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https://www.readbyqxmd.com/read/27919865/shared-decision-making-in-patients-with-low-risk-chest-pain-prospective-randomized-pragmatic-trial
#1
Erik P Hess, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, Victor M Montori
OBJECTIVE:  To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN:  Multicenter pragmatic parallel randomized controlled trial. SETTING:  Six emergency departments in the United States. PARTICIPANTS:  898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain...
December 5, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27918408/full-practice-authority-for-nurse-practitioners
#2
Deborah Dillon, Faye Gary
Implementation of the Affordable Care Act (2010) enabled more than 30 million people to have new access to primary care services. On the basis of current utilization patterns, demand for primary care providers is expected to grow more rapidly than physician supply. This imbalance is expected to worsen, as the aging population requires more health care resources. In addition, more patients are requiring critical care services and physician numbers are not keeping with this growing need. Restrictions on resident physician practice hours have impacted inpatient care as well...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27918401/establishing-a-viable-workforce-pipeline-of-primary-care-nurse-practitioners-benefits-of-a-health-system-and-academic-partnership
#3
Billie Madler, Mary Helland
Maldistribution and shortages of primary care providers, changing reimbursement structures, movement from inpatient to community-based models of care, an aging population, and health care reform lead to increased numbers of patients seeking care. All of these phenomena have a part in creating a health care landscape that requires industry leaders enlist innovative strategies to meet the health care needs of their communities. Delivery of high-quality, efficient care by qualified providers is essential for the success of any health care system...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27911972/integrating-behavioral-health-into-pediatric-primary-care-implications-for-provider-time-and-cost
#4
Natasha Gouge, Jodi Polaha, Rachel Rogers, Amy Harden
OBJECTIVES: Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not...
December 2016: Southern Medical Journal
https://www.readbyqxmd.com/read/27906960/perceptions-and-attitudes-towards-medication-error-reporting-in-primary-care-clinics-a-qualitative-study-in-malaysia
#5
A Samsiah, Noordin Othman, Shazia Jamshed, Mohamed Azmi Hassali
OBJECTIVE: To explore and understand participants' perceptions and attitudes towards the reporting of medication errors (MEs). METHODS: A qualitative study using in-depth interviews of 31 healthcare practitioners from nine publicly funded, primary care clinics in three states in peninsular Malaysia was conducted for this study. The participants included family medicine specialists, doctors, pharmacists, pharmacist assistants, nurses and assistant medical officers...
2016: PloS One
https://www.readbyqxmd.com/read/27902555/primary-care-nurse-practitioner-practice-characteristics-barriers-and-opportunities-for-interprofessional-teamwork
#6
Lusine Poghosyan, Allison A Norful, Grant R Martsolf
Developing team-based care models and expanding nurse practitioner (NP) workforce in primary care are recommended by policy makers to meet demand. Little is known how to promote interprofessional teamwork. Using a mixed-methods design, we analyzed qualitative interview and quantitative survey data from primary care NPs to explore practice characteristics important for teamwork. The Interprofessional Teamwork for Health and Social Care Framework guided the study. We identified NP-physician and NP-administration relationships; organizational support and governance; time and space for teamwork; and regulations and economic impact as important...
January 2017: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893940/community-healthcare-professionals-overestimate-the-risk-of-fatal-anaphylaxis-for-food-allergic-children
#7
H J Hanna, J Emmanuel, S Naim, T Umasunthar, R J Boyle
BACKGROUND: Fatal food anaphylaxis is rare, but a major concern for people with food allergy and their carers. We evaluated whether community healthcare professionals accurately estimate risk of fatal anaphylaxis for food allergic children, and whether accurate risk estimation is related to competence in recognizing and managing anaphylaxis. METHODS: We enrolled 90 community healthcare professionals in a cross-sectional survey - 30 primary care nurses, 30 school first aiders, 30 community pharmacists...
December 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27893509/educating-providers-in-return-to-play-suggested-guidelines-postconcussion
#8
Angela Macci Bires, Amanda L Leonard, Brandon Thurber
As the awareness of concussions increases, it is imperative to be able to evaluate, diagnose, and treat concussed individuals properly to prevent further complications or death. The primary purpose of this study was to compare a provider's current awareness and comfort level as it relates to the return-to-play guidelines for concussions. A secondary aim was to evaluate current protocols that are in use and determine whether they coincide with the suggested guidelines. An educational intervention was implemented to assess the knowledge and confidence of health care providers...
January 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/27892421/screening-for-atrial-fibrillation-during-influenza-vaccinations-by-primary-care-nurses-using-a-smartphone-electrocardiograph-iecg-a-feasibility-study
#9
Jessica Orchard, Nicole Lowres, S Ben Freedman, Laila Ladak, William Lee, Nicholas Zwar, David Peiris, Yasith Kamaladasa, Jialin Li, Lis Neubeck
BACKGROUND: People with unknown atrial fibrillation (AF), who are often asymptomatic, have a substantially increased risk of stroke. Although recommended in European guidelines, AF screening is not routinely performed. Screening at the time of influenza vaccination presents an ideal opportunity to detect AF in large numbers in a primary care medical setting, with an existing annual recall system for patients aged ≥65 years. DESIGN: Cross-sectional pilot study of handheld smartphone electrocardiogram (iECG) screening to identify unknown AF...
October 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/27890530/provider-perspectives-on-adding-biomarker-screening-for-tobacco-smoke-exposure-to-lead-screening-at-well-child-visits
#10
Winta Ghidei, Gail Brottman, Eline Lenne, Tukhanh Quan, Anne Joseph
INTRODUCTION: Measurement of cotinine, a biomarker of tobacco smoke exposure, can accurately identify children at risk of health consequences from secondhand smoke. This study reports perspectives from pediatric health care providers on incorporating routine cotinine screening into well-child visits. METHODS: Key informant interviews (N = 28) were conducted with pediatric primary care providers: physicians, nurse practitioners, and registered nurses. RESULTS: Themes identified in the interviews included the following: (a) Cotinine screening would assess children's exposure to tobacco smoke more reliably than parental report; (b) Addressing positive cotinine screening results might require additional resources; (c) Wheezing and a history of emergency department visits increased the salience of cotinine screening; and (d) A better understanding of the significance of specific cotinine test values would improve utility...
November 24, 2016: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/27887795/clinician-knowledge-clinician-barriers-and-perceived-parental-barriers-regarding-human-papillomavirus-vaccination-association-with-initiation-and-completion-rates
#11
Lila J Finney Rutten, Jennifer L St Sauver, Timothy J Beebe, Patrick M Wilson, Debra J Jacobson, Chun Fan, Carmen Radecki Breitkopf, Susan T Vadaparampil, Robert M Jacobson
PURPOSE: We tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level. METHODS: We conducted a survey from October 2015 through January 2016 among primary care clinicians (n=280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination...
November 23, 2016: Vaccine
https://www.readbyqxmd.com/read/27887032/provider-perception-of-pharmacy-services-in-the-patient-centered-medical-home
#12
Nicole P Albanese, Alyssa M Pignato, Scott V Monte
BACKGROUND: Despite the positive data on clinical outcomes, cost savings, and provider experience, no study has surveyed providers to evaluate what pharmacy services they find to be worthwhile. OBJECTIVE: To determine what clinical, cost/access, and educational pharmacy services providers in a patient-centered medical home (PCMH) consider worthwhile and the perceived barriers to successful pharmacist incorporation. METHODS: A cross-sectional online survey was distributed to primary care physicians, nurse practitioners, and physician assistants in a PCMH physician group...
November 24, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27876403/characterizing-the-high-risk-homebound-patients-in-need-of-nurse-practitioner-co-management
#13
Masha G Jones, Katherine A Ornstein, David M Skovran, Theresa A Soriano, Linda V DeCherrie
By providing more frequent provider visits, prompt responses to acute issues, and care coordination, nurse practitioner (NP) co-management has been beneficial for the care of chronically ill older adults. This paper describes the homebound patients with high symptom burden and healthcare utilization who were referred to an NP co-management intervention and outlines key features of the intervention. We compared demographic, clinical, and healthcare utilization data of patients referred for NP co-management within a large home-based primary care (HBPC) program (n = 87) to patients in the HBPC program not referred for co-management (n = 1027)...
November 19, 2016: Geriatric Nursing
https://www.readbyqxmd.com/read/27875994/do-primary-care-professionals-agree-about-progress-with-implementation-of-primary-care-teams-results-from-a-cross-sectional-study
#14
E Tierney, M O'Sullivan, L Hickey, A Hannigan, C May, W Cullen, N Kennedy, L Kineen, A MacFarlane
BACKGROUND: Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals' views of this process. This study compares Primary Healthcare Professionals' perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland...
November 22, 2016: BMC Family Practice
https://www.readbyqxmd.com/read/27870547/prescribers-perceptions-of-medication-discontinuation-survey-instrument-development-and-validation
#15
Amy Linsky, Steven R Simon, Kelly Stolzmann, Barbara G Bokhour, Mark Meterko
OBJECTIVES: Primary care providers (PCPs) and clinical pharmacists have concerns about the adverse consequences of using medications inappropriately and generally support the notion of reducing unnecessary drugs. Despite this attitude, many factors impede clinicians' ability to discontinue medication in clinical settings. We sought to develop a survey instrument that assesses PCPs' and pharmacists' experiences, attitudes, and beliefs toward medication discontinuation. STUDY DESIGN: Survey development and psychometric assessment...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27866392/drug-caused-deaths-in-australian-medical-practitioners-and-health-care-professionals
#16
Jennifer L Pilgrim, Rhyse Dorward, Olaf H Drummer
BACKGROUND AND AIMS: There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent...
November 20, 2016: Addiction
https://www.readbyqxmd.com/read/27855723/exceeding-the-recruitment-target-in-a-primary-care-paediatric-trial-an-evaluation-of-the-choice-of-moisturiser-for-eczema-treatment-comet-feasibility-randomised-controlled-trial
#17
Kingsley Powell, Victoria J Wilson, Niamh M Redmond, Daisy M Gaunt, Matthew J Ridd
BACKGROUND: Recruiting to target in randomised controlled trials of investigational medicinal products (CTIMPs) in primary care and paediatric populations is notoriously difficult. More evidence is needed for effective recruitment strategies in these settings. We report on the impact of different recruitment strategies used in the Choice of Moisturiser in Eczema Treatment (COMET) study - a feasibility trial comparing the effectiveness of four emollients for the treatment of childhood eczema - recruiting via general practitioner (GP) surgeries...
November 17, 2016: Trials
https://www.readbyqxmd.com/read/27855101/long-term-cost-effectiveness-of-collaborative-care-vs-usual-care-for-people-with-depression-and-comorbid-diabetes-or-cardiovascular-disease-a-markov-model-informed-by-the-coincide-randomised-controlled-trial
#18
Elizabeth M Camacho, Dionysios Ntais, Peter Coventry, Peter Bower, Karina Lovell, Carolyn Chew-Graham, Clare Baguley, Linda Gask, Chris Dickens, Linda M Davies
OBJECTIVES: To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). SETTING: 36 primary care general practices in North West England. PARTICIPANTS: 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180)...
October 7, 2016: BMJ Open
https://www.readbyqxmd.com/read/27855058/is-the-australian-75-health-assessment-person-centred-a-qualitative-descriptive-study-of-older-people
#19
Kay Price, Karen Grimmer, Jan Foot
Objective The aim of the present study was to explore the perspectives of older people following their recent participation in a 75+ Health Assessment (75+HA) and interrogate these perspectives using a person-centred lens.Methods A qualitative descriptive study design was used within a larger study funded by the Australian Primary Health Care Research Institute. Nineteen participants from four different general practices in one Australian state described their perceptions of the 75+HA in a face-to-face interview...
November 18, 2016: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/27835945/external-validation-of-multidimensional-prognostic-indices-ado-bodex-and-dose-in-a-primary-care-international-cohort-proepoc-copd-cohort
#20
Maite Espantoso-Romero, Miguel Román Rodríguez, Ana Duarte-Pérez, Jaime Gonzálvez-Rey, Pedro A Callejas-Cabanillas, Durdica Kasuba Lazic, Berta Anta-Agudo, Pere Torán Monserrat, Rosa Magallon-Botaya, Biljana Gerasimovska Kitanovska, Heidrun Lingner, Radost S Assenova, Claudia Iftode, Francisco Gude-Sampedro, Ana Clavería
BACKGROUND: Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014)...
November 11, 2016: BMC Pulmonary Medicine
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