Annals of family medicine
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Annals of family medicine · Mar 2019
Primary Care Clinician Adherence to Specialist Advice in Electronic Consultation.
Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service and how eConsult affects clinical management of patients in primary care. ⋯ We found little evidence of barriers to implementing specialist advice with use of eConsult, which suggests recommendations given through service were actionable. With a high primary care clinician adherence to specialist recommendations and primary care clinician-to-patient communication, we conclude that eConsult delivers good-quality care and improves patient management.
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Annals of family medicine · Mar 2019
The Practice Gap: National Estimates of Screening and Counseling for Alcohol, Tobacco, and Obesity.
Tobacco use, lack of physical activity and poor diet, and alcohol consumption are leading causes of death in the United States. We estimated screening and counseling rates by using a nationally representative sample of adults aged 35 years and older with a preventive care supplement to the 2014 Medical Expenditure Panel Survey. Receipt of the recommended level of services ranged from nearly two-thirds (64.2% for obesity, 61.9% for tobacco use) to less than one-half (41.0% for alcohol misuse). There is significant room for improving care delivery, but primary care practices probably also need additional resources to raise screening and counseling rates.
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Loneliness is associated with poor health outcomes, and there is growing attention on loneliness as a social determinant of health. Our study sought to determine the associations between community factors and loneliness. ⋯ Living in zip codes with higher unemployment, poor access to health care, lower income, higher proportions of blacks, and poor transportation was associated with higher mean loneliness scores. Future studies that examine interventions addressing loneliness may be more effective if they consider social context and community characteristics.
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I am a primary care physician diagnosed with breast cancer in 2016. After my diagnosis, I began to wonder, is it ever appropriate to disclose my situation, my diagnosis, any details about my cancer journey to my patients? On the one hand, physicians go to great lengths to protect privacy; on the other hand, patients appreciate the ability to share and connect, including knowing that their doctor has been through something similar. In this essay, I explore the nuances of over-sharing versus making a personal connection and how the two elements of this dual role might ultimately benefit each other.
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Annals of family medicine · Mar 2019
Randomized Controlled TrialVisit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial.
Time during primary care visits is limited. We tested the hypothesis that a waiting room health information technology (IT) tool to help patients identify and voice their top visit priorities would lead to better visit interactions and improved quality of care. ⋯ A simple waiting room-based tool significantly improved visit communication. Patients using the Visit Planner were more prepared and more likely to begin the visit by communicating their top priorities. These changes did not, however, lead to further reduction in aggregate clinical care gaps beyond the improvements seen in the usual care arm.