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1.
Braz Oral Res ; 34: e011, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32130361

RESUMEN

Telehealth has been applied in the Unified Health System (SUS) as a tool for qualifying professionals and improving the healthcare provided to the population served by the system. The aim of the present study was to evaluate the impact of teleconsultations on the qualifications of the clinical approach of the oral health teams involved in primary health care (PHC) in the state of Rio Grande do Sul under the Telehealth Brazil Networks Programme. The sample population of the study was composed of 285 dentists and 132 oral health assistants belonging to the Family Health Teams. A chi-square test was used to investigate possible associations between the absolute number of teleconsultations performed and several independent variables, namely, gender, age, dental specialty, time since graduation, time working in the Family Health Strategy (FHS), employment status, type of training institution, familiarity with information technology, and work satisfaction at the health facility. The level of significance was p < 0.05. Use of the oral health teleconsultation service led to a reduction of more than 45% in the number of referrals to other levels of care. However, no significant association was found between the number of teleconsultations and the independent variables analysed. The use of teleconsultations proved to be a powerful tool for professional training, for increasing the effectiveness of PHC, and for improving the oral healthcare provided.


Asunto(s)
Personal de Odontología/estadística & datos numéricos , Odontólogos/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adulto , Brasil , Estudios Transversales , Atención Odontológica/estadística & datos numéricos , Servicios de Salud Dental/normas , Personal de Odontología/educación , Odontólogos/educación , Educación a Distancia/métodos , Educación a Distancia/estadística & datos numéricos , Femenino , Humanos , Masculino , Salud Bucal , Atención Primaria de Salud/métodos , Valores de Referencia , Encuestas y Cuestionarios , Telemedicina/métodos , Factores de Tiempo
4.
Neurology ; 94(4): 165-175, 2020 01 28.
Artículo en Inglés | MEDLINE | ID: mdl-31919114

RESUMEN

OBJECTIVE: To review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries. METHODS: A systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles. RESULTS: The 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans. CONCLUSIONS: Cost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.


Asunto(s)
Servicios de Salud Comunitaria/métodos , Países en Desarrollo , Epilepsia/terapia , Atención Primaria de Salud/métodos , Humanos
5.
Postgrad Med ; 132(1): 102-108, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31928276

RESUMEN

Background: Little is known about patient preference regarding the physical exam in non-urgent primary care settings.Objective: To determine the differences between a patient's expectations of the physical exam and the actual components of the physical examination performed during a non-urgent visit.Design: A total of 452 surveys administered in the waiting room of a VA primary care clinic in West Haven, CT.Key results: The response rate was 91.6% (n = 414). For 15 of 16 maneuvers on the survey, more respondents believed a reasonable provider should conduct it than received it at their annual physical exam; for 7 of them (breast, axillary, rectal, pelvic, total body skin exam, electrocardiogram, and stress test), over twice as many respondents believed they should be done than received them. There was an association between a patient's perception of their primary care provider and the number of maneuvers recalled at their annual exam (P < 0.001), and a gap in the number of maneuvers expected from a reasonable provider by nonwhite and white patients (P < 0.001).Limitations: Convenience sample, response bias (healthy patients are more likely to respond) and recall bias.Conclusion: Patient perception of their primary care provider is strongly associated with the number of maneuvers recalled during an annual physical. Furthermore, the number of maneuvers expected by a patient is influenced by race, with nonwhite patients desiring more. This suggests the need for further research on the role of race in the expectations of healthcare providers.


Asunto(s)
Prioridad del Paciente , Examen Físico , Atención Primaria de Salud/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Físico/métodos , Examen Físico/psicología , Encuestas y Cuestionarios , Adulto Joven
7.
Postgrad Med ; 132(1): 91-101, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31573835

RESUMEN

Objective: An important clinical gap reported by primary care physicians (PCPs) in managing knee osteoarthritis patients is the lack of validated tools to help them guide conservative treatment decision-making. This study aimed at evaluating the clinical utility of adding to current medical management (CMM) by PCPs, a dynamic knee kinesiography (KneeKG) exam assessing biomechanical risk factors linked to osteoarthritis progression.Design: In this 6-month cluster randomized controlled trial, primary care clinics were randomized into three groups: 1-CMM by PCPs, 2-CMM+KneeKG, and 3-CMM+KneeKG+Education (a self-management education session and two follow-up group meetings). Primary outcomes were scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and overall score.Results: Of the 894 patients referred from 87 clinics, 515 participated, 449 (87.2%) completed the study. At 6-month follow-up, patients in both KneeKG groups reported statistically significant improvement on the KOOS overall score (Group2: +5.5; Group3: +5.0), and on the symptoms, pain, and activities of daily living subscales compared to control group (all p < 0.05). They also reported significantly higher satisfaction levels with global care (both p < 0.01). Group 3-CMM+KneeKG+Education showed statistically significant improvements in objective functional tests as well as greater global impression of change in pain, function, quality of life, and global condition (all p < 0.05).Conclusions: Results demonstrated significant improvements in terms of pain, function, and satisfaction in KneeKG groups relative to the CMM. Adding education and supervision further improves clinical outcomes. These findings may support the added value of a KneeKG exam in assisting PCPs in the management of knee osteoarthritis patients.


Asunto(s)
Terapia por Ejercicio/métodos , Osteoartritis de la Rodilla/terapia , Animales , Terapia por Ejercicio/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/fisiopatología , Atención Primaria de Salud/métodos , Resultado del Tratamiento
8.
Ann Otol Rhinol Laryngol ; 129(2): 170-174, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31625409

RESUMEN

OBJECTIVES: To categorize the primary reasons for electronic consults (eConsults) to otolaryngology from primary care physicians (PCPs). To determine how many patients avoided subsequent in-person otolaryngology office visits. METHODS: This is a retrospective analysis of a pilot study that took place between 2016 and 2017 regarding eConsults to adult otolaryngology placed by primary care physicians at the University of California, San Diego (UCSD) Medical Center. The complaints were categorized as related to the following: ear, nose, throat or neck. Initial recommendations were classified as (1) providing education only (no intervention), (2) suggesting medical therapy provided by the PCP, or (3) suggesting surgical intervention. Univariate statistics and multinomial logistic regression were used to analyze the association of problem type with the need for follow-up in the otolaryngology offices. The data was analyzed for differences in patient age and gender. RESULTS: The study population included 64 patients (average age 54.6 years, 60.9% male). Within this group, 41% of consults were for ear complaints, 15% for nose complaints, 28% had throat-related complaints, and 16% had neck-related complaints. In-person follow-up was not required for 82.8% of the consults. Overall, 76.9% of ear, 100% of nose, 88.9% of throat, and 70.0% of neck complaints did not require in-person visits. CONCLUSIONS: eConsults to otolaryngology were primarily for ear concerns. Of the eConsults, 82.4% did not require in-person follow-up. We therefore conclude that the use of eConsults prevented substantial office visits that would not otherwise be necessary. Efforts should be made to promote the widespread use of eConsults, which may to the more efficient use of resources.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Otolaringología , Enfermedades Otorrinolaringológicas/terapia , Atención Primaria de Salud/métodos , Derivación y Consulta , Consulta Remota/estadística & datos numéricos , Centros Médicos Académicos , Femenino , Humanos , Persona de Mediana Edad , Proyectos Piloto , Estudios Retrospectivos
9.
Lancet ; 395(10217): 42-52, 2020 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-31839279

RESUMEN

BACKGROUND: Antivirals are infrequently prescribed in European primary care for influenza-like illness, mostly because of perceived ineffectiveness in real world primary care and because individuals who will especially benefit have not been identified in independent trials. We aimed to determine whether adding antiviral treatment to usual primary care for patients with influenza-like illness reduces time to recovery overall and in key subgroups. METHODS: We did an open-label, pragmatic, adaptive, randomised controlled trial of adding oseltamivir to usual care in patients aged 1 year and older presenting with influenza-like illness in primary care. The primary endpoint was time to recovery, defined as return to usual activities, with fever, headache, and muscle ache minor or absent. The trial was designed and powered to assess oseltamivir benefit overall and in 36 prespecified subgroups defined by age, comorbidity, previous symptom duration, and symptom severity, using a Bayesian piece-wise exponential primary analysis model. The trial is registered with the ISRCTN Registry, number ISRCTN 27908921. FINDINGS: Between Jan 15, 2016, and April 12, 2018, we recruited 3266 participants in 15 European countries during three seasonal influenza seasons, allocated 1629 to usual care plus oseltamivir and 1637 to usual care, and ascertained the primary outcome in 1533 (94%) and 1526 (93%). 1590 (52%) of 3059 participants had PCR-confirmed influenza infection. Time to recovery was shorter in participants randomly assigned to oseltamivir (hazard ratio 1·29, 95% Bayesian credible interval [BCrI] 1·20-1·39) overall and in 30 of the 36 prespecified subgroups, with estimated hazard ratios ranging from 1·13 to 1·72. The estimated absolute mean benefit from oseltamivir was 1·02 days (95% [BCrI] 0·74-1·31) overall, and in the prespecified subgroups, ranged from 0·70 (95% BCrI 0·30-1·20) in patients younger than 12 years, with less severe symptoms, no comorbidities, and shorter previous illness duration to 3·20 (95% BCrI 1·00-5·50) in patients aged 65 years or older who had more severe illness, comorbidities, and longer previous illness duration. Regarding harms, an increased burden of vomiting or nausea was observed in the oseltamivir group. INTERPRETATION: Primary care patients with influenza-like illness treated with oseltamivir recovered one day sooner on average than those managed by usual care alone. Older, sicker patients with comorbidities and longer previous symptom duration recovered 2-3 days sooner. FUNDING: European Commission's Seventh Framework Programme.


Asunto(s)
Antivirales/administración & dosificación , Gripe Humana/terapia , Oseltamivir/administración & dosificación , Atención Primaria de Salud/métodos , Adolescente , Adulto , Anciano , Antivirales/uso terapéutico , Niño , Preescolar , Terapia Combinada , Europa (Continente) , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Oseltamivir/uso terapéutico , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
10.
Brasilia; s.n; [2020?].
No convencional en Portugués | LILACS | ID: biblio-1050456

RESUMEN

priorizar o atendimento de casos suspeitos de novo Coronavírus, medidas de controle e registrar o atendimento no sistema de informação da Atenção Primária (SISAB)


Asunto(s)
Humanos , Atención Primaria de Salud/métodos , Infecciones por Coronavirus/prevención & control , Enfermedades Respiratorias/complicaciones , Notificación de Enfermedades/normas
11.
Med Clin North Am ; 104(1): 15-24, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31757233

RESUMEN

Urticaria is a common presenting problem to the primary care provider. Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens. Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause. Inducible stimuli causing hives should be excluded using specific provocation testing. Treatment follows a standardized algorithmic approach as outlined by the Joint Task Force Practice Parameter and/or International Urticaria guidelines. Patients not responsive to steps 1 or 2 should be referred to an urticaria specialist for further evaluation and treatment. The prognosis and outcome of urticaria is generally very favorable for most patients.


Asunto(s)
Atención Primaria de Salud/métodos , Urticaria/diagnóstico , Enfermedad Aguda , Comités Consultivos/normas , Enfermedad Crónica , Hipersensibilidad a las Drogas/complicaciones , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnóstico , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Pronóstico , Derivación y Consulta , Urticaria/etiología
12.
PLoS Negl Trop Dis ; 13(12): e0007937, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31841503

RESUMEN

BACKGROUND: Chagas disease has crossed South America's borders and in recent years has spread to regions that were not previously affected. Early diagnosis and treatment of Chagas disease improves the clinical prognosis and prevents vertical transmission. Taking into account the lack of evidence of how primary care services manage Chagas disease in a non-endemic country, this study assessed Chagas disease knowledge, attitudes and practices among primary health care professionals. METHODS AND PRINCIPAL FINDINGS: Between 2017 and 2019, eight focus groups were formed with 41 family physicians and 40 nurses from healthcare centers in Madrid, Spain, and 70 field notes were collected during non-participant observation. The family physicians and nurses showed a lack of general knowledge about Chagas disease, and they did not identify the country of origin to request the blood test. The family physicians and nurses thought that the population did not talk broadly about Chagas disease because of the stigma or shame. The role of nurses was more focused on vaccination status and chronic disease follow-up, and family physicians assumed a facilitating role to send patients to different hospital facilities. Communication between primary care professionals and the hospital is a barrier frequently experienced by family physicians. CONCLUSIONS: The diagnosis of CD in non-endemic countries continues being an important challenge for health systems. The results obtained with the study of the knowledge, attitudes and practices at primary care through a qualitative approach allows to obtain evidence that could help to develop strategies for the screening of CD in a protocolized way in order to avoid that the diagnosis depends exclusively on the request of the patient.


Asunto(s)
Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/tratamiento farmacológico , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Atención Primaria de Salud/métodos , Competencia Profesional/estadística & datos numéricos , Femenino , Humanos , Masculino , España
13.
Aust N Z J Public Health ; 43(6): 538-543, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31667912

RESUMEN

OBJECTIVE: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. METHODS: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. RESULTS: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. CONCLUSION: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs' role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/organización & administración , Grupo de Ascendencia Oceánica/psicología , Atención Primaria de Salud/organización & administración , Prisioneros , Prestación de Atención de Salud/métodos , Femenino , Humanos , Masculino , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Atención Primaria de Salud/métodos , Prisioneros/psicología , Prisioneros/estadística & datos numéricos , Investigación Cualitativa , Apoyo Social
14.
Pediatrics ; 144(6)2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31704770

RESUMEN

OBJECTIVES: Incomplete subspecialty referrals, whether unscheduled or unattended, represent unmet patient needs and an opportunity to improve patient safety and experiences. Our objectives were to describe the rates of appointment scheduling and visit attendance after pediatric subspecialty referral and to examine patient and systems factors associated with scheduled referrals and attended appointments. METHODS: We conducted a retrospective review of referrals within a network of 52 primary and urgent care sites from November 2016 to October 2017. We included referrals for children ≤17 years old referred to medical or surgical subspecialists. We examined patient and health systems factors associated with (1) appointment scheduling and (2) visit attendance. RESULTS: Of 20 466 referrals, 13 261 (65%) resulted in an appointment scheduled within 90 days and 10 514 (51%) resulted in a visit attended within 90 days. In adjusted analyses, referral to surgical subspecialists was associated with an increased likelihood of appointment scheduling but a decreased likelihood of visit attendance. Compared with appointments scheduled within 7 days, appointments with intervals from referral to scheduled appointment exceeding 7 days were associated with decreasing likelihood of visit attendance (adjusted odds ratio 8-14 days 0.48; 95% confidence interval 0.37-0.61). Patient factors associated with decreased likelihood of both appointment scheduling and visit attendance included African American race, public insurance, and lower zip code median income. CONCLUSIONS: Patient and system factors were associated with variation in appointment scheduling and visit attendance. Decreased interval to appointment was significantly associated with visit attendance. These factors represent targets for interventions to improve referral completion.


Asunto(s)
Citas y Horarios , Pediatría/tendencias , Atención Primaria de Salud/tendencias , Derivación y Consulta/tendencias , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pediatría/métodos , Atención Primaria de Salud/métodos , Estudios Retrospectivos , Factores de Tiempo
16.
Rev Saude Publica ; 53: 98, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31778397

RESUMEN

OBJECTIVES: To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS: A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool - child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS: Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS: Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants' health care.


Asunto(s)
Servicios de Salud del Niño/provisión & distribución , Servicios de Salud del Niño/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Brasil , Estudios Transversales , Salud de la Familia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Garantía de la Calidad de Atención de Salud , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios
17.
Rev Med Suisse ; 15(669): 1968-1971, 2019 Oct 30.
Artículo en Francés | MEDLINE | ID: mdl-31663696

RESUMEN

We have been studying multimorbidity in epidemiology and clinical practice since the 1970s. Growing experience shows that the concept of multimorbidity is helpful for epidemiologists to describe population-level changes, but of little use to patients and clinicians who 'diagnose' multimorbidity. Several large, rigorous clinical trials show that organizational changes in primary care can improve the care of these complex patients, but do not improve directly health-related quality of life. This article describes the history of multimorbidity and results of recent randomized trials to prompt a discussion of new approaches to improve the experience of people living with multiple chronic diseases.


Asunto(s)
Enfermedad Crónica , Multimorbilidad/tendencias , Atención Primaria de Salud/métodos , Enfermedad Crónica/epidemiología , Enfermedad Crónica/terapia , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto
18.
Afr Health Sci ; 19(2): 1841-1848, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31656466

RESUMEN

Background: Maternal, fetal and neonatal mortality are 10 to 100 fold higher in many low-income compared to high-income countries. Reasons for these discrepancies include limited antenatal care and delivery outside health facilities. Objectives: The study aimed at conducting a baseline survey to assess the current levels of maternal health indicators in six counties in Western Kenya. Methods: This was a cross sectional study conducted targeting women residing in Uasin-Gishu, ElgeyoMarakwet, TransNzoia, Bungoma, Busia and Kakamega counties who had given birth five years prior to the interview. Socio-demographic and maternal indicators were collected using forms adopted from KDHS 2009. Interviews were conducted in the homesteads between December 2015 and June 2016. Results: A total of 6257 women participated in the study, median age 27 years IQR 23-32. Majority of the women had post-primary level of education, were married and 40% were members of an income-generating activity. 56.8% were using modern family planning method, 49% attended WHO recommended four plus antenatal clinic visits and only 20% attended in the first trimester. Majority, 85% had their most recent delivery in a health facility. Conclusion: Findings suggest that women are not attending recommended four plus antenatal clinic visits and even those that attend are few are during the first trimester.


Asunto(s)
Salud Materna , Centros de Salud Materno-Infantil/organización & administración , Servicios de Salud Materno-Infantil/normas , Cooperación del Paciente , Atención Prenatal/estadística & datos numéricos , Atención Primaria de Salud/métodos , Adulto , Niño , Centros Comunitarios de Salud/organización & administración , Conducta Anticonceptiva , Estudios Transversales , Femenino , Humanos , Kenia , Mortalidad Materna , Embarazo , Atención Primaria de Salud/organización & administración , Factores Socioeconómicos
19.
Med Care ; 57(11): 905-912, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31568165

RESUMEN

BACKGROUND: It is unclear whether Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs) [medical doctors (MDs), nurse practitioners, and physician assistants] in a team care model. METHODS: We surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. We identified PCP dyads of 2 providers in Medicare data and compared the results to those from our survey. Sensitivity, specificity, and positive predictive value (PPV) of dyads in Medicare data at different threshold numbers of shared patients were reported. We also identified PCPs who work in the same practice by Social Network Analysis (SNA) of Medicare data and compared the results to the surveys. RESULTS: With a cutoff of sharing at least 30 patients, the sensitivity of identifying dyads was 27.8%, specificity was 91.7%, and PPV 72.2%. The PPV was higher for MD-nurse practitioner/physician assistant pairs (84.4%) than for MD-MD pairs (61.5%). At the same cutoff, 90% of PCPs identified in a practice from the survey were also identified by SNA in the corresponding practice. In 5 of 8 surveyed practices with at least 3 PCPs, about ≤20% PCPs identified in the practices by SNA of Medicare data were not identified in the survey. CONCLUSIONS: Medicare data can be used to identify shared care with low sensitivity and high PPV. Community discovery from Medicare data provided good agreement in identifying members of practices. Adapting network analyses in different contexts needs more validation studies.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Medicare/estadística & datos numéricos , Grupo de Atención al Paciente/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Interpretación Estadística de Datos , Prestación de Atención de Salud/métodos , Humanos , Colaboración Intersectorial , Enfermeras Practicantes/estadística & datos numéricos , Asistentes Médicos/estadística & datos numéricos , Médicos de Atención Primaria/estadística & datos numéricos , Atención Primaria de Salud/métodos , Texas , Estados Unidos
20.
Med Clin North Am ; 103(6): 1077-1092, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31582005

RESUMEN

Compared to clinicians previously surveyed, primary care providers employed in a health system known for clinical genomics were more likely to have ordered or referred a patient for genetic testing, but had only modestly more genetics training and reported similarly low levels of comfort answering patient questions about genetic risk. Most supported population genomic screening, reported willingness to get screened themselves, and judged a hypothetical patient's decision to be screened favorably relative to a similar patient's decision to decline screening. Stakeholder perceptions of the ethical appropriateness of nudging at-risk patients to discuss testing with counselors were mixed.


Asunto(s)
Asesoramiento Genético , Pruebas Genéticas/métodos , Atención Primaria de Salud , Asesoramiento Genético/ética , Asesoramiento Genético/métodos , Asesoramiento Genético/psicología , Humanos , Medicina de Precisión/métodos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Secuenciación del Exoma Completo
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