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Primary Care Transformation

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https://www.readbyqxmd.com/read/28810112/patient-and-physician-perceptions-of-genetic-testing-in-primary-care
#1
Samuel A Evenson, H Eugene Hoyme, Jan E Haugen-Rogers, Eric A Larson, Susan E Puumala
INTRODUCTION: The convergence of biomedical informatics and translational genomics is changing the way we practice. Primary care will play a pivotal role in this transformation. We therefore sought to assess general knowledge about genetic testing among outpatient internal medicine providers, and the patients that they serve across a five state region in the Midwest. METHODS: One thousand take-home paper surveys were created and distributed to internal medicine patients at 13 Midwestern clinics...
November 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28808852/patient-experience-with-the-patient-centered-medical-home-in-michigan-s-statewide-multi-payer-demonstration-a-cross-sectional-study
#2
Issidoros Sarinopoulos, Diane L Bechel-Marriott, Jean M Malouin, Shaohui Zhai, Jason C Forney, Clare L Tanner
BACKGROUND: The literature on patient-centered medical homes (PCMHs) and patient experience is somewhat mixed. Government and private payers are promoting multi-payer PCMH initiatives to align requirements and resources and to enhance practice transformation outcomes. To this end, the multipayer Michigan Primary Care Transformation (MiPCT) demonstration project was carried out. OBJECTIVE: To examine whether the PCMH is associated with a better patient experience, and whether a mature, multi-payer PCMH demonstration is associated with even further improvement in the patient experience...
August 14, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28801393/protocol-for-the-mwellcare-trial-a-multicentre-cluster-randomised-12-month-controlled-trial-to-compare-the-effectiveness-of-mwellcare-an-mhealth-system-for-an-integrated-management-of-patients-with-hypertension-and-diabetes-versus-enhanced-usual-care-in-india
#3
Dilip Jha, Priti Gupta, Vamadevan S Ajay, Devraj Jindal, Pablo Perel, David Prieto-Merino, Pramod Jacob, Jonathan Nyong, Vidya Venugopal, Kavita Singh, Shifalika Goenka, Ambuj Roy, Nikhil Tandon, Vikram Patel, Dorairaj Prabhakaran
INTRODUCTION: Rising burden of cardiovascular disease (CVD) and diabetes is a major challenge to the health system in India. Innovative approaches such as mobile phone technology (mHealth) for electronic decision support in delivering evidence-based and integrated care for hypertension, diabetes and comorbid depression have potential to transform the primary healthcare system. METHODS AND ANALYSIS: mWellcare trial is a multicentre, cluster randomised controlled trial evaluating the clinical and cost-effectiveness of a mHealth system and nurse managed care for people with hypertension and diabetes in rural India...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28776723/opportunities-in-the-integration-of-primary-care-and-public-health-nursing-two-case-exemplars-on-physical-activity-and-nutrition
#4
Robin A Evans-Agnew, Kala A Mayer, Lori L L Miller
OBJECTIVE: The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition...
August 4, 2017: Nursing Forum
https://www.readbyqxmd.com/read/28776185/modulation-of-cellular-energetics-by-galactose-and-pioglitazone
#5
David Grimm, Leonardo Altamirano, Sudip Paudel, Leah Welker, Mary E Konkle, Nilay Chakraborty, Michael A Menze
The Warburg effect is ameliorated by culturing transformed cells in the presence of galactose instead of glucose as the primary carbon source. However, metabolic consequences may occur in addition to sensitizing the cells to mitochondrial toxins. The screening of pharmaceutical agents against transformed cells while using galactose must therefore be carefully evaluated. Pioglitazone is employed in clinical applications to treat type-2 diabetes but clearly has other off-target effects. Human hepatocellular carcinoma cells (HepG2) were cultured in glucose or galactose-containing medium to investigate the role of pioglitazone on cellular bioenergetics by calorimetry and respirometry...
August 3, 2017: Cell and Tissue Research
https://www.readbyqxmd.com/read/28774352/-you-started-something-%C3%A2-then-i-continued-by-myself-a-qualitative-study-of-physical-activity-maintenance
#6
Charlotte Wahlich, Carole Beighton, Christina Victor, Rebecca Normansell, Derek Cook, Sally Kerry, Steve Iliffe, Michael Ussher, Peter Whincup, Julia Fox-Rushby, Elizabeth Limb, Cheryl Furness, Tess Harris
BACKGROUND: Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45-75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component...
August 4, 2017: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/28762300/social-justice-access-and-quality-of-healthcare-in-an-age-of-austerity-users-perspective-from-rural-iceland
#7
Sonja S Gustafsdottir, Kristjana Fenger, Sigridur Halldorsdottir, Thoroddur Bjarnason
Iceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users' perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014)...
2017: International Journal of Circumpolar Health
https://www.readbyqxmd.com/read/28758641/dropconnected-neural-networks-trained-on-time-frequency-and-inter-beat-features-for-classifying-heart-sounds
#8
Edmund Kay, Anurag Agarwal
OBJECTIVE: Automatic heart sound analysis has the potential to improve the diagnosis of valvular heart diseases in the primary care phase, as well as in countries where there is neither the expertise nor the equipment to perform echocardiograms. An algorithm has been trained, on the PhysioNet open-access heart sounds database, to classify heart sounds as normal or abnormal. APPROACH: The heart sounds are segmented using an open-source algorithm based on a hidden semi-Markov model...
July 31, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28753604/socs1-function-in-bcr-abl-mediated-myeloproliferative-disease-is-dependent-on-the-cytokine-environment
#9
Özlem Demirel, Olivier Balló, Pavankumar N G Reddy, Olesya Vakhrusheva, Jing Zhang, Astrid Eichler, Ramona Fernandes, Susanne Badura, Hubert Serve, Christian Brandts
Treatment with tyrosine kinase inhibitors is the standard of care for Philadelphia chromosome positive leukemias. However the eradication of leukemia initiating cells remains a challenge. Circumstantial evidence suggests that the cytokine microenvironment may play a role in BCR-ABL mediated leukemogenesis and in imatinib resistance. Gene expression analyses of BCR-ABL positive ALL long-term cultured cells revealed strong reduction of SOCS mRNA expression after imatinib treatment, thereby demonstrating a strong inhibition of cytokine signaling...
2017: PloS One
https://www.readbyqxmd.com/read/28751103/-prevalence-and-characterization-of-overactive-bladder-detected-in-a-population-in-madrid-with-self-administered-oab-v3-questionnaire-in-primary-care
#10
Javier C Angulo, María P Calderín, Yolanda Fernández, Miriam González, Esther Gómez, Maria B Herreros, Purificación Peñasco, Manuela Zapatero, Juan F Dorado
OBJECTIVE: Determining the prevalence of symptoms suggestive of overactive bladder (OAB) in a Spanish population and evaluate the impact of these symptoms on well-being and labour productivity in this population. DESIGN: Transversal study. LOCATION: Primary health care, Madrid, Spain. PARTICIPANTS: Males and females >30 years. INTERVENTIONS: Classification by primary care physicians with the Overactive Bladder Awareness Tool abbreviated version (OAB-V3)...
July 24, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28750140/the-diagnosis-and-management-of-male-genital-lichen-sclerosus-a-retrospective-review-of-301-patients
#11
G Kravvas, T N Shim, P R Doiron, A Freeman, C Jameson, S Minhas, A Muneer, C B Bunker
INTRODUCTION: Male genital lichen sclerosus (MGLSc) is an acquired, chronic, inflammatory skin disease that is associated with significant morbidity and squamous cell carcinoma of the penis (PSCC). However, some clinical, diagnostic and management controversies endure, including the relationship with penile intraepithelial neoplasia (PeIN). OBJECTIVES: To clarify clinical presentations, diagnostic approaches, histological findings, response to treatment and the relationship with PeIN...
July 27, 2017: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/28746071/toward-a-utopian-model-for-teaching-and-nonteaching-services-every-journey-begins-with-a-first-step
#12
Lisa M Bellini, Jack Ende
Nonteaching services are an imperfect step toward enabling inpatient teaching services to transition from an unregulated, natural state, driven solely by the exigencies of patient volume and throughput, to one that is more controlled and intends to achieve the proper balance between service and education. As career educators the authors prefer to view nonteaching services as critical components of an integrated system that enables the best possible patient care and learning, yet they acknowledge that, to meet the needs of patients and learners, teaching and nonteaching services alike must be truly complementary, collaborative, and integrated components of a single system...
July 25, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28737412/integrated-care-clinic-creating-enhanced-clinical-pathways-for-integrated-behavioral-health-care-in-a-family-medicine-residency-clinic-serving-a-low-income-minority-population
#13
Jerica M Berge, Lisa Trump, Stephanie Trudeau, Damir S Utržan, Michele Mandrich, Andrew Slattengren, Tanner Nissly, Laura Miller, Macaran Baird, Eli Coleman, Michael Wootten
INTRODUCTION: Research examining the implementation and effectiveness of integrated behavioral health (BH) care in family medicine/primary care is growing. However, research identifying ways to consistently use integrated BH in busy family medicine/primary care settings with underserved populations is limited. This study describes 1 family medicine clinic's transformation into a fully integrated BH care clinic through the development of an Integrated Care Clinic (ICC) and enhanced clinical pathways to promote regular use of behavioral health clinicians (BHCs)...
July 24, 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28724010/management-of-primary-care-a-challenge-for-international-cooperation-in-health
#14
Luiz Eduardo Fonseca, Maria Cristina Botelho de Figueiredo, Celina Santos Boga Marques Porto
The need to resolve immediate problems in basic healthcare systems and the decisions that must be made in the daily management of healthcare centers must reach beyond awareness of common sense, and be reinforced by the evidence sought in scientific knowledge that will provide a new look at the facts and phenomena that happen on a daily basis. This article examines an experience of triangular cooperation in health between Angola, Brazil and Japan, which took place in Luanda, Angola between 2011 and 2014. The "Project to Strengthen the Healthcare Through the Development of Human Resources at the Josina Hospital and in other Healthcare Services, and to Revitalize Primary Healthcare in Angola (ProForsa)", with the involvement of Fiocruz as the party executing the primary healthcare component...
July 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28720628/the-patient-centered-medical-home-pcmh-framing-typology-for-understanding-the-structure-function-and-outcomes-of-pcmhs
#15
Autumn M Kieber-Emmons, William L Miller
INTRODUCTION: Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcomes by each type. METHODS: Using the Patient-Centered Primary Care Collaborative 2012 to 2013 Annual Review, this secondary analysis of the published PCMH literature extracted data from publications of 59 PCMHs...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720627/costs-of-transforming-established-primary-care-practices-to-patient-centered-medical-homes-pcmhs
#16
Neil S Fleming, Briget da Graca, Gerald O Ogola, Steven D Culler, Jessica Austin, Patrice McConnell, Russell McCorkle, Phil Aponte, Michael Massey, Cliff Fullerton
BACKGROUND: The patient-centered medical home (PCMH) shows promise for improving care and reducing costs. We sought to reduce the uncertainty regarding the time and cost of PCMH transformation by quantifying the direct costs of transforming 57 practices in a medical group to National Committee for Quality Assurance (NCQA)-recognized Level III PCMHs. METHODS: We conducted structured interviews with corporate leaders, and with physicians, practice administrators, and office managers from a representative sample of practices regarding time spent on PCMH transformation and NCQA application, and related purchases...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28716120/advancing-team-based-primary-health-care-a-comparative-analysis-of-policies-in-western-canada
#17
Esther Suter, Sara Mallinson, Renee Misfeldt, Omenaa Boakye, Louise Nasmith, Sabrina T Wong
BACKGROUND: We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. METHODS: We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites...
July 17, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28715535/improving-adherence-to-long-term-opioid-therapy-guidelines-to-reduce-opioid-misuse-in-primary-care-a-cluster-randomized-clinical-trial
#18
Jane M Liebschutz, Ziming Xuan, Christopher W Shanahan, Marc LaRochelle, Julia Keosaian, Donna Beers, George Guara, Kristen O'Connor, Daniel P Alford, Victoria Parker, Roger D Weiss, Jeffrey H Samet, Julie Crosson, Phoebe A Cushman, Karen E Lasser
Importance: Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. Objective: To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. Design, Setting, and Participants: Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain...
July 17, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28708933/colorectal-cancer-screening-at-us-community-health-centers-examination-of-sociodemographic-disparities-and-association-with-patient-provider-communication
#19
Sue C Lin, Duane McKinley, Alek Sripipatana, Laura Makaroff
BACKGROUND: Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients...
July 14, 2017: Cancer
https://www.readbyqxmd.com/read/28706917/insights-into-study-design-and-statistical-analyses-in-translational-microbiome-studies
#20
REVIEW
Jyoti Shankar
Research questions in translational microbiome studies are substantially more complex than their counterparts in basic science. Robust study designs with appropriate statistical analysis frameworks are pivotal to the success of these translational studies. This review considers how study designs can account for heterogeneous phenotypes by adopting representative sampling schemes for recruiting the study population and making careful choices about the control population. Advantages and limitations of 16S profiling and whole-genome sequencing, the two primary techniques for measuring the microbiome, are discussed followed by an overview of bioinformatic processing of high-throughput sequencing data from these measurements...
June 2017: Annals of Translational Medicine
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