Time to integrate oral health screening into medicine? A survey of primary care providers of older adults and an evidence-based rationale for integration.

OBJECTIVE: Primary care providers were assessed regarding their training and interest to screen oral conditions in patients ≥55 years old. BACKGROUND: Oral health (OH) is an essential component of overall health and can affect systemic health. Medical/dental integration in older adults is underdeveloped. METHODS: A brief survey assessed primary care providers' self-reported skills, practices and barriers towards integrating OH screening into adult primary care. Data were collected using Survey Monkey® . Respondents were physicians and advanced practice providers (APPs) working at a large mid-western safety-net hospital. Descriptive statistics, T-tests and Chi-squared tests were reported. RESULTS: Eighty-two of 202 participants (41%) completed the survey. Most respondents were female (75%). A majority were physicians (68%); the remainder APPs. All providers (100%) reported OH was important or extremely important to overall health. More physicians (93%) reported not being well-trained to address adult OH issues and perceived less medical-oral health integration in their practice (16%) compared to APPs (P < .05). Time was more of a barrier with APPs (74%), compared to physicians (51%), to integrate OH screening activities (P < .05). Most providers reported other barriers such as inadequate OH training and insurance coverage. Providers endorsed that OH should be assessed frequently (56%) including providing referrals to dentists (77%) and educating patients on oral-systemic issues (63%). More female than male providers endorsed dental referrals and educating patients (P < .05). CONCLUSION: Primary care providers embraced greater medical/dental integration for older adults. Instituting OH activities appears to be supported. Future interventions that are feasible in primary care settings are examined.

One Leader's Journey Toward Empanelment.

Empanelment is an important step toward managing population health. Achieving empanelment in a fee-for-service world necessitates organizational support for panel size measurement and creativity regarding use of panel size to inform access decisions. Empanelment efforts and access must be balanced to create sustainable, high-quality care models and to improve practitioner and patient experiences.

Physicians caring for physicians: the perspective of the primary care physician.

OBJECTIVES: How physicians provide longitudinal primary care to physician-patients (ie, physicians as patients) has not been well studied. The potential challenges of providing care to physician-patients include maintaining professional boundaries and adhering to practice guidelines. The objective was to explore the differences in identifying how physicians perceive caring for physicians-patients in the longitudinal setting versus caring for other patients in the general population. METHODS: The study consisted of focus groups, followed by quantitative survey. Participants were primary care physicians (internal medicine and family medicine) at an academic multispecialty group practice. Thematic analysis of focus groups informed the development of the survey. RESULTS: In focus groups, participants identified several benefits, challenges, and differences in caring for physician-patients versus the general population. When these findings were explored further by quantitative survey, participants noted differences in care regarding chart documentation protocols, communication of results, and accommodation of schedules. They agreed that there were benefits to providing care to physician-patients, such as believing their work was valued and discussing complex issues with greater ease. There also were challenges, including anxiety or self-doubt. Participants also agreed on the following strategies when caring for this population: make recommendations based on evidence-based medicine, follow routine assessment and examination protocols, follow routine scheduling and communication protocols, recommend the same follow-up visit schedule, and define boundaries of the relationship. CONCLUSIONS: Physicians perceive caring for physician-patients as different and rewarding, although some find that it provokes anxiety. Many are willing to make concessions regarding scheduling and testing. With increasing experience, the anxiety decreased as did the need to follow protocols and maintain boundaries. Further investigation is needed to determine the impact of physician experience and training on the quality of care for physician-patients.

Personalized healthcare in the era of value-based healthcare.

Medical care in the USA is plagued by high costs, poor quality and fragmented care delivery. In response, new methods of integrated healthcare delivery are needed, including the patient-centered medical home. At the same time, we need to revitalize our approach to the practice of medicine, moving to a personalized approach, even as we increasingly focus on population management. Some aspects of personalized healthcare have the potential to add significant cost to the system, while others can improve value. This article aims to provide an overview of the current healthcare climate, discuss evolving models of care in the era of healthcare reform and describe the increasingly important role of personalized healthcare in this process.