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Primary care medical home

Gregory P Beehler, Paul R King, Christina L Vair, Julie Gass, Jennifer S Funderburk
The VA has integrated psychologists and other licensed mental health providers, known collectively as co-located collaborative care (CCC) providers, into patients' primary care medical homes to improve mental health services for veterans. However, it is unclear if CCC providers are routinely using mental health measures as part of evidence-based, coordinated care. This study aimed to determine the prevalence and predictors of CCC provider utilization of brief, validated measures. A retrospective review of VA electronic medical records from 8403 veterans diagnosed with depression, posttraumatic stress disorder, or anxiety disorder was conducted...
October 21, 2016: Journal of Clinical Psychology in Medical Settings
Pierre Cornillon, Sébastien Loiseau, Bruno Aublet-Cuvelier, Virginie Guastella
BACKGROUND: Patients under palliative care and in hospital-at-home services are frequently transferred to emergency departments. We set out to identify the reasons for these presentations to determine the proportion that might be avoidable. METHODS: We conducted a retrospective study by assessment of patient files. We studied admissions to four emergency departments in an area of France (Puy-de-Dôme) between September 2011 and August 2013. Reasons for transfer and diagnostic conclusion by emergency doctors were noted...
October 21, 2016: BMC Palliative Care
Alexis K Huynh, Martin L Lee, Melissa M Farmer, Lisa V Rubenstein
BACKGROUND: Stepped wedge designs have gained recognition as a method for rigorously assessing implementation of evidence-based quality improvement interventions (QIIs) across multiple healthcare sites. In theory, this design uses random assignment of sites to successive QII implementation start dates based on a timeline determined by evaluators. However, in practice, QII timing is often controlled more by site readiness. We propose an alternate version of the stepped wedge design that does not assume the randomized timing of implementation while retaining the method's analytic advantages and applying to a broader set of evaluations...
October 21, 2016: BMC Medical Research Methodology
Marisa Elena Domino, Mona Kilany, Rebecca Wells, Joseph P Morrissey
OBJECTIVE: To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. DATA SOURCES/STUDY SETTING: Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. STUDY DESIGN: We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses...
October 21, 2016: Health Services Research
Wanjiku F M Njoroge, Cody A Hostutler, Billie S Schwartz, Jennifer A Mautone
There are multiple barriers to accessing high quality, evidence-based behavioral health care for children and adolescents, including stigma, family beliefs, and the significant paucity of child and adolescent psychiatrists. Although equal access continues to be an unmet need in the USA, there is growing recognition that integrated behavioral health services in pediatric primary care have the potential to reduce health disparities and improve service utilization. In a joint position paper, the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) highlighted the multiple benefits of children receiving initial behavioral health screening, assessment, and evidence-based behavioral health treatments in the medical home...
December 2016: Current Psychiatry Reports
Karen E van den Hondel, Anne Linde Saaltink, Peter Paul M Bender
BACKGROUND: Forensic physicians are responsible for first-line medical care of detainees (individuals held in custody) in the police station. The Dutch police law contains a 'duty of care', which gives the police responsibility for the apparent mentally ill and/or confused people they encounter during their work. The police can ask a forensic physician to do a primary psychiatric assessment of any apparent mentally ill detainee. The forensic physician determines if the apparent mentally ill behavior of the detainee is due to a somatic illness, or has a psychiatric cause for which the detainee needs admission to a psychiatric hospital...
October 11, 2016: Journal of Forensic and Legal Medicine
Suzanne Oparil
Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%)...
September 2016: Journal of Hypertension
Steven Steinhubl
Despite having the basic tools necessary to appropriately identify and manage individuals with hypertension for over half a century it remains the single greatest contributing risk factor to morbidity and mortality worldwide today. Since diagnosis and effective treatment availability are not issues, this major failing in care can be attributed to inadequate systems of care: systems that have led to only <20% of hypertensive individuals globally having their blood pressure adequately controlled. Even in the US, where it is one of the most common reasons for a primary care visit, and with over $42...
September 2016: Journal of Hypertension
Robert P Olympia, Robert Wilkinson, Jennifer Dunnick, Brendan J Dougherty, Debra Zauner
OBJECTIVE: The aims of this study were to describe pediatric emergency department (ED) referrals from urgent care centers and to determine the percentage of referrals considered essential and serious. METHODS: A prospective study was conducted between April 2013 and April 2015 on patients younger than 21 years referred directly to an ED in central Pennsylvania from surrounding urgent care centers. Referrals were considered essential or serious based on investigations/procedures performed or medications/consultations received in the ED...
October 8, 2016: Pediatric Emergency Care
Richard G Malish
The Army transitioned to a Patient-Centered Medical Home concept for primary care beginning in 2011. In spite of organizational commitment to the paradigm, the transition has not been without pitfalls. This performance improvement project operated under the hypothesis that focusing on the market-based incentives of a capitated system would result in a quantum leap toward the Patient-Centered Medical Home ideal. Utilizing a simple teaching device to repetitively highlight clinic and provider behaviors incentivized in a value-based payment system, a single clinic achieved significant improvements in enrollment, patient satisfaction, and measures associated with prevention while assuming an identity as a "virtual clinic"...
October 2016: Military Medicine
Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Stefan Stefanovic, Markus Wallwiener, Uros Karic, Christoph Domschke, Luka Katic, Florin-Andrei Taran, Aleksandra Pesic, Andreas Hartkopf, Peyman Hadji, Martin Teufel, Florian Schuetz, Christof Sohn, Peter Fasching, Andreas Schneeweiss, Sara Brucker
PURPOSE: The capture of adequate treatment outcomes and quality of life (QOL) of advanced breast cancer patients in clinical routine represents a great challenge. Patient-reported outcomes (PROs) are data elements directly reported by patients about experiences with care, including symptoms, functional status, or quality of life. There is growing interest in the medical community for the evaluation and implementation of PROs of adverse events (PRO-AEs). Recent interest in PROs in health care has evolved in the context of patient centeredness...
October 17, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Mandira Paul, Sharad D Iyengar, Birgitta Essén, Kristina Gemzell-Danielsson, Kirti Iyengar, Johan Bring, Marie Klingberg-Allvin
BACKGROUND: Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion. METHODS: A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion...
October 17, 2016: BMC Public Health
Sami Ridwan, Horst Urbach, Susanne Greschus, Johanna von Hagen, Jonas Esche, Azize Boström
BACKGROUND: Given the young age of onset and the high probability of long-term disability after SAH, the financial impact is expected to be substantial. Primary objective was to highlight subsequent treatment costs after the acute in-hospital stay including rehabilitation and home care in comparison to ischemic stroke. METHODS: The study included 101 patients with aneurysmal SAH treated July 2007 through April 2009. In-hospital expenses were calculated using the German Diagnose Related Groups DRG...
October 12, 2016: World Neurosurgery
Mark E Kunik, A Lynn Snow, Nancy Wilson, Amber B Amspoker, Shubhada Sansgiry, Robert O Morgan, Jun Ying, Gayle Hersch, Melinda A Stanley
OBJECTIVES: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). DESIGN: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months SETTING: Houston, TX. PARTICIPANTS: A total of 203 community-dwelling veterans with pain and dementia and their caregivers...
April 27, 2016: American Journal of Geriatric Psychiatry
Neal A deJong, Elisabeth P Dellon, Emily B Vander Schaaf, Alan D Stiles, Rachael A Carr, Michael J Steiner
OBJECTIVES: To assess whether the perception of enhanced access by parents in their child's primary care and main specialty practices is associated with preference for contacting either practice when problems arise with a child's chronic condition. STUDY DESIGN: In this cross-sectional survey study of parents whose children use both primary and specialty practices, we assessed perceptions of 3 components of enhanced access: (1) appointment availability when needed, (2) electronic communication with practices, and (3) other staff that help manage a child's health care needs...
October 11, 2016: Journal of Pediatrics
Gerald Kayingo, Owais Gilani, Vasco Deon Kidd, Mary L Warner
BACKGROUND AND OBJECTIVES: The transformation of primary care (PC) training sites into patient-centered medical homes (PCMH) has implications for the education of health professionals. This study investigates the extent to which physician assistant (PA) students report learning about the PCMH model and how clinical exposure to PCMH might impact their interest in a primary care career. METHODS: An electronic survey was distributed to second-year PA students who had recently completed their PC rotation from 12 PA programs...
October 2016: Family Medicine
Cari Levy, Emily A Whitfield
OBJECTIVE: To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs. DESIGN: Descriptive, unmatched study. SETTING: VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs). PARTICIPANTS: Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011...
October 14, 2016: Journal of the American Geriatrics Society
Roque da Silva Araújo, Edna Apparecida Moura Arcuri, Victor Cauê Lopes
Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. Results: half of the users did not know the condition of inactivity...
October 10, 2016: Revista Latino-americana de Enfermagem
Diana Wucherer, Tilly Eichler, Johnanes Hertel, Ingo Kilimann, Steffen Richter, Bernhard Michalowsky, Jochen René Thyrian, Stefan Teipel, Wolfgang Hoffmann
BACKGROUND: Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD). OBJECTIVE: Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM. METHODS: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany...
October 5, 2016: Journal of Alzheimer's Disease: JAD
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