J Am Board Fam Med
-
Although people with severe mental illness (SMI) have high rates of diabetes and other metabolic disorders, adherence to recommended screening guidelines is low. This study aimed to compare primary care clinicians' and psychiatrists' attitudes toward metabolic monitoring and treatment of patients with SMI. ⋯ Systemic problems with care coordination and these varying expectations likely contribute to poor cardiometabolic outcomes in this vulnerable population.
-
Multicenter Study
Practice Characteristics Associated with Better Implementation of Patient Self-Management Support.
Advanced primary care models emphasize patient-centered care, including self-management support (SMS). This study aimed to promote the translation of SMS into primary care practices and reported on key baseline practice characteristics that may impact SMS implementation. ⋯ Careful attention-and action-on key practice characteristics and context may create more favorable initial conditions for practice change efforts to improve SMS in primary care practices.
-
Body mass index (BMI) is a traditional method of measuring obesity and an accepted quality measure in many health systems. However, little is known about how patients' understanding of BMI has progressed/changed in the last several years. The primary purpose of this study was to determine the change in patients' knowledge of BMI and weight-related risk factors. A secondary outcome of this study was to determine the incidence of physician discussion about BMI with the patient. ⋯ In this cross-sectional cohort study, it was found that patients' knowledge about BMI and weight-related risk factors has increased modestly. However, despite the increase in patients' knowledge and discussions about BMI with their primary care physician, there was not a decrease in BMI. Future studies are needed to provide more detailed information about the discussion between patients and providers in relation to the patient's personal weight status.
-
This study sought to understand clinicians' and patients' experience managing chronic noncancer pain (CNCP) and opioids in safety-net primary care settings. This article explores the time requirements of safer opioid prescribing for medically and socially complex patients in the context of safety-net primary care. ⋯ Time pressure was identified as a major barrier to safer opioid prescribing. Efforts, including changes to reimbursement structures, are needed to relieve time stress on primary care clinicians treating medically and socially complex patients with CNCP in safety-net settings.
-
Basal insulin therapy is a critical part of effective type 2 diabetes (T2D) management for many patients, yet its initiation and titration are often delayed or avoided. Aversion to basal insulin therapy contributes to unnecessary hyperglycemia and poorer outcomes for patients. Primary care physicians often make decisions regarding the initiation of basal insulin in T2D, as they work closely with patients and are well placed to discuss and manage the transition to basal insulin therapy. ⋯ Time concerns can be addressed via group classes and mobile technology and by working with diabetes educators in the community. Hypoglycemia or weight gain can be minimized with proper titration and use of second-generation basal insulins. This article reviews strategies for the initiation of basal insulin therapy, with an emphasis on the characteristics and titration of second-generation basal insulins, introducing current guidelines and offering suggestions for recognizing and overcoming barriers to insulin therapy in the management of T2D.