IU Indianapolis ScholarWorks :: Browsing by Subject "Primary Care"

Browsing by Subject "Primary Care"

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Data Report: 2015 Indiana Nursing Licensure Survey
(2016-06) Vaughn, S., Gano, L., Maxey, H.
The mission of the Bowen Center for Health Workforce Research and Policy is to improve population health by contributing to informed health workforce policy through data management, community engagement, and original research. The Bowen Center has a rich history of collecting, analyzing, and disseminating health workforce data and research for the State of Indiana. These health workforce data are important to informing health workforce policy and planning efforts throughout Indiana. The nursing workforce represents the largest segment of the health workforce and works in a variety of settings to fulfill direct patient care, coordination of care, administrative and research roles.1 In fact, in 2015 Indiana had nearly 104,000 registered nurses (RNs) renew their professional license. Furthermore, as the number of medical students choosing to specialize in primary care decreases, the number of advanced practice nurses (APNs) has more than doubled over the past 20 years.2 Understanding the supply and distribution of the RN and APN workforce is critical to understand their capacity to meet healthcare needs and improve population health. The data presented in this report provides a snapshot of key demographic and practice characteristics for the RN workforce.
Data Report: 2016 Indiana Physician Licensure Survey
(2016-05) Vaughn, S., Gano, L., Maxey, H.
The Bowen Center for Health Workforce Research and Policy, formerly called the Bowen Research Center, has a rich history of collecting, analyzing, and disseminating health workforce data and research for the State of Indiana. These health workforce data are important to informing health workforce policy and planning efforts through the State. Although the health workforce is comprised of a myriad of health professionals, the physician workforce may be regarded as the backbone of the healthcare system, which makes collecting and disseminating timely data on the supply and distribution of Indiana’s physician workforce critical to informing any health workforce policy or planning efforts. The 2016 Indiana Physician Licensure Survey Data Report presents key information and data collected from the physician re-licensure survey administered by the Indiana Professional Licensing Agency (IPLA) during physicians’ biennial license renewal. As of 2015, 26,536 physicians were licensed to practice in the State of Indiana. Of these, 10,057 physicians reported having an Indiana practice address. The majority of Indiana physicians reported having only one practice location in the state. Consistent with national trends, Indiana’s physicians are concentrated in populous, urban areas. In addition to understanding the geographic distribution of this workforce, practice characteristics are critical to determining capacity at the community level. A total of 6,285 (62%) physicians reported working 37 hours or more per week in direct patient care. Furthermore, roughly 52% of the physician workforce reported not offering a sliding fee scale. Also, 8.5% of Indiana physicians reported not accepting Medicaid. This report details important demographic and practice characteristics for the physician workforce. The report also examines these data for the primary care physician workforce and the psychiatric workforce. The 2015 Indiana Physician Licensure Survey Data Report presents a snapshot of data on the physician workforce in order to provide stakeholders with information needed to improve the quality and accessibility of health care for Indiana residents through policy making, workforce development, and resource allocation.
Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids
(Oxford Academic, 2016-10) Henry, Stephen G.; Chen, Meng; Matthias, Marianne S.; Bell, Robert A.; Kravitz, Richard L.; Communication Studies, School of Liberal Arts
Objective. To describe the development and initial application of the Chronic Pain Coding System., Design. Secondary analysis of data from a randomized clinical trial., Setting. Six primary care clinics in northern California., Subjects. Forty-five primary care visits involving 33 clinicians and 45 patients on opioids for chronic noncancer pain., Methods. The authors developed a structured coding system to accurately and objectively characterize discussions about pain and opioids. Two coders applied the final system to visit transcripts. Intercoder agreement for major coding categories was moderate to substantial (kappa = 0.5–0.7). Mixed effects regression was used to test six hypotheses to assess preliminary construct validity., Results. Greater baseline pain interference was associated with longer pain discussions (P = 0.007) and more patient requests for clinician action (P = 0.02) but not more frequent negative patient evaluations of pain (P = 0.15). Greater clinician-reported visit difficulty was associated with more frequent disagreements with clinician recommendations (P = 0.003) and longer discussions of opioid risks (P = 0.049) but not more frequent requests for clinician action (P = 0.11). Rates of agreement versus disagreement with patient requests and clinician recommendations were similar for opioid-related and non-opioid–related utterances., Conclusions. This coding system appears to be a reliable and valid tool for characterizing patient-clinician communication about opioids and chronic pain during clinic visits. Objective data on how patients and clinicians discuss chronic pain and opioids are necessary to identify communication patterns and strategies for improving the quality and productivity of discussions about chronic pain that may lead to more effective pain management and reduce inappropriate opioid prescribing.
Improving CPAP Adherence for Obstructive Sleep Apnea: A Practical Application Primer on CPAP Desensitization
(2020) Chernyak, Yelena
Introduction: Obstructive sleep apnea (OSA) is a common medical condition with well-established morbidity and mortality. Continuous positive airway pressure (CPAP) is a highly effective treatment prescribed to most individuals with OSA that has documented poor adherence rate for a variety of reasons including claustrophobia and discomfort. CPAP desensitization is an effective, simple, and brief treatment shown to improve adherence rates to CPAP. Methods: A psychologist specializing in behavioral sleep medicine developed this module focused on teaching medical residents the techniques of CPAP desensitization. The educational activity was an interactive 45-minute seminar which included a didactic component followed by a case presentation and interactive role-play. A post-seminar survey was used to evaluate the content of the workshop, as well as growth in awareness and perception of knowledge and skills with a pre- to post-workshop evaluation. Results: In a survey of 25 primary care and psychiatry residents and sleep medicine fellows, 92% of respondents indicated that the topic of CPAP barriers and CPAP desensitization was important. Ratings of self-reported knowledge and skills improved nearly one-third following the workshop. Qualitative feedback indicated the utility and enthusiasm learners had for this topic. Discussion: The workshop on CPAP desensitization was a valuable tool that should be disseminated more widely to improve treatment adherence in the significant portion of the population that suffers from OSA which does not use adherence to positive airway pressure therapy. The workshop is applicable to other health professionals including medical students and nursing, social work, or psychology trainees.
Indiana Primary Health Care: Description, Distribution, Challenges, and Strategic Recommendation to Empowered Decision Making
(2012-12) Maxey, Hannah L.; Malcolm, Amber; Norwood, Connor W.; Sheff, Zachary; Walters, Staci Jo
Mind-Body Skills Groups for Adolescents with Depression in Primary Care: A Pilot Study
(Journal of Pediatric Health Care, 2020) Aalsma, Matthew C.; Jones, Lindsey D.; Staples, Julie K.; Garabrant, Jennifer M.; Gordon, James S.; Richtsmeier Cyr, Lynda; Salgado, Eduardo F.; Salyers, Michelle P.
Objective: To determine acceptability and preliminary effectiveness of Mind-Body Skills Groups (MBSGs) as a treatment for depressed adolescents in primary care. Methods: A single arm clinical trial was conducted. A 10-week MBSG program was implemented in primary care. Participants completed self-report measures at baseline, post-intervention, and 3-months following the MBSGs. Measures included the Children’s Depression Inventory-2, Suicidal Ideation Questionnaire, Mindful Attention Awareness Scale, Self-Efficacy for Depressed Adolescents, rumination subscale of the Children’s Response Style Questionnaire, and a short acceptability questionnaire. Results: Participants included 43 adolescents. The total depression scores significantly improved following the MBSG intervention and continued to improve significantly from post-treatment to follow-up. Mindfulness, self-efficacy, rumination, and suicidal ideation all had significant improvement following the intervention. Acceptability of the program was strong, and attendance was excellent. Discussion: Preliminary evidence suggests that MBSGs are an acceptable treatment for primary care settings and lead to improved depression symptoms in adolescents.
Patient and Physician Race and the Allocation of Time and Patient Engagement Efforts to Mental Health Discussions in Primary Care: An Observational Study of Audiorecorded Periodic Health Examinations
(Wolters Kluwer, 2017-07) Foo, Patricia K.; Frankel, Richard M.; McGuire, Thomas G.; Zaslavsky, Alan M.; Lafata, Jennifer Elston; Tai-Seale, Ming; Medicine, School of Medicine
This study investigated racial differences in patient-physician communication around mental health versus biomedical issues. Data were collected from audiorecorded periodic health examinations of adults with mental health needs in the Detroit area (2007-2009). Patients and their primary care physicians conversed for twice as long, and physicians demonstrated greater empathy during mental health topics than during biomedical topics. This increase varied by patient and physician race. Patient race predicted physician empathy, but physician race predicted talk time. Interventions to improve mental health communication could be matched to specific populations based on the separate contributions of patient and physician race.
Perspectives on Colon Cancer Screening—A Physician Panel Discussion for Preclinical Medical Students
(Association of American Medical Colleges, 2020-10) Dilly, Christen K.; Craven, Hannah J.; Molleston, Jean P.; Medicine, School of Medicine
Introduction Colon cancer is the third most common cancer in the US, and the survival rate improves drastically with early detection. It is important for medical students to understand screening options, and to be able to effectively discuss these options with their patients. While basic information about colon cancer screening is ubiquitous in US medical school curricula, no published curricula describe teaching students the nuances of negotiating this discussion with patients and tailoring screening to individual patients' needs. Methods We developed a 90-minute session for second-year medical students as part of a gastroenterology and nutrition course. We provided a short lecture on colon cancer screening. We then had a panel of practicing gastroenterologists and a primary care physician discuss their approaches to six hypothetical cases. The students reflected in writing on what they learned from the session and on their opinions of the session format. Results Of second-year medical students, 139 attended the session and 110 submitted written reflections on the session (79% response rate). The students perceived significant gains in knowledge, communication skills, and attitudes around the discussions. Discussion This expert panel session taught medical students knowledge and communication skills related to colon cancer screening. The session could be easily implemented at any medical school, either at the preclinical or clinical level.
Real-World Massage Therapy Produces Meaningful Effectiveness Signal for Primary Care Patients with Chronic Low Back Pain: Results of a Repeated Measures Cohort Study
(Oxford University Press, 2017-07-01) Elder, William G.; Munk, Niki; Love, Margaret M.; Bruckner, Geza G.; Stewart, Kathryn E.; Pearce, Kevin; Health Sciences, School of Health and Human Sciences
Objective: While efficacy of massage and other nonpharmacological treatments for chronic low back pain is established, stakeholders have called for pragmatic studies of effectiveness in "real-world" primary health care. The Kentucky Pain Research and Outcomes Study evaluated massage impact on pain, disability, and health-related quality of life for primary care patients with chronic low back pain. We report effectiveness and feasibility results, and make comparisons with established minimal clinically important differences. Methods: Primary care providers referred eligible patients for 10 massage sessions with community practicing licensed massage therapists. Oswestry Disability Index and SF-36v2 measures obtained at baseline and postintervention at 12 and 24 weeks were analyzed with mixed linear models and Tukey's tests. Additional analyses examined clinically significant improvement and predictive patient characteristics. Results: Of 104 enrolled patients, 85 and 76 completed 12 and 24 weeks of data collection, respectively. Group means improved at 12 weeks for all outcomes and at 24 weeks for SF-36v2's Physical Component Summary and Bodily Pain Domain. Of those with clinically improved disability at 12 weeks, 75% were still clinically improved at 24 weeks ( P < 0.01). For SF-36v2 Physical and Mental Component Summaries, 55.4% and 43.4%, respectively, showed clinically meaningful improvement at 12 weeks, 46.1% and 30.3% at 24 weeks. For Bodily Pain Domain, 49.4% were clinically improved at 12 weeks, 40% at 24 weeks. Adults older than age 49 years had better pain and disability outcomes than younger adults. Conclusions: Results provide a meaningful signal of massage effect for primary care patients with chronic low back pain and call for further research in practice settings using pragmatic designs with control groups.

Browsing by Subject "Primary Care"

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