Survey of Primary Care Provider Comfort in Treating Psychiatric Patients in 2 Community Clinics: A Pilot Study.

Context: Patients with mental health needs are often treated by primary care providers (PCPs). Little is known about current PCP attitudes and comfort level with mental health disorders and treatments despite their role in managing these illnesses.Objective: To quantify PCP comfort with the management of psychiatric disorders and treatments.Methods: PCPs in 2 community clinics were given a survey of psychiatric disorders, treatments, and perceived benefit of assistance from a mental health professional (data were collected during provider meetings in May 2017 and February 2021). Questions were ranked using a Likert scale from 1 to 5 with 1 being "least comfortable," 3 being "neutral," and 5 being "very comfortable." Survey responses about medications and disorders were averaged (ie, mean values were calculated) to approximate PCP comfort with providing psychiatric care with and without support.Results: A total of 71 surveys were sent, and 54 were completed. Overall, respondents indicated comfort greater than neutral in 4 of the 14 disorder-related questions (ie, for anxiety disorders, unipolar depression, attention-deficit/hyperactivity disorder [ADHD], and sleep disorders) and 7 of the 19 treatment-related questions (ie, for selective serotonin reuptake inhibitors [SSRIs]/serotonin-norepinephrine reuptake inhibitors [SNRIs], second-generation antipsychotics, other sleep medications, other antidepressants, stimulants, non-stimulant treatments for ADHD, and tricyclics). SSRIs/SNRIs were the only item with average comfort greater than 4. Mean overall PCP comfort was 2.73 without support. PCP comfort increased significantly with support from a therapist (3.24) or a psychiatrist (4.11) (P < .001), with backup from a psychiatrist providing significantly more comfort than a therapist (P < .001).Discussion: These data show ongoing low comfort levels of PCPs in treating psychiatric conditions, suggesting a need for ongoing educational and collaborative approaches to address this critical unmet need.

Predicting length of stay and conversion to open cholecystectomy for acute cholecystitis using the 2013 Tokyo Guidelines in a US population.

BACKGROUND: The 2013 Tokyo Guidelines (TG13) for acute cholecystitis have not been studied extensively in US populations. METHODS: A retrospective review of patients with acute cholecystitis within a single system from 2009 to 2013 was performed. The diagnosis and severity of acute cholecystitis were assigned by the TG13. The primary outcome measures were length of stay and conversion to open cholecystectomy. RESULTS: Four hundred and forty-five patients with acute cholecystitis were studied. For all patients, length of stay (P < 0.001), disposition to home (P < 0.001), and morbidity (P = 0.003) were related to increasing TG13 grade. For surgical patients (n = 256), worsened outcomes with increasing TG13 grade were seen for conversion to open (P = 0.001), operative duration (P < 0.001), length of stay (P < 0.001), disposition to home (P < 0.001), and readmission (P = 0.037). On multivariate analysis, TG13 grade was an independent predictor of increasing length of stay (P = 0.009) and conversion to open surgery (grade 2: OR 7.63 (2.25-25.90), grade 3: OR 24.2 (5.0-116.37)). CONCLUSIONS: Wide adoption of the TG13 in the US can better inform patients, hospital systems, and payers of the expected outcomes of acute cholecystitis.