ABSTRACT
Alcohol use disorder is a major public health concern, contributing to significant morbidity and mortality worldwide. Alcohol-associated liver disease is a major consequence of alcohol use disorder, with liver transplantation becoming the leading indication for this condition. This abstract describes a case study of a 39-year-old Native American man with severe alcohol-associated liver disease, illustrating the challenges and solutions in providing comprehensive care in a remote location. The patient's treatment involved a multidisciplinary approach, combining hepatology, addiction therapy, and telemedicine services. Despite initial difficulties, the patient achieved complete abstinence and significant improvement in liver function, avoiding the need for transplantation. This case highlights the importance of interdisciplinary care and the potential of telemedicine for managing complex cases of alcohol-associated liver disease and alcohol use disorder in remote areas, ultimately improving patient outcomes and reducing healthcare burdens.
ABSTRACT
INTRODUCTION: Workforce development is a vital process for advancing the field of integrated behavioral health in primary care (IBHPC) and depends on the development of job-specific skills that meet the needs of patients and other team members. Job-specific skills guide both university- and worksite-based training programs in preparing future cohorts of health care professionals in IBHPC; however, there are no extant training criteria for nontrainee primary care providers. METHOD: A multiround survey using a modified Delphi technique was conducted. Participants were recruited from a large national research network, university alumni and community health center partners. Participants included allopathic and osteopathic physicians, physician assistants and nurse practitioners serving as primary care providers in a variety of IBHPC settings. In the survey, participants were instructed to categorize 22 skills as "Essential," "Compatible," or "Irrelevant" for IBHPC practice. Categorized responses were analyzed using descriptive statistics and comments were analyzed using a modified thematic analysis method. RESULTS: Fifty-four participants were recruited for the study, with 43 participating in round 1, 38 participating in round 2, and 36 participating in round 3. After 3 rounds, 19 skills received at least 80% consensus as "Essential" and 22 received at least 50% consensus as "Essential." Comment themes revealed participants were overall agreeable with skills, but had concerns about role, training, and time constraints. DISCUSSION: Primary care providers can prepare for and enhance IBHPC practice by developing skills identified as essential. Employers can adapt this skill list for efforts related to recruiting, hiring, and onboarding. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Subject(s)
Nurse Practitioners , Humans , Delphi Technique , Health Personnel , Primary Health Care , Delivery of Health CareABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID-19) disrupted and undermined primary care delivery. The goal of this study was to examine the financial impacts the pandemic has had on primary care clinicians and practices. METHODS: The American Academy of Family Physicians National Research Network and the Robert Graham Center distributed weekly surveys from March 27, 2020, through June 15, 2020, to a network of more than 1960 physicians. Responses to the question, "Could you please tell us about any financial impact the COVID-19 pandemic has had on your practice, if any?" were analyzed using a grounded theory approach of qualitative analysis. The number of unique respondents who answered the financial impact question totaled 461 over the 12 weeks. RESULTS: Severe declines in patient visits, causing drastic revenue reductions, greatly impacted the ability to serve patients. Primary care clinicians and practices experienced significant changes in several areas about financial implications: patient visits, financial strain, staffing and telehealth. DISCUSSION: Preliminary findings revealed that even with Coronavirus Aid, Relief, and Economic Security Act, also known as CARES Act, funding, business viability remains questionable for some primary care practices. CONCLUSIONS: Low patient visits directly resulted in decreased revenues, which in turn, impacted staffing decisions and fueled telehealth implementation. It is difficult to predict whether patient visits will increase after June. Alternate payment models could provide some financial stability and address business viability.