

Disparities in diagnostic capabilities have been noted between rural and urban health care facilities. We believe the clinical evaluation of peripheral arterial disease (PAD) by rural physicians may be similarly affected. Patients referred for arterial physiologic testing in an urban and rural regional health care network for a consecutive 7-month period were reviewed. Patients were classified into 3 groups based on referring physician specialty: (1) vascular surgeon or vascular medicine specialist (Vasc), (2) urban primary care physician (Urban), and (3) rural primary care physician (Rural). Normal patients were defined by a posterior tibial (PT) or dorsalis pedis (DP) ankle-brachial index (ABI) of ⩾0.90, bilaterally. Abnormal patients had both PT and DP ABI <0.90 in one or both extremities. Group comparisons were made for normal and abnormal patients, age (⩾65 years old), and gender. Patients with history of amputations, angioplasty, bypass graft, stent, calcification (PT or DP ABI ⩾1.30), and previous physiologic testing outside the designated period of analysis were considered a separate subclassification and analyzed separately. Emergency room referrals, inpatients, and patients with incomplete examination data were excluded from the analysis. A total of 430 patient exams were evaluated. Group-Rural had significantly greater numbers of normal ABI patients compared with Group-Urban ( P = .0028) and Group-Vasc ( P = .0000). No significant differences were noted between all groups for age and gender. Substantial disparities were noted in normal and abnormal ABI patients between rural health care physicians and their urban primary care and vascular specialist counterparts. Significantly greater numbers of normal ABI referrals by rural primary care physicians may warrant enhanced PAD diagnosis education or telemedicine alternatives.

scholarly journals Communication between health professionals and their influence on the coordination of care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M F M Mendes ◽  
I C Samico ◽  
Z M A Hartz
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Diagnostic Errors ◽  
Care Physician ◽  
Primary Role ◽  
Coordination Of Care ◽  
Levels Of Care ◽  
Specialized Care

Abstract Background Problems linked to the coordination of care may represent a lack of communication between levels of care and reflect diagnostic errors, duplication of tests and unnecessary hospitalizations. This study aims to understand the role of communicational relationships between professionals and their influence on coordination between levels of care. Methods An evaluative and qualitative nature research. 24 interviews were carried out, with primary care physicians and specialists, institutional supporters and managers of a public health network in Pernambuco, Brazil. The content thematic analysis worked out sought to identify synergies and contradictions in the relationships between the actors. Results Knowledge about the role of primary care was incomplete, not being understood its primary role as a care provider. The primary care physician was not recognized as the responsible physician by most professionals. The specialists considered the references poorly filled out and showed a lack of confidence in the primary care physician, who in turn revealed that he did not receive any counter-reference and difficulty in contacting a specialist. Few articulation mechanisms have been reported between levels and the use of informal communication mechanisms. The managers acknowledged the existence of problems, but highlighted the commitment of management in the actions for organizing the network. The “goodwill” of the professionals was considered an articulation facilitator, but not a sufficient practice. Conclusions The results allowed to deepen the look at the complexity of the relationships between the actors and how they can influence coordination. Since is perceived the communicational tensions and weaknesses, it is urgent to think of strategies that establish institutionalized spaces for meetings and dialogues that allow articulation among professionals. Key messages The study analyzes communicational relationships between primary and specialized care professionals and their influence on the coordination of care. Strategies for mutual collaboration are mandatory.

scholarly journals International variations in primary care physician consultation time: a systematic review of 67 countries

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017902 ◽  
Author(s):  
Greg Irving ◽  
Ana Luisa Neves ◽  
Hajira Dambha-Miller ◽  
Ai Oishi ◽  
Hiroko Tagashira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Primary Care Physician ◽  
Low Income ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Physician Satisfaction ◽  
Physician Consultation ◽  
The Relationship ◽  
Global Population

ObjectiveTo describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes.Design and outcome measuresThis is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes.ResultsOne hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction.ConclusionThere are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.

scholarly journals Rheumatic polymyalgia: clinic, diagnosis, principles of therapy (to help the primary care physician)

2021 ◽  
pp. 164-169
Author(s):  
M. S. Svetlova
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Care Physician ◽  
Diagnostic Methods ◽  
Malignant Neoplasms ◽  
Adequate Treatment ◽  
Laboratory Activity

In recent decades, there has been an increase in the number of elderly people. Among the patients of the primary care physician, without a doubt, those who are over 60 years old predominate. A feature of the elderly is polymorbidity. Combined pathology, numerous complaints of patients make it difficult to diagnose diseases, require patience from the doctor, and, of course, knowledge. There are diseases that are peculiar only to the elderly, developing only after 50 years. These include rheumatic polymyalgia. This pathology is not frequent and, in this regard, is not very familiar to outpatient therapists. However, it is to them that elderly patients turn with complaints of pain and stiffness in the shoulder and/or pelvic girdle, in the neck, in the joints of the hands, fever, weight loss, sleep disorders, depression, general malaise (the main complaints of patients with rheumatic polymyalgia). The above-mentioned clinical manifestations, as well as the high laboratory activity inherent in this disease, make the doctor look for malignant neoplasms, infectious, systemic processes. This takes a long time, the diagnosis is delayed, the sufferings of the patient are prolonged. The article presents data on the prevalence, clinical features, methods of diagnosis of rheumatic polymyalgia and its differential diagnosis. The criteria of the disease, the principles of management of the patient at the outpatient stage  (step-by-step treatment with glucocorticoids, alternative approaches, prevention of side effects of therapy, which develop quite often) are also given. Awareness of primary care physicians about rheumatic polymyalgia, its manifestations and diagnostic methods will speed up the diagnosis, timely consultation of the patient with a rheumatologist, which will allow you to start adequate treatment, significantly improve the quality of life of an elderly patient, and prevent the destabilization of concomitant diseases.

scholarly journals Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study

10.2196/16700 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e16700 ◽  
Author(s):  
Mara G Bianchi ◽  
Andre Santos ◽  
Eduardo Cordioli
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Care Physician ◽  
Pigmentary Disorders ◽  
The World ◽  
Skin Conditions

Background Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. Objective Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. Methods This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. Results Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. Conclusions Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

Sign in / Sign up

Export Citation Format

Share Document