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Primary care track

D E Beaton, M Vidmar, K B Pitzul, R Sujic, N K Rotondi, E R Bogoch, J E M Sale, R Jain, J Weldon
: We evaluated the impact of a more intensive version of an existing post-fracture coordinator-based fracture prevention program and found that the addition of a full-risk assessment improved treatment rates. These findings provide additional support for more intensive programs aimed at reducing the risk of re-fractures. INTRODUCTION: Evidence-based guidelines support coordinator-based programs to improve post-fracture osteoporosis guideline uptake, with more intensive programs including bone mineral density (BMD) testing and/or treatment being associated with better patient outcomes...
October 21, 2016: Osteoporosis International
Madhav V 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 2016: Journal of the Association of Physicians of India
Christopher Rowe, Eric Vittinghoff, Glenn-Milo Santos, Emily Behar, Caitlin Turner, Phillip Coffin
OBJECTIVES: Opioid overdose mortality has tripled in the USA since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events...
October 20, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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
Kate Button, Fiona Morgan, Helen Hodgson, Alison L Weightman, Steve Jones
BACKGROUND: Musculoskeletal (MSK) conditions are the most frequently reported chronic conditions and one of the biggest causes of disability in the UK. Given the ageing population and the impact of these problems, the demand for MSK treatment will rise. Despite reduced waiting times, MSK pathways have remained variable and inconsistent and need to be improved to meet patient needs. The aim of this systematic review is to understand the evidence for the effectiveness of current models of service delivery and care pathways for adult hip/knee pain patients accessing secondary care for specialist opinions...
August 1, 2016: Systematic Reviews
Wenjing Tao, Janne Agerholm, Bo Burström
BACKGROUND: Reimbursement systems provide incentives to health care providers and may drive physician behaviour. This review assesses the impact of reimbursement system on socioeconomic and racial inequalities in access, utilization and quality of primary care. METHODS: A systematic search was performed in Web of Science and PubMed for English language studies published between 1980 and 2013, supplemented by reference tracking. Articles were selected based on inclusion criteria, and data extraction and critical appraisal were performed by two authors independently...
October 4, 2016: BMC Health Services Research
Susie Hoffman, Theresa M Exner, Naomi Lince-Deroche, Cheng-Shiun Leu, Jessica L Phillip, Elizabeth A Kelvin, Anisha D Gandhi, Bruce Levin, Dinesh Singh, Joanne E Mantell, Kelly Blanchard, Gita Ramjee
BACKGROUND: Timely linkage to care by newly-diagnosed HIV+ individuals remains a significant challenge to achieving UNAIDS 90-90-90 goals. Current World Health Organization (WHO) guidelines recommend initiating anti-retroviral treatment (ART) regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. We evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study...
2016: PloS One
David A Fessler, Grace C Huang, Jennifer Potter, Joseph J Baker, Howard Libman
BACKGROUND: Declining mortality has led to a rising number of persons living with HIV (PLWH) and concerns about a future shortage of HIV practitioners. AIM: To develop an HIV Primary Care Track for internal medicine residents. SETTING: Academic hospital and community health center with a history of caring for PLWH and lesbian, gay, bisexual, and transgender (LGBT) patients. PARTICIPANTS: Internal medicine residents. PROGRAM DESCRIPTION: We enrolled four residents annually in a 3-year track with the goal of having each provide continuity care to at least 20 PLWH...
October 4, 2016: Journal of General Internal Medicine
William B Weeks, Bruno Ventelou, Marc Karim Bendiane
OBJECTIVE: Recently, French policymakers have tried to improve care at the end-of-life, by improving access to community-based palliative care, particularly for patients with cancer and neurological diseases. If effective, these efforts should reduce the proportion of such patients who die in the hospital. In light of these policies, we sought to determine the effectiveness of these efforts on reducing inpatient deaths by conducting a retrospective, observational analysis of patients aged 65 and older who were admitted to hospitals in France between 2010 and 2013 for 1 of 3 non-surgical conditions...
September 5, 2016: Annals of Palliative Medicine
Marie-Louise Mares, David H Gustafson, Joseph E Glass, Andrew Quanbeck, Helene McDowell, Fiona McTavish, Amy K Atwood, Lisa A Marsch, Chantelle Thomas, Dhavan Shah, Randall Brown, Andrew Isham, Mary Jane Nealon, Victoria Ward
BACKGROUND: Millions of Americans need but don't receive treatment for substance use, and evidence suggests that addiction-focused interventions on smart phones could support their recovery. There is little research on implementation of addiction-related interventions in primary care, particularly in Federally Qualified Health Centers (FQHCs) that provide primary care to underserved populations. We used mixed methods to examine three FQHCs' implementation of Seva, a smart-phone app that offers patients online support/discussion, health-tracking, and tools for coping with cravings, and offers clinicians information about patients' health tracking and relapses...
September 29, 2016: BMC Medical Informatics and Decision Making
C Raina MacIntyre, Robert Menzies, Elizabeth Kpozehouen, Michael Chapman, Joanne Travaglia, Michael Woodward, Lisa Jackson Pulver, Christopher J Poulos, David Gronow, Timothy Adair
On the 20th June, 2014 the National Health and Medical Research Council's Centre for Research Excellence in Population Health "Immunisation in under Studied and Special Risk Populations", in collaboration with the Public Health Association of Australia, hosted a workshop "Equity in disease prevention: vaccines for the older adults". The workshop featured international and national speakers on ageing and vaccinology. The workshop was attended by health service providers, stakeholders in immunisation, ageing, primary care, researchers, government and non-government organisations, community representatives, and advocacy groups...
September 26, 2016: Vaccine
Anne E Sales, Mary Ersek, Orna K Intrator, Cari Levy, Joan G Carpenter, Robert Hogikyan, Helen C Kales, Zach Landis-Lewis, Tobie Olsan, Susan C Miller, Marcos Montagnini, Vyjeyanthi S Periyakoil, Sheri Reder
BACKGROUND: The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments...
September 29, 2016: Implementation Science: IS
Christian Graß, Federica Stretti, Waseem Zakhary, Edwin Turton, Sophia Sgouoropoulou, Meinhard Mende, Joerg Ender
BACKGROUND: Fast track (FT) treatment in cardiac anaesthesia is state of the art. Aim of our study was to compare FT treatment in a post anaesthetic care unit (PACU) with limited opening hours with a PACU opened for unlimited hours. Primary endpoints were extubation time (ET), length of stay (LOS) in PACU and LOS in intermediate care unit (IMC). Secondary endpoints were FT success/failure, hospital LOS, re- intubation and in hospital mortality. METHODS: At our institution, FT is usually managed in a PACU with limited opening hours from 10am to 10pm, Monday to Friday (PACU12)...
September 27, 2016: Minerva Anestesiologica
Satish P Deshpande
Patient satisfaction has become an important measure of health care services and outcomes. The purpose of this empirical study was to investigate factors that impact the satisfaction of primary care physicians (PCPs) by patients of different races in the United States. This is an empirical analysis of the Center for Studying Health System Change's 2010 Health Tracking Household Survey. Correlation and regression analyses were done to examine the impact of various factors on PCP satisfaction of 12 472 American respondents...
September 23, 2016: Health Care Manager
A T Dalcin, G J Jerome, S L Fitzpatrick, T A Louis, N-Y Wang, W L Bennett, N Durkin, J M Clark, G L Daumit, L J Appel, J W Coughlin
BACKGROUND: Behavioural weight loss programs are effective first-line treatments for obesity and are recommended by the US Preventive Services Task Force. Gaining an understanding of intervention components that are found helpful by different demographic groups can improve tailoring of weight loss programs. This paper examined the perceived helpfulness of different weight loss program components. METHODS: Participants (n = 236) from the active intervention conditions of the Practice-based Opportunities for Weight Reduction (POWER) Hopkins Trial rated the helpfulness of 15 different components of a multicomponent behavioural weight loss program at 24-month follow-up...
October 2015: Obesity Science & Practice
Ilknur Tugal-Tutkun
PURPOSE OF REVIEW: The primary systemic vasculitides represent a spectrum of rare but life-threatening conditions that may also affect the eye in various forms. This article reviews recently published data on ocular manifestations of systemic vasculitis. RECENT FINDINGS: Early diagnosis and timely treatment has led to better visual outcomes in giant cell arteritis (GCA). Gene expression from orbital tissues could distinguish granulomatosis with polyangiitis (GPA) from sarcoidosis and Graves disease, but not from idiopathic orbital inflammation...
September 21, 2016: Current Opinion in Rheumatology
Xin-Xin Liu, Hua-Feng Pan, Zhi-Wei Jiang, Shu Zhang, Zhi-Ming Wang, Ping Chen, Yan Zhao, Gang Wang, Kun Zhao, Jie-Shou Li
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols or fast-track (FT) programs enable a shorter hospital stay and lower complication rate. Minimally invasive surgery (MIS) is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries. However, little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer. The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone...
2016: Chinese Medical Journal
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
R M A van Erp, I P J Huijnen, A J A Köke, F E Abbink, M den Hollander, R J E M Smeets
: Biopsychosocial interventions provided in multidisciplinary settings are promising for improving functional disability levels in patients with chronic low back pain (CLBP). These multidisciplinary biopsychosocial interventions mainly focus on cognitive-behavioural approaches that aim to change negative cognitions, emotions, behaviour, work and social factors. As some patients with CLBP treated in primary care settings also experience psychosocial factors that influence their level of disability, these patients may benefit from the provision of a biopsychosocial intervention in primary care...
May 11, 2016: Physiotherapy
Fran Baum, Toby Freeman, David Sanders, Ronald Labonté, Angela Lawless, Sara Javanparast
This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009-2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives...
November 2016: Social Science & Medicine
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