Browsing by Subject "primary care"

Now showing 1 - 10 of 28
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    Addressing Food Insecurity: Lessons Learned from Co-Locating a Food Pantry with a Federally Qualified Health Center
    (Ubiquity Press, 2022-09-30) Reinoso, Deanna; Haut, Dawn; Claffey, Stephen; Hahn Keiner, Kathy; Chavez, Alejandra; Nace, Nicole; Carter, Amy; Pediatrics, School of Medicine
    Introduction: Social determinants of health, such as food insecurity, contribute to chronic health conditions, decreased quality of life, and health disparities. Increasingly, healthcare systems seek to address social determinants of health by integrating medical and social care. Description: Eskenazi Health Center Pecar is a Federally Qualified Health Center providing comprehensive primary care to vulnerable patients in Indianapolis, IN, USA. This health center, in coalition with community partners, established and continually developed an integrated food pantry model to address food insecurity, improve nutrition education, and support patient access to healthy food. Discussion: Food insecurity and poor nutrition are common in primary care and contribute to the incidence and outcomes of chronic conditions such as obesity, hypertension, and diabetes. Long-term management of food assistance and nutrition programs requires substantial resources, partnerships, and leadership. We describe lessons learned in food pantry partnership, funding, logistics, and sustainability in a collaborative food access model integrated into healthcare. These lessons learned can be utilized by other health systems to scale up and accelerate strategies to better address food security and nutrition education. This paper articulates best practices for integrating a food pantry model within primary care with the goal of long-term sustainability and direct impact on patient health outcomes.
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    Anticholinergics Influence Transition from Normal Cognition to Mild Cognitive Impairment in Older Adults in Primary Care
    (Wiley, 2018) Campbell, Noll L.; Lane, Kathleen A.; Gao, Sujuan; Boustani, Malaz A.; Unverzagt, Fred; Medicine, School of Medicine
    Study Objective To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care. Design This observational cohort study was conducted over a mean follow‐up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to 4 years. Data Source Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC). The cognitive diagnosis was derived from a cognitive screening and diagnosis study. Participants A total of 350 adults 65 years and older without dementia and receiving primary care in a safety net health care system. Measurement and Main Results Cognitive diagnosis followed a two‐phase screening and consensus‐based neuropsychiatric examination to determine a baseline diagnosis as normal cognition, mild cognitive impairment (MCI), or dementia, with a follow‐up neuropsychiatric examination and consensus‐based diagnosis repeated annually. The Anticholinergic Cognitive Burden scale was used to identify anticholinergics dispensed up to 10 years before enrollment and annually throughout the study. A total standard daily dose of anticholinergics was calculated by using pharmacy dispensing data from the INPC. Among 350 participants, a total of 978 diagnostic assessments were completed over a mean follow‐up of 3.2 years. Compared with stable cognition, increasing use of strong anticholinergics calculated by total standard daily dose increased the odds of transition from normal cognition to MCI (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.01–1.31, p = 0.0342). Compared with stable MCI, strong anticholinergics did not influence the reversion of MCI to normal cognition (OR 0.95, 95% CI 0.86–1.05, p = 0.3266). Conclusion De‐prescribing interventions in older adults with normal cognition should test anticholinergics as potentially modifiable risk factors for cognitive impairment.
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    Brief Report: Pediatrician Referral Practices for Early Self-injury in Young Children with Intellectual and Developmental Disabilities
    (Springer, 2023-02) Fodstad, Jill Cherie; Gonzalez , Alexus M.; Barber , McKenzie; Curtin, Michelle; Psychiatry, School of Medicine
    The purpose of this study was to examine the frequency and quality of primary care physician (PCP) recommendations to investigate the management of young children with delays and self-injury (SIB; e.g., head banging) from the time of initial SIB concern to specialty referral as recommended by the American Academy of Pediatrics (AAP). Via a structured electronic health record review, PCP referrals and recommendations were examined for a cohort of 250 children (10–59 months old) with delays and SIB. Only a small portion of cohort charts reviewed (8.0%) received AAP recommended intervention via referral to subspecialty providers by their PCP. Further, only 37.5% received SIB-specific care recommendations. Findings suggest that future targeted education is needed to improve primary care access to AAP recommended intervention for young children with delays and early SIB.
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    Electronic Health Record Availability and Anxiety Treatment in Office Based Practices
    (2016-10) Harman, Jeffrey S.; Mills, Jon; Cook, Robert L.; Harle, Christopher A.; Department of Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: This study compared the probability of receiving anxiety treatment during a physician visit to primary care practices with and without an electronic health record (EHR). Methods: The 2007–2010 National Ambulatory Medical Care Survey was used to identify visits for anxiety (N=290). The outcome was receipt of anxiety treatment. The independent variable was the presence of a fully functioning EHR. Logistic regression was used to conduct the analysis. Results: Patients who were seen in practices with a fully functioning EHR had lower odds of being offered antianxiety medication (adjusted odds ratio [AOR]=.37, 95% confidence interval [CI]=.15–.90, p=.028), mental health counseling (AOR=.43, CI=.18–1.04, p=.061), and any anxiety treatment (AOR=.40, CI=.15–1.05, p=.062) compared with patients at practices without a fully functioning EHR. Conclusions: EHRs may have a negative impact on the delivery of care for anxiety during primary care visits. Future studies should monitor the impact of EHRs on delivery and quality of care.
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    Evaluation of Race and Ethnicity Across a Statewide System of Early Autism Evaluation
    (Elsevier, 2023-03) Martin, Ann Marie; Ciccarelli, Mary R.; Swigonski, Nancy; McNally Keehn, Rebecca; Pediatrics, School of Medicine
    We evaluated racial and ethnic disparities across the Early Autism Evaluation Hub system, a statewide network for autism diagnosis. Our findings suggest that this system has the potential to reduce longstanding disparities in autism spectrum disorder diagnosis for children from racial and ethnic minority backgrounds.
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    Examining the Efficacy of Project ECHO to Improve Clinicians' Knowledge and Preparedness to Treat Adolescent Vaping
    (Sage, 2022-06-30) Oliver , Alexander P.; Bell , Lauren A.; Agley , Jon; Bixler , Kristina; Hulvershorn, Leslie A.; Adams, Zachary W.; Psychiatry, School of Medicine
    As adolescent vaping reaches epidemic rates in the United States, it is imperative that pediatric clinicians have access to medical knowledge on best practices for screening, assessing, and treating vaping-related substance use. The Teen Vaping ECHO (Extension for Community Healthcare Outcomes) program was developed to offer practical learning sessions focused on clinical management of adolescent vaping. This study describes the development, implementation, and evaluation of the program’s impact on participants’ knowledge, attitudes, and practices regarding treatment of adolescent vaping from registration to the end of the series. Participants were generally knowledgeable about vaping at registration and reported significant increases in comfort talking with patients about vaping, counseling patients on nicotine replacement products, and frequency of implementing best-practice screening strategies at the end of the series. This study suggests ECHO programs focused on improving clinical management of adolescent vaping may increase accessibility of evidence-based care and reduce harms associated with vaping in youth.
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    GME Expansion to Community Hospitals: Residency Training Beyond the Academic Health Center
    (2020-03-06) Cico, Stephen John; Bratcher, Linda; Leveque, Emilie; Howenstine, Michelle
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    Group Visits to Improve Pediatric ADHD Chronic Care Management
    (Lippincott, Williams, and Wilkins, 2015-10) Bauer, Nerissa S.; Szczepaniak, Dorota; Sullivan, Paula D.; Mooneyham, GenaLynne; Pottenger, Amy; Johnson, Cynthia S.; Downs, Stephen M.; Department of Pediatrics, IU School of Medicine
    Objective: Children with attention-deficit hyperactivity disorder (ADHD) may experience continued impairment at home and school even after medication initiation. Group visits offer a way for pediatricians to provide more time to address ongoing needs. A pilot study was undertaken to examine whether a group visit model improved ADHD management in the pediatric medical home. Methods: Parents and children aged 6 to 18 years with ADHD were recruited and randomized to group visits or a usual care control. Data included attendance at ADHD follow-up visits, parent-rated ADHD symptoms, adaptive functioning, and quality of life. Longitudinal linear mixed models (continuous variables) and generalized linear mixed models (binary outcomes) were used to compare groups. In our statistical models, child and family were random effects; study assignment was a fixed effect. Results: Twenty families representing 29 children participated (intervention: 9 parents/13 children and control: 11 parents/16 children). Aside from race, baseline characteristics of participants were similar. None of the intervention families missed the expected 5 ADHD follow-up visits over 1 year; control families missed 1 or more visits over the same period. Intervention families reported an improved level of adaptive functioning at 12 months compared with control (mean severity score: 3.7 vs 4.4, p = .003). All families reported greater limitations and poorer quality of life compared with national norms. Conclusion: Group visits in the pediatric medical home can improve adherence, and preliminary results show a variety of improvements for the family.
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    Health Information Exchange Use in Primary Care
    (2020-08) Apathy, Nathan Calvert; Harle, Christopher A.; Vest, Joshua R.; Blackburn, Justin; Adler-Milstein, Julia; Dixon, Brian E.
    The United States has invested over $40 billion in digitizing the health care system, yet the anticipated gains in improved care coordination, quality, and cost savings remain largely unrealized. This is due in part to limited interoperability and low rates of health information exchange (HIE) use, which can support care coordination and improve provider decision-making. Primary care providers are central to the US health care delivery system and frequently function as care coordinators, yet capability and HIE use gaps among these providers limit the potential of these digital systems to achieve their intended goals. I study HIE use in the context of primary care to examine 1) factors associated with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences in HIE system use patterns across discrete groups of system users. First, I use a national sample of primary care providers to analyze market and practice factors related to HIE use for patient referrals. Overall, I find that only 43% of primary care provider referrals used HIE. Furthermore, I find substantial variation in HIE use rates across electronic health record (EHR) vendors. Second, I use HIE system log data to understand the breadth and depth of HIE use among teams, a care model underpinning primary care delivery reform efforts. I find that although use of HIE systems remains low, in primary care settings it overwhelmingly takes place in a manner consistent with team-based care workflows. Furthermore, team-based use does not differ in breadth from single provider HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to 16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I then compare two of these user groups and find user-level variation in volume and efficiency of use, both of which have implications for HIE system design and usability improvements. Ultimately, these findings help to inform how HIE use can be increased and improved in primary care, moving the US health care system closer to realizing the coordination, quality, and cost savings made possible by a digitized delivery system.
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    Hospitalists and the Decline of Comprehensive Care
    (2016-09) Gunderman, Richard; Department of Radiology and Imaging Sciences, IU School of Medicine