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Nurse practitioner as primary care provider

Isabelle Dibu Mulango, Julius Atashili, Bradley N Gaynes, Tsi Njim
BACKGROUND: Mental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division. METHODS: A cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division...
March 13, 2018: BMC Psychiatry
Susan Bidwell, Andrea Copeland
INTRODUCTION Pegasus Health Charitable Ltd, a Christchurch Primary Health Organisation, is contracted by the Canterbury District Health Board to provide continuing professional development for primary care practitioners in the region. Rurally located health practitioners have largely been unable to participate because of the travel time and distances involved. AIM The initiative reported in this paper aimed to fill this gap by developing an accessible and high-quality multidisciplinary model of professional development for general practitioners, nurse practitioners, practice nurses and community pharmacists in rural areas of North Canterbury, New Zealand...
December 2017: Journal of Primary Health Care
Tinne Smets, Bregje B D Onwuteaka-Philipsen, Rose Miranda, Lara Pivodic, Marc Tanghe, Hein van Hout, Roeline H R W Pasman, Mariska Oosterveld-Vlug, Ruth Piers, Nele Van Den Noortgate, Anne B Wichmann, Yvonne Engels, Myrra Vernooij-Dassen, Jo Hockley, Katherine Froggatt, Sheila Payne, Katarzyna Szczerbińska, Marika Kylänen, Suvi Leppäaho, Ilona Barańska, Giovanni Gambassi, Sophie Pautex, Catherine Bassal, Luc Deliens, Lieve Van den Block
BACKGROUND: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries...
March 12, 2018: BMC Palliative Care
Leah L Zullig, Katherine Ramos, Callie Berkowitz, Julie J Miller, Rowena J Dolor, Bridget F Koontz, S Yousuf Zafar, D Hutch Allen, Jennifer A Tenhover, Hayden B Bosworth
Cancer survivorship care plans (SCPs) are endorsed to support quality care for cancer survivors, but uptake is slow. We assessed knowledge, needs, and preferences for SCP content and delivery from a wide variety of stakeholders. We focused SCP content for head and neck cancer as it is a disease prone to long-term side effects requiring management from multiple providers. We conducted telephone-based, qualitative interviews. We purposively sampled head and neck cancer survivors (n = 4), primary care physicians in the community (n = 5), and providers affiliated with a large academic medical center (n = 5) who treat head and neck cancer, cancer specialists (n = 6), and nurse practitioners/supportive care staff (n = 5)...
March 10, 2018: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
Jessica M Downes, Donald G Klepser, Jennifer Foster, Maggie Nelson
PURPOSE: The implementation of a chronic pain protocol (CPP) and its effects on the management of long-term opioid therapy are described. SUMMARY: The CPP used at a federally qualified health center and primary care clinic was updated in 2015 and included a prescribing ceiling in morphine equivalent dose (MED) per day and standardized the prescribing of chronic opioids. Intermittent urine drug screening performed at least once annually was added as a requirement of the pain management contract between the provider and the patient...
March 1, 2018: American Journal of Health-system Pharmacy: AJHP
G Michael Allan, Jamil Ramji, Danielle Perry, Joey Ton, Nathan P Beahm, Nicole Crisp, Beverly Dockrill, Ruth E Dubin, Ted Findlay, Jessica Kirkwood, Michael Fleming, Ken Makus, Xiaofu Zhu, Christina Korownyk, Michael R Kolber, James McCormack, Sharon Nickel, Guillermina Noël, Adrienne J Lindblad
OBJECTIVE: To develop a clinical practice guideline for a simplified approach to medical cannabinoid use in primary care; the focus was on primary care application, with a strong emphasis on best available evidence and a promotion of shared, informed decision making. METHODS: The Evidence Review Group performed a detailed systematic review of 4 clinical areas with the best evidence around cannabinoids: pain, nausea and vomiting, spasticity, and adverse events. Nine health professionals (2 generalist family physicians, 2 pain management-focused family physicians, 1 inner-city family physician, 1 neurologist, 1 oncologist, 1 nurse practitioner, and 1 pharmacist) and a patient representative comprised the Prescribing Guideline Committee (PGC), along with 2 nonvoting members (pharmacist project managers)...
February 2018: Canadian Family Physician Médecin de Famille Canadien
Clíona Ní Cheallaigh, Aisling O'Leary, Shay Keating, Aileen Singleton, Sheila Heffernan, Eamon Keenan, Lisa Robson, Jess Sears, John Moloney, Sanjeev Arora, Colm Bergin, Suzanne Norris
The Extension of Community Healthcare Outcomes (ECHO) project is a novel educational intervention designed in New Mexico to transfer subspecialty knowledge about hepatitis C virus (HCV) to primary care providers, thereby increasing patient access to HCV care. The ECHO model has been shown to deliver educational benefits and to result in good treatment outcomes for HCV-infected individuals in the USA; however, this approach has not been assessed in a European setting. We sought to evaluate the feasibility, acceptability and implementation of the ECHO model in Ireland using a pilot study...
July 2017: BMJ Innovations
Daniela Gonçalves-Bradley, Jaspreet K Khangura, Gerd Flodgren, Rafael Perera, Brian H Rowe, Sasha Shepperd
BACKGROUND: In many countries emergency departments (EDs) are facing an increase in demand for services, long waits, and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. However, it is unknown how this impacts the quality of patient care and the utilisation of hospital resources, or if it is cost-effective. This is the first update of the original Cochrane Review published in 2012...
February 13, 2018: Cochrane Database of Systematic Reviews
Hal Lewis, Mirna Becevic, Danny Myers, Dyann Helming, Rachel Mutrux, David Fleming, Karen Edison
INTRODUCTION: The present maldistribution of dermatologists in the USA may make it difficult for patients to access timely and quality care. Access to specialty care may be even more challenging for rural and underserved patients due to geographical limitations and other socioeconomic hardships. With over one-third of primary care patients seeking care for at least one skin problem, it is important to follow the American Academy of Dermatology Special Positioning Workgroup\'s core areas of impact regarding treatment of conditions that affect millions of patients by using a team-based approach and telemedicine technologies...
February 2018: Rural and Remote Health
I A A Perfors, C W Helsper, E A Noteboom, E van der Wall, N J de Wit, A M May
BACKGROUND: Due to the ageing population and improving diagnostics and treatments, the number of cancer patients and cancer survivors is increasing. Policymakers, patients and professionals advocate a transfer of (part of) cancer care from the hospital environment to the primary care setting, as this could stimulate personalized and integrated care, increase cost-effectiveness and would better meet the patients' needs and expectations. The effects of structured active follow-up from primary care after cancer diagnosis have not been studied yet...
February 5, 2018: BMC Cancer
Sushena Krishnaswamy, Euan M Wallace, Jim Buttery, Michelle L Giles
Maternal vaccination is a safe and effective strategy to reduce maternal and neonatal morbidity and mortality from pertussis and influenza. However, despite recommendations for maternal vaccination since 2010, uptake remains suboptimal. Barriers to uptake have been studied widely and include lack of integration of vaccination into routine pregnancy care and access to vaccination services. Standing orders for administration of vaccines without the need for a physician review or prescription have been demonstrated to improve uptake as part of multi-model interventions to increase antenatal influenza and post-partum pertussis vaccination...
January 30, 2018: Vaccine
Jeong Su Lee, Heidi Lempp, Vivek Srivastava, Elizabeth Barley
Introduction: Fifteen million people are affected by one or more long-term conditions in England. The cost of caring for this patient group increases every year. Several studies have been conducted to find out why people with those conditions choose to access Accident and Emergency (A&E) frequently. To our knowledge, there is no study that compares the three groups (patients, family members and hospital clinicians), and this approach may enhance understanding of A&E admissions in England...
2018: BMJ Open Respiratory Research
Madhav G Deo
A buzzword in Indian press and amongst the policy makers is that India is short of the WHO recommended doctor to population ratio of 1:1000. The recommendations were formulated to facilitate programs to achieve some of the health related UN-Millennium Development Goals (MDGs). Infections and malnutrition, which can be comfortably handled by a basic MBBS doctor, were the dominant health issues at the time of the formulation of the MDGs. However, all countries worldwide are going through health epidemiological transition and health impact of the non-communicable disorders (NCDs) can be no more ignored even by the low income nations...
October 2017: Journal of the Association of Physicians of India
Ruby Biezen, Danilla Grando, Danielle Mazza, Bianca Brijnath
INTRODUCTION: Influenza vaccination has been shown to be safe and effective against influenza and in the prevention of complicating secondary respiratory illnesses. However, its uptake in young children remains low. This study explored the views, attitudes and practices of parents and primary care providers (PCPs) on their knowledge and acceptance of influenza vaccination in children under 5. METHODS: Using a cross-sectional qualitative research design, we conducted 30 in-depth interviews with PCPs (i...
January 5, 2018: Vaccine
Roberta Heale, Susan James, Elizabeth Wenghofer, Marie-Luce Garceau
Aim To evaluate the organizational processes that influence the quality of care for patients with multimorbidity at nurse practitioner-led clinics (NPLCs). BACKGROUND: People are living longer, most with one or more chronic diseases (mulitmorbidity) and primary healthcare for these patients has become increasingly complex. One response was the establishment of new models of primary healthcare. NPLCs are an example of a model developed in Ontario, Canada, which feature nurse practitioners as the primary care providers practicing within an interprofessional team...
January 9, 2018: Primary Health Care Research & Development
Sueziani B Zainudin, Aslena B Hussain
AIMS: Obligatory Ramadan fasting is challenging in the management of Muslims with diabetes due to increased risk of complications from altered meals and activities. This study aimed to evaluate the knowledge, perception and practice of healthcare professionals in diabetes management during fasting and the outcome of education on management. MATERIALS AND METHODS: We surveyed healthcare professionals enrolled in pre-Ramadan education involving an endocrinologist, diabetes specialized nurse and dietician...
December 28, 2017: Diabetes & Metabolic Syndrome
Joanes Faustine Mboineki, Weihong Zhang
BACKGROUND: The Tanzanian health sector suffers from shortages of healthcare workers as well as uneven distribution of healthcare workers in urban and rural areas. Task shifting-delegation of tasks from professionals to other healthcare team members with less training, such as medical attendants-is practiced, compromising quality of care. Advanced practice nursing is underutilized. OBJECTIVE: The purpose of this study was to explore the views of nurses and physicians on current responses to shortages of healthcare workers and the potential for utilization of advanced practice nurses...
January 2018: Nursing Research
Peter C Emary, Amy L Brown, Douglas F Cameron, Alexander F Pessoa, Jennifer E Bolton
OBJECTIVE: The purpose of this study was to evaluate a chiropractic service for back pain patients integrated within a publicly funded, multidisciplinary, primary care community health center in Cambridge, Ontario, Canada. METHODS: Patients consulting for back pain of any duration were referred by their medical doctor or nurse practitioner for chiropractic treatment at the community health center. Patients completed questionnaires at baseline and at discharge from the service...
November 2017: Journal of Manipulative and Physiological Therapeutics
Roberta Heale, Elizabeth Wenghofer, Susan James, Marie-Luce Garceau
Background Nurse Practitioner-Led Clinics are a new model of primary healthcare in Ontario. Nurse Practitioner-Led Clinics are distinctive in that nurse practitioners are the primary care providers working with an interprofessional team. There have been no evaluations of the quality of care within the Nurse Practitioner-Led Clinic model. Purpose Evaluation of the Nurse Practitioner-Led Clinic model, specifically for complex clinical presentations, will provide insights that may be used to inform improvements to the delivery of care in the Nurse Practitioner-Led Clinics...
March 2018: Canadian Journal of Nursing Research, Revue Canadienne de Recherche en Sciences Infirmières
Susan Watkinson, Ramesh Seewoodhary
Red eye is a common ocular presentation in primary care, and there are several challenges that healthcare practitioners may encounter when caring for such patients. The main ocular conditions that can give rise to red eye are: primary acute angle closure glaucoma, acute iritis, dry eye, blepharitis and conjunctivitis. Red eye can be classified as sight-threatening or non-sight-threatening. Many patients presenting with painless red eye and normal vision usually recover well. However, when red eye is associated with pain, photophobia, watering and blurred vision, it is potentially sight-threatening and must be addressed urgently...
December 6, 2017: Nursing Standard
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