J Am Board Fam Med
-
Multicenter Study
Staff and Clinician Work-Life Perceptions after Implementing Systems-Based Improvements to Opioid Management.
The Six Building Blocks Program is an evidence-based approach to primary care redesign for opioid management among patients with chronic pain. This analysis assesses the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. ⋯ Clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management. Further research is needed on patient experiences specific to practice redesign programs.
-
Multicenter Study Observational Study
Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model.
Medication-assisted treatment (MAT) for opioid use disorder (OUD) is underused in primary care. Little is known about patient demographics associated with MAT initiation, particularly among models with an interdisciplinary approach, including behavioral health integration. We hypothesize few disparities in MAT initiation by patient characteristics after implementing this model for OUD. ⋯ MAT initiation varied by patient characteristics, including disparities by insurance coverage and race/ethnicity. The addition of behavioral health did not eliminate disparities in care, but higher odds of initiation among those with a documented psychiatric diagnosis may suggest this model reaches some vulnerable populations. Additional research is needed to further examine these findings.
-
Comparative Study Observational Study
The Effects of Telephone Visits and Rurality on Veterans Perceptions of Access to Primary Care.
The objectives of this study were to examine if self-reported access to primary care is associated with actual patient wait times and use of telephone visits, and to assess whether this relationship differs by rural residence. ⋯ These findings contribute to our understanding of factors associated with patient perceptions of access by highlighting complex interrelationships between strategies intended to improve access to care and how they can have differing impacts on perceptions among those living in rural or urban locations.
-
While there have been several articles detailing the importance of stakeholder engagement in research broadly and in practice-based research networks (PBRNs) specifically, few of these articles offer a replicable engagement approach that is detailed enough to translate to another setting. The goal of this article is to offer a detailed example of building stakeholder engagement infrastructure that could be replicated or translated to other settings. ⋯ This article presents a detailed timeline and replicable approach to building a stakeholder engagement infrastructure in a regional PBRN. This article details a practical process that is embedded in the lived values of practice-based research.
-
Chronic diseases such as type 2 diabetes place a large burden on the health care system and are associated with increased morbidity and mortality. A team-based multidisciplinary approach that organizes care to improve chronic disease management may actually decrease traditional continuity of care metrics. Visit entropy (VE) provides a novel measure of care organization produced by team-based approaches. Higher VE, reflecting more disorganized care, has been associated with more hospital readmissions. We hypothesized that higher VE was also associated with reduced adherence to the D5 quality criteria. ⋯ More organized care reflected by a lower VE is associated with improved odds of D5 diabetic control. VE represents a better measure of care organization in team-based medical home environments than traditional continuity of care metrics.