Annals of family medicine
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Annals of family medicine · May 2019
Multicenter StudyChronic Opioid Prescribing in Primary Care: Factors and Perspectives.
Primary care clinicians write 45% of all opioid prescriptions in the United States, but little is known about the characteristics of patients who receive them and the clinicians who prescribe opioids in primary care settings. Our study aimed to describe the patient and clinician characteristics and clinicians' perspectives of chronic opioid prescribing in primary care. ⋯ Although patients prescribed opioids in primary care have higher risks of opioid-related harms, clinicians report multiple barriers in deprescribing chronic opioids. Future studies should examine strategies to mitigate these harms and engage patients in shared decision making about their chronic opioid use.
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Annals of family medicine · May 2019
Predictors of Adverse Outcomes in Uncomplicated Lower Respiratory Tract Infections.
Presentation with acute lower respiratory tract infection (LRTI) in primary care is common. The aim of this study was to help clinicians treat patients presenting with LRTI in primary care by identifying those at risk of serious adverse outcomes (death, admission, late-onset pneumonia). ⋯ In routine practice most patients presenting with LRTI in primary care can be identified as at intermediate or low risk of serious outcome.
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Annals of family medicine · May 2019
Comparative StudyComparing Buprenorphine-Prescribing Physicians Across Nonmetropolitan and Metropolitan Areas in the United States.
Although there is a tremendous need to increase the use of buprenorphine for the treatment of opioid use disorder in rural areas, little is known about current rural/urban differences in treatment practices. We aimed to examine physician characteristics, treatment practices, and concordance with treatment guidelines among buprenorphine prescribers across different locations of practice. ⋯ There are important differences in characteristics of buprenorphine prescribers in nonmetropolitan areas compared with more urban areas, including the fact that the majority of nonmetropolitan physicians are primary care physicians. Although treatment access in rural areas is an ongoing challenge, buprenorphine treatment practices are similar. Understanding buprenorphine prescribers and their treatment practices may help inform tailored strategies to address treatment needs in different locations.
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Annals of family medicine · May 2019
Meta AnalysisPotentially Inappropriate Prescribing Among Older Persons: A Meta-Analysis of Observational Studies.
Potentially inappropriate prescribing (PIP) is a common yet preventable medical error among older persons in primary care. It is uncertain whether PIP produces adverse outcomes in this population, however. We conducted a systematic review with meta-analysis to pool the adverse outcomes of PIP specific to primary care. ⋯ This meta-analysis provides consolidated evidence on the wide-ranging impact of PIP among older persons in primary care. It highlights the need to identify PIP in primary care, calls for further research on PIP interventions in primary care, and points to the need to consider potential implications when deciding on the operational criteria of PIP.
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Annals of family medicine · May 2019
A New Comprehensive Measure of High-Value Aspects of Primary Care.
To develop and evaluate a concise measure of primary care that is grounded in the experience of patients, clinicians, and health care payers. ⋯ The person-centered primary care measure reliably, comprehensively, and parsimoniously assesses the aspects of care thought to represent high-value primary care by patients, clinicians, and payers. The measure is ready for further validation and outcome analyses, and for use in focusing attention on what matters about primary care, while reducing measurement burden.