Family practice
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Smoking cessation interventions requires attending to the circumstances and needs of individual patients. We aimed at highlighting the discordances between patients' and physicians' perspectives on contextual factors that should be considered during smoking cessation. ⋯ Our results highlight the importance of patient-centered care, the need to engage discussions about patients' values, beyond what is thought to be important, to avoid overlooking their real context.
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As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC). ⋯ Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care.
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Several articles have appeared in the medical literature on the use of ultrasound in primary care. Point-of-care ultrasound refers to ultrasound protocols performed at the bedside to evaluate many conditions such as aortic aneurysm or assessment of left ventricular function by estimation of ejection fraction. ⋯ It should be considered that the use of ultrasound in general practice can not only be an aid to diagnosis but also an active screening tool, accessible even to those with basic training in ultrasound; the left ventricle and large abdominal vessels are indeed clearly visible with this technique, which with little training can become accessible to many. In a working organization, so few trained physicians would be sufficient to screen the target population of the entire group and extend the assessment to a large number of participants.
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Medication for opioid use disorder (MOUD) is the management of opioid use disorder (OUD) on an outpatient basis with buprenorphine or buprenorphine/naloxone (or methadone, which is limited to federally certified opioid treatment programs). Primary care practices are well poised to provide comprehensive care for patients with OUD, including provision of MOUD. The aim of this study was to assess provider and staff OUD attitudes and role perceptions before and after implementation of a MOUD clinical service line. ⋯ There was no change in the role legitimacy domain. Implementation of a primary care-based MOUD service line positively affected provider and staff motivation, attitudes, satisfaction, sense of safety, role support, and adequacy when working with patients with OUD. This highlights the benefits of MOUD-specific clinical support to optimize care delivery within primary care.
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At the onset of the COVID-19 pandemic, the pressure on hospitals increased tremendously. To alleviate this pressure, a remote patient monitoring system called the COVID Box was developed and implemented in primary care. The aim was to assess whether the COVID Box in primary care could reduce emergency department (ED) referrals due to a COVID-19 infection. ⋯ No difference was found in ED referrals between the intervention and control groups in our primary analysis. In the subgroup analysis, we found a nonsignificant trend that remote monitoring could reduce the ED referrals. While the overall study found comparable ED referrals between groups, the subgroup analysis suggested a promising prospect in reducing ED referrals due to remote monitoring of higher-risk patients with acute respiratory disease in primary care.