Author Interviews, Geriatrics, JAMA, Ophthalmology, Primary Care / 03.03.2016

MedicalResearch.com Interview with: Dr. Albert Siu M.D., M.S.P.H. Chair of the U.S. Preventive Services Task Force Chairman and professor of the Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai Director of the Geriatric Research, Education, and Clinical Center James J. Peters Veterans Affairs Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Siu: Impaired vision is a serious and common problem facing older adults and can affect their independence, ability to function, and quality of life. When the Task Force reviewed the research around screening older adults for vision impairment in a primary care setting, we concluded that the current evidence is insufficient to assess the balance of benefits and harms. As a result, we issued an I statement, which is consistent with the 2009 final and 2015 draft recommendations. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Siu: Older adults who are having problems seeing should talk to their primary care doctor or an eye specialist. Primary care doctors can explore the various causes of vision problems and do an eye exam to check for refractive error. An eye specialist can do a full eye exam to look for and treat refractive errors and other eye conditions that affect vision, such as cataracts and age-related macular degeneration (AMD). With regards to clinicians, in the absence of clear evidence, they should use their clinical judgment when deciding whether to screen patients who have not reported any concerns about their vision. (more…)
Author Interviews, Cost of Health Care, Primary Care / 07.01.2016

MedicalResearch.com Interview with: Sapna Kaul, Ph.D Huntsman Cancer Institute 2000 Circle of Hope Salt Lake City, UT 84112 Medical Research: What is the background for this study? What are the main findings? Dr. Kaul: The United States has the highest healthcare expenditures in the world, and close to one-third of these expenditures are believed to be unnecessary. One potential reason for these unnecessary expenditures is that patients may ask for medical services that are unnecessary. At the same time, primary care physicians (PCP) could find it difficult to refuse to prescribe unnecessary medical services as they may worry that it may compromise patient satisfaction. Also, there is a shortage of primary care workforce in the U.S. and PCPs may have insufficient time to effectively address patient requests. We investigated 2 types of unnecessary medical practices initiated by patient requests: (1) providing unnecessary specialty referrals, and (2) prescribing brand-name drugs when generic alternatives were available. To explore these practices, we used data on 840 U.S. PCPs from a national survey of physicians conducted in 2009. Over 50% of primary care physicians reported providing unnecessary specialty referrals and 39% prescribed brand-name drugs at patient requests. Several provider and organizational factors, such as physician specialty and solo/2-person practice, were related to reporting unnecessary practices. (more…)
Author Interviews, JAMA, Mental Health Research, Primary Care / 13.11.2015

Shahrzad Mavandadi, PhD Research Health Science Specialist and Investigator Veterans Integrated Services Network 4 Mental Illness Research, Education, and Clinical Center Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, PennsylvaniaMedicalResearch.com Interview with: Shahrzad Mavandadi, PhD Research Health Science Specialist and Investigator Veterans Integrated Services Network 4 Mental Illness Research, Education, and Clinical Center Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Pennsylvania  Medical Research: What is the background for this study? Dr. Mavandadi: Mental health (MH) conditions are underidentified and undertreated in later life.  This is particularly true among subgroups of older adults who are more vulnerable to developing mental health issues, have poor access to specialty care, and are less responsive to treatment and therapy.  Thus, we sought to evaluate longitudinal MH outcomes among low-income, community-dwelling older adults enrolled in an evidence-based, collaborative mental health care management service (i.e., the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program).  The SUSTAIN program integrates mental health with primary care (which is where the majority of behavioral health conditions in later life are managed) and provides standardized, measurement-based, software-aided MH assessment and connection to community resources to older adults by telephone. While there is a strong evidence base for the efficacy of collaborative care models for me conditions, little is known about the amount or level of patient and provider support that is needed to achieve optimal behavioral health outcomes.  Thus, we specifically examined outcomes among older adults randomized to one of two program arms of varying intensity: MH symptom monitoring alone or mental health symptom monitoring plus MH care management.   MH care management involved care managers who provided education, counseling, and decision support to patients and their primary care providers, a licensed mental health clinician who supervised the care managers, and the use of an algorithm to help guide pharmacological and non-pharmacological treatment plans.  The sample consisted of 1018 older adults prescribed an antidepressant or anxiolytic by their non-behavioral health providers who presented with clinically significant symptoms at intake. (more…)
Author Interviews, Emergency Care, OBGYNE, Primary Care / 30.10.2015

MedicalResearch.com Interview with: Alfred Sacchetti, M.D. Department of Emergency Medicine Our Lady of Lourdes Medical Center, Camden, NJ Thomas Jefferson University, Philadelphia, PA Medical Research: What is the background for this study? Dr. Sacchetti: Much of the value of the "Affordable Care Act" is based on the concept that a primary care provider will limit the need for Emergency Department visits.  Unfortunately, this has never been proven, particularly for women's health issues. The purpose of our study was to determine if a relationship with a primary care provider did limit the need to access Emergency Department services. Medical Research: What are the main findings? Dr. Sacchetti: What our results demonstrated was that patients with a primary care Obstetrical / Gynecologic provider utilized the emergency department to the same extent as patients without a documented primary OB/GYN relationship.   Patients with women's health issues still required the services of the ED, even with an established primary care provider.  What was very interesting was that Emergency Department use was not restricted to off hours in the evenings and on weekends.  In fact the use of the ED occurred as much during the 9-5 hours on the weekdays as it did during other times.  The majority of the ED visits were for ambulatory complaints, with most patients being discharged to home after their care. (more…)
Author Interviews, Dermatology, Melanoma, Primary Care / 24.10.2015

MedicalResearch.com Interview with: Simone Ribero,  M.D., Ph.D.  University of Turin Department of Medical Sciences Italy & King’s College London Department of Twin Research and Genetic Epidemiology St Thomas’ campus London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Ribero: The total body naevus count is the principal risk factor for melanoma. having more than 100 moles increases  6 times the risk of developping a melanoma. In our study we described a model to predict the total number naevus count with the count of one arm. (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, Primary Care / 22.10.2015

Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA 98105MedicalResearch.com Interview with: Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA 98105 Medical Research: What is the background for this study? What are the main findings? Dr. Broussard: I am a clinical assistant professor of gastroenterology and I practice and teach fellows and residents GI at a safety-net hospital in Seattle and I was seeing too many late stage colorectal cancer (CRC) in our patient population. CRC is preventable with screening, and I wanted to see how the primary care clinics were performing in getting patients screened. When I looked at the baseline percentages, I realized this was an opportunity for improvement. I teamed up with an internal medicine resident Kara Walter, and we did a deep dive into the process of screening. The results of the poster presentation are a product of this teamwork, with cooperation and input from the directors of the six primary care clinics at our hospital. The main findings are that performing the FIT test is complicated and tricky for some patients, that this process can be streamlined with providing a toilet hat, a prepaid postage envelope, and improved and visual instructions. After one year, we saw statistically significant increases in overall screening with FIT in our patient population. (more…)
Author Interviews, Diabetes, Primary Care / 18.10.2015

MedicalResearch.com Interview with: Jay H. Shubrook DO FACOFP, FAAFP Professor Primary Care Department Director of Clinical Research and Diabetes Services Touro University California College of Osteopathic Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Shubrook: Type 2 DM is a progressive disease that is marked by declining beta cell function that results is worsening hyperglycemia. Current guidelines recommend a stepped approach in which people start with lifestyle and then sequentially add medications. The guidelines recommend that treatments be assessed regularly and titrated every 2-3 months. Unfortunately this does not happen. Clinical inertia is coming when treating diabetes where years -- not months- will pass before treatments are titrated. Time is not our friend in type 2 diabetes so we need to find a way to intervene earlier so we can see durable glucose control and hopefully longer terms preservation of beta cell function. The INSPIRE trial (intensive insulin as the primary treatment of type 2 diabetes) tested the effect of a pulse of early basal and bolus insulin therapy on glucose control, side effects (hypoglycemia, weight gain) and beta cell function. This regimen was compared to intensive oral therapy (2009 ADA treatment guidelines0 but medications titrated monthly). In short this randomized controlled multi center clinical trials explored does a 12 week pulse of basal-bolus insulin control glucose better than 15 months of on going and monthly titrated medications. The results showed that 12 weeks of insulin therapy (and then all treatment stopped) had similar A1c reduction and time to and need for rescue therapy compared to intensively treated on going oral medications for 15 months. Rates of hypoglycemia were low and intact those in the insulin arm lost weight while those in the medication arm gained weight. (more…)
Author Interviews, Electronic Records, Primary Care / 27.09.2015

MedicalResearch.com Interview with: Dr-Talley-HolmanTalley Holman, PhD, MBA  Senior eHealth Systems Analyst, Practice Advancement American Academy of Family Physicians Leawood, KS 66211  and John Beasley MD Professor of Family Medicine School of Medicine and Public Health and the Department of Industrial and Systems Engineering University of Wisconsin Madison, WIJohn Beasley MD Professor of Family Medicine School of Medicine and Public Health and the Department of Industrial and Systems Engineering University of Wisconsin Madison, WI Medical Research: What is the background for this study? Dr. Holman: From an engineering standpoint, tools such as EHRs are designed based on objectives, and the workflows that are created are developed to achieve those objectives. In health care, workflows have not been well understood, so designers have made assumptions when pressed to create tools to address specific situations, problems, or issues. However, the effectiveness of many of these tools is lacking, based on feedback. This led us to take a step back and ask if there is a standard workflow, and if so, what is it? Dr. Beasley: Physicians (and staff) have noted that the EHR is not doing a good job of supporting their work - and changes are made that appear to disrupt the physician’s workflow. There appears to have been an assumption on the part of designers/implementers that workflow is linear. (more…)
Author Interviews, Cost of Health Care, Primary Care / 17.09.2015

Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT 84108MedicalResearch.com Interview with: Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT  84108   Medical Research: What is the background for this study? What are the main findings? Dr. Magill: The Patient Centered Medical Home (PCMH) model of primary care is becoming more common. The model focuses on team delivery of care with other medical staff joining the primary care provider/clinician to provide for all patients’ healthcare needs.  However, the cost of sustaining PCMH functions is not well understood. This  study assessed direct personnel cost of delivering PCMH services in 20 diverse primary care practices in Utah and Colorado. The main finding is that PCMH services cost on average around $105,000 per clinician FTE per year, or around $4.00 per member per month for an imputed panel size of 2000 patients per FTE clinician.  (more…)
Accidents & Violence, Author Interviews, CDC, JAMA, Primary Care / 05.08.2015

Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, GeorgiaMedicalResearch.com Interview with: Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Klevens: The United States Preventive Services Task Force recommends women of reproductive age be screened for partner violence but others, such as the World Health Organization and the Cochrane Collaborative conclude there is insufficient evidence for this recommendation. Our randomized clinical trial allocated 2700 women seeking care in outpatient clinics to 1 of 3 study groups: computerized partner violence screening and provision of local resource list, universal provision of partner violence resource list without screening, or a no-screen/no resource list control group.  No differences were found in women’s quality of life, days lost from work or housework, use of health care and partner violence services, or the recurrence of partner violence after 1 year. In this three-year follow-up, no differences were found in the average number of hospitalizations, emergency room visits or ambulatory care visits. (more…)
Author Interviews, Compliance, Cost of Health Care, Emergency Care, Primary Care, UCSD / 15.07.2015

Nadereh Pourat, PhD Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health Adjunct Professor, UCLA School of Dentistry Director of Research, UCLA Center for Health Policy ResearchMedicalResearch.com Interview with: Nadereh Pourat, PhD Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health Adjunct Professor, UCLA School of Dentistry Director of Research, UCLA Center for Health Policy Research Medical Research: What is the background for this study? What are the main findings? Dr. Pourat: We have succeeded to insure most of the uninsured population in the U.S., but now have to figure out how to reduce costs while improving health. We had the opportunity to examine the role of continuity with a primary care provider, which is one of the pathways that looked promising in improving health and reducing costs. We were evaluating a major demonstration program in California called the Health Care Coverage Initiative (HCCI) and one of the participating counties implemented a policy to increase adherence by only paying for visits if patients went to their assigned providers. We examined what happened to patients who always or sometimes adhered to their provider versus those who never adhered. We found that adherence or continuity reduced emergency department use and hospitalizations. This would lead to savings because of the high costs of these services. Medical Research: What should clinicians and patients take away from your report? Dr. Pourat: The study shows that both patients and clinicians would benefit from continuity with the primary care provider. Clinicians can actually make a difference in helping patients: they can teach patients about self-care and help them manage their conditions better. Patients would benefit from following through with treatment plans and experience less medical error and duplication of services which are potentially harmful. Continuity fosters rapport and trust between patients and providers and can be beneficial to both. (more…)
Author Interviews, Cost of Health Care, Education, Johns Hopkins, Primary Care / 15.06.2015

MedicalResearch.com Interview with: Eric T. Roberts and Darrell Gaskin Johns Hopkins University Bloomberg School of Public Health Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Response: This study looked at the implications of the Affordable Care Act’s expansion of Medicaid on the need for additional physicians working in primary care. Since 2014, 11 million low-income adults have signed up for Medicaid, and this figure will likely increase as more states participate in the expansion. Many new Medicaid enrollees lacked comprehensive health insurance before, and will be in need of primary and preventive care when their Medicaid coverage begins. In light of these questions, in this study, we projected the number of primary care providers that are needed to provide care for newly-enrolled adults. We forecast that, if all states expand Medicaid, newly-enrolled adults will make 6.1 million additional provider visits per year. This translates into a need for 2,100 additional full time-equivalent primary care providers. We conclude that this need for additional providers is manageable, particularly if Congress fully funds key primary care workforce training programs, such as the National Health Service Corps. (more…)
Author Interviews, Cost of Health Care, Primary Care / 15.05.2015

Judith Hibbard, Ph.D. Senior Researcher, Health Policy Research Group University of OregonMedicalResearch.com Interview with: Judith Hibbard, Ph.D. Senior Researcher, Health Policy Research Group University of Oregon MedicalResearch: What is the background for this study? What are the main findings? Dr. Hibbard: Two important trends are happening in health care today: 1) Policies which move away from paying for volume and toward paying for value; and 2) The emphasis on patient engagement and the need for the patient to play a key part in the care process. Because so many quality outcomes are determined to a large extent by patient behaviors, there is an implied assumption that if you pay primary care clinicians (PCPs) more for better quality outcomes, they will also try to engage the patient as a necessary partner in reaching quality targets. That is, there is a tacit assumption that clinicians will naturally engage patients if you incentivize them on the quality metrics. We had an opportunity to examine the soundness of this assumption, when we conducted a study of primary care clinicians whose compensation was based 40% on their performance of quality metrics. The findings show that the vast majority of clinicians did not invest their efforts in patient engagement and activation, when trying to maximize their income under this model. They put their efforts in other areas. However, a year later they were very frustrated that their income was influenced by patient behaviors. This was their greatest frustration with the compensation model, and they indicated that “patient’s unwillingness to change their behavior” as the greatest barrier to achieving their quality goals. (more…)
Author Interviews, Global Health, Pediatrics, Primary Care / 12.05.2015

MedicalResearch.com Interview with: Elizabeth Cecil, MSc Department of Primary Care and Public, Health, Imperial College London London, United Kingdom Medical Research: What is the background for this study? What are the main findings? Response: Unplanned hospital admissions in children have been rising for more than a decade placing strain on health care resources in the UK. Unnecessary hospital admission exposes children to hospital acquired infections and an over invasive approach, and is inconvenient for their families as well as adding to pressures on staff dealing with sicker children. Our team from Imperial College London were interested in assessing the impact of primary care policy reforms on short stay admissions, in England. The reforms were nationally implemented in April 2004 and reduced the availability of primary care physicians for children. Our study, found that reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions and with fewer children’s admissions being referred by a primary care physician. Over the study period from April 2000 to March 2012, we found that more than half of the 7.8 million unplanned hospital admissions for children younger than 15 years were short-stay admissions for potentially avoidable infections and chronic conditions. The primary care policy reforms implemented in April 2004 were associated with an 8 percent increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3 percent annual increasing trend. Notably, the policy reforms were not associated with an increase in short-stay admission rates for infectious illness. (more…)
Author Interviews, Cost of Health Care, Emergency Care, Primary Care / 07.05.2015

Karoline Mortensen, Ph.D. Assistant Professor Department of Health Services Administration University of Maryland College Park, MDMedicalResearch.com Interview with: Karoline Mortensen, Ph.D. Assistant Professor Department of Health Services Administration University of Maryland College Park, MD Medical Research: What is the background for this study? Dr. Mortensen: For twenty years, use of hospital emergency departments has been on the rise in the United States, particularly among low-income patients who face barriers to accessing health care outside of hospitals including not having an identifiable primary health care provider. Almost half of emergency room visits are considered “avoidable.” The Emergency Department-Primary Care Connect Initiative of the Primary Care Coalition, which ran from 2009 through 2011, linked low-income uninsured and Medicaid patients to safety-net health clinics. Medical Research: What are the main findings? Dr. Mortensen: “Our study found that uninsured patients with chronic health issues – such as those suffering from hypertension, diabetes, asthma, COPD, congestive heart failure, depression or anxiety – relied less on the emergency department after they were linked to a local health clinic for ongoing care,” says Dr. Karoline Mortensen, assistant professor of health services administration at the University of Maryland School of Public Health and senior researcher. “Connecting patients to primary care and expanding the availability of these safety-net clinics could reduce emergency department visits and provide better continuity of care for vulnerable populations.” (more…)
Author Interviews, Cost of Health Care, Emergency Care, Primary Care / 09.04.2015

Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at BirminghamMedicalResearch.com Interview with: Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at Birmingham MedicalResearch: What is the background for this study? Dr. Xin: Research suggests that nearly half of all emergency department (ED) visits in the United States are for nonurgent conditions, leading to billions of dollars in potentially avoidable spending annually. A well-functioning primary care system has the capacity to provide timely, adequate, and effective care for patients in order to avoid nonurgent emergency department use and care costs. This study examined how deficiencies in ambulatory care were associated with nonurgent emergency department care costs nationwide, and to what extent these costs can be reduced if deficiencies in primary care systems could be improved. MedicalResearch: What are the main findings? Dr. Xin: Patient perceived poor and intermediate levels of primary care quality had higher odds of nonurgent emergency department care costs (OR=2.22, p=0.035, and OR=2.05, p=0.011, respectively) compared to high quality care, with a marginal effect (at means) of 13.0% and 11.5% higher predicted probability of nonurgent ED care costs. These ambulatory care quality deficiency related costs amounted up to $229 million for private plans (95% CI: $100 million, $358 million), $58.5 million for public plans (95% CI: $33.9 million, $83.1 million), and an overall of $379 million (95% CI: $229 million, $529 million) at the national level. (more…)
Author Interviews, Dental Research, Primary Care / 01.04.2015

Judith Haber, PhD, APRN, BC, FAAN Associate Dean, Graduate Programs The Ursula Springer Leadership Professor in Nursing New York, NY 10003MedicalResearch.com Interview with: Judith Haber, PhD, APRN, BC, FAAN Associate Dean, Graduate Programs The Ursula Springer Leadership Professor in Nursing New York, NY 10003 Medical Research: What is the background for this study? What are the main findings? Dr. Haber: The background of the project originally aligns with publication of the Surgeon General's Report (2000), challenging health providers to think about the "mouth as a window to the body".  More recent Institute of Medicine (IOM) reports, Advancing Oral Health in America (2011) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) highlighted the extant problems with oral health access, oral health disparities and outcomes and the potential role of the primary care workforce in addressing this population health issue.  However, there is a dearth of curricular focus on oral health in the curriculum of health professionals.  The IOM challenged the Health Resource and Service Administration (HRSA) to convene an Expert Panel to develop interprofessional oral health core clinical (IPOHCC) competencies; the report, Integrating Oral Health and Primary Care Practice, delineating the IPOHCC competencies, was published in 2014.   Our HRSA funded initiative, Teaching Oral-Systemic Health (TOSH), focuses on building interprofessional oral health workforce capacity with a special focus on the nursing, medical and dental professions.  We have operationalized the IPOHCC competencies by transforming the HEENT component of the health history, physical exam, risk assessment, diagnosis, and management plan, including collaboration and referral, to the HEENOT approach.  When a health professional uses the HEENOT approach, he or she cannot forget about oral health. (more…)
AHA Journals, Author Interviews, Primary Care / 25.03.2015

Barry L. Carter, PharmD Professor of Pharmacy Professor of Family Medicine U Iowa Carver College of MedicineMedicalResearch.com Interview with: Barry L. Carter, PharmD Professor of Pharmacy Professor of Family Medicine U Iowa Carver College of Medicine Medical Research: What is the background for this study? What are the main findings? Response: Numerous studies and meta-analyses have found physician-pharmacist collaborative models can improve blood pressure (BP) control.  In these models, pharmacists are located within primary care offices to assist with patient management. The physician delegates responsibility to pharmacists to perform a medication history, identify problems and barriers to achieving disease control, perform counseling on lifestyle modification and adjust medications following hypertension guidelines.  However, it was not known if this model would be implemented in a large number of diverse primary care offices, if the effect could be sustained after discontinuation and if the intervention was as effective in under-represented minorities as in Whites. In this study, 32 clinics from throughout the U.S. were randomized to a 9 month intervention that was discontinued, a 24-month pharmacist intervention our usual care.  All subjects received structured research measured blood pressure at baseline, 6, 9, 12, 18 and 24 months.  We enrolled 625 subjects and 53% were from minority groups, 53% had < 12 years of education, 50% had diabetes or chronic kidney disease and 25% had Medicaid or self-pay for their care payments.  All of these variables typically make it much more difficult to achieve BP control.  BP control was 43% in the intervention groups and 34% in the control group at 9-months (adjusted OR 1.57 [95% CI 0.99-2.50], p = 0.059). However, when using the higher BP goals in the 2014 guidelines, blood pressure control was achieved in 61% of intervention subjects and 45% of control subjects at 9 months [(adjusted OR, 2.03 [95% CI 1.29-3.22], p=0.003). Of importance was the finding that the degree of systolic BP reduction (6 mm Hg) with the intervention compared to usual care was not only statistically significant but also the same in minority subjects (2/3 Black and 1/3 Hispanic) compared to all subjects. Interestingly, BP control seemed to be maintained in the subjects from minority groups at 18 and 24 months in both the group with the short (9-month) or sustained (24 month) intervention. In contrast, blood pressure control deteriorated slightly in non-minority subjects in all three groups. (more…)
Alcohol, Author Interviews, Primary Care / 27.02.2015

Dr. Kristy Barnes Le MD Department of Internal Medicine Wake Forest School of Medicine Winston-Salem, NCMedicalResearch.com Interview with: Dr. Kristy Barnes Le MD Department of Internal Medicine Wake Forest School of Medicine Winston-Salem, NC Medical Research: What is the background for this study? What are the main findings? Response: Because about 1 in 6 Americans binge drink, it is important that physicians know how to screen for at-risk drinking and be able to effectively address alcohol use with their patients.   Alcohol screening and brief intervention (SBI) has been shown to be an effective tool to detect and reduce hazardous alcohol use, but it has not yet gained wide acceptance in practice or in medical education.  We know that lack of confidence contributes to practicing physicians’ hesitancy to screen and intervene with at-risk drinkers, but this had not been studied in resident physicians. We set out to determine how primary care resident physicians screen and intervene with their patients who drink, how they feel about discussing at-risk drinking, and what barriers they have to performing  Alcohol screening and brief intervention. Our main findings are: 1.)  Resident physicians are using the wrong screening instruments at the wrong times, and are not adequately performing the brief intervention when they do detect hazardous drinking. Less than 20% of residents in this study used screening instruments that are capable of detecting at-risk or binge drinking, while the remainder used instruments designed to detect alcohol use disorders.  And, only 17% screened for at-risk drinking at acute-care visits, where the consequences of binge drinking (such as injuries) are most likely to appear.  Additionally, when a brief intervention was performed, only a quarter of residents usually or always included the three recommended elements of feedback, advice, and goal-setting. 2.)  Resident physicians do not feel confident addressing at-risk drinking with their patients. Only 21% felt they could help their patient with hazardous drinking cut down or stop using alcohol and only 17% felt they had been successful in doing so in the past.  Interestingly, U.S.-born residents and those reporting no religious affiliation were even more likely to express lack of confidence. 3.)  Lastly, residents report barriers that include lack of adequate training (53 %), the belief that talking with patients is unlikely to make a difference (44 %), and just being too busy (39%).  The hours of reported  Alcohol screening training did not vary with residency year, perhaps indicating that most of it was done prior to residency. Clearly, the several hours they report getting (mean of 9.8 hours) is either not covering the right topics, or not teaching them in a way that leads to changes in practice. (more…)
Author Interviews, Exercise - Fitness, Gender Differences, Primary Care / 10.02.2015

Molly B. Conroy MD, MPH Assistant Professor of Medicine, Epidemiology, and Clinical and Translational Science University of Pittsburgh, Pittsburgh, PA,MedicalResearch.com Interview with: Molly B. Conroy MD, MPH Assistant Professor of Medicine, Epidemiology, and Clinical and Translational Science University of Pittsburgh, Pittsburgh, PA, Medical Research: What is the background for this study? What are the main findings? Response: The background for the study is the fact that middle-aged women are at high risk for being physically inactive, which puts them at higher risk for heart disease, cancer, and other chronic health problems. We compared an interventionist-led physical activity and weight loss program delivered in coordination with primary care to a booklet that women were asked to use to exercise by themselves at home. We found that women who received the interventionist-led program had significantly greater increases in physical activity at 3 months, compared to women who received booklet. At 12 months, women who received the interventionist-led program were still more active than they were before starting the program, although the difference between the 2 groups was no longer significant. (more…)
Author Interviews, Primary Care, Radiology / 27.01.2015

Christine Hughes Hadley Hart Group, Chicago, IllinoisMedicalResearch.com Interview with: Christine Hughes Hadley Hart Group, Chicago, Illinois Medical Research: What is the background for this study? Response: Value in healthcare is a popular topic today. Yet no clear value measures have been developed which could be used in policy decisions on reimbursement for diagnostic imaging procedures.  Within the imaging sector it is a given that imaging has value.  However efforts to articulate that value to payers and policy makers and others outside the sector have come up short.   We did conduct qualitative research with radiologists but during this process of mapping a value chain it became clear that those M.D.s who use the data that radiology provides to make decisions on patient care could better speak to imaging’s value.  And primary care because of the gatekeeper status for all types of care seemed appropriate. Medical Research: What are the main findings? Response: Primary care physicians highly value access to advanced imaging: 88% of the PCPs indicated that advanced imaging increases their diagnostic confidence; 90% believe imaging provides data not otherwise available; 88% reported access to imaging  permits better clinical decision making;  88% reported increases confidence in treatment choices , and 86% say it shortens time to definitive diagnosis. Most  Primary care physicians ( 85%) believe that patient care would be negatively impacted without access to advanced imaging. One very interesting finding is in differences in attitudes and valuations in younger vs. older physicians towards advanced imaging modalities.  For the purposes of this part of the analysis we divided the survey respondents into those in practice 1-20 years and those practicing radiology more than 21 years.  Presumably those practicing less 21 years trained with ready access to advanced imaging versus those who presumably having practiced without ready access to the advanced imaging modalities of MRI, CT and PET. Respondents who have practiced without ready access attach higher value to the ability to shorten the time to definitive diagnosis, ability to replace invasive procedures, make better clinical decisions, and believe the quality of patient care would be negatively impacted without access to advanced imaging.  The younger physicians attach more value to the practice efficiency issues such as enabling the Primary care physician to see more patients, or patient centric issues like the ability to communicate on a visual level with the patient. (more…)
Author Interviews, Cognitive Issues, Depression, Primary Care / 31.12.2014

Patrick Monahan, Ph.D. Associate Professor Indiana University School of Medicine and School of Public HealthMedicalResearch.com Interview with: Patrick Monahan, Ph.D. Associate Professor Indiana University School of Medicine and School of Public Health Medical Research: What is the background for this study? Dr. Monahan: Primary care providers need a clinical practical (e.g., brief, inexpensive, simple, user-friendly, easily standardized, and widely available) multidomain instrument to measure and monitor the cognitive, functional, and psychological symptoms of patients suffering from multiple chronic conditions. The tool also needs to be sensitive to change so that providers can use it to monitor patient outcomes and adjust the care plan accordingly. We created such a tool and then investigated its psychometric properties (in other words, reliability and validity) in our study of 291 older patients (aged 65 and older) who had at least one recent visit to our urban primary care clinics in Indianapolis, Indiana. These patients had presented with evidence of cognitive or depression problems because these patients and their caregivers were participating in a collaborative care model for such patients. Medical Research: What are the main findings? Dr. Monahan: The Healthy Aging Brain Care (HABC) Monitor demonstrated excellent reliability and validity in this study where patients self-reported their symptoms. Our previous study also showed excellent reliability and validity of the HABC Monitor when the patients’ symptoms were reported by their informal caregiver. (more…)
Author Interviews, Primary Care, Race/Ethnic Diversity / 19.10.2014

Arjumand Siddiqi, Sc.D., Assistant Professor Departments of Epidemiology and Social and Behavioral Sciences Dalla Lana School of Public Health University of Toronto Toronto, Ontario CanadaMedicalResearch.com Interview with: Arjumand Siddiqi, Sc.D., Assistant Professor Departments of Epidemiology and Social and Behavioral Sciences Dalla Lana School of Public Health University of Toronto Toronto, Ontario Canada MedicalResearch: What are the main findings of the study? Dr. Siddiqi: The main finding of the study is that, in a society with universal health insurance (Canada), racial disparities in access to primary care are drastically reduced, with some important exceptions. (more…)
Author Interviews, Brigham & Women's - Harvard, Compliance, Kidney Disease, Primary Care / 20.08.2014

Mallika L. Mendu, M.D. Division of Renal Medicine Brigham and Women’s Hospital Boston, MA 02115.MedicalResearch.com Interview with: Mallika L. Mendu, M.D. Division of Renal Medicine Brigham and Women’s Hospital Boston, MA 02115. Medical Research: What are the main findings of the study? Dr. Mendu: Our study found that implementation of a chronic kidney disease (CKD) checklist, a tool that succinctly and clearly outlines CKD management guidelines, in a primary care clinic improved adherence to a number of significant management guidelines. We conducted a prospective study during a one year period among 13 primary care providers, four of whom were assigned to use a CKD checklist incorporated into the electronic medical record during visits with patients with CKD. Patients whose providers utilized a CKD checklist had higher rates of adherence to annual albuminuria testing, parathyroid hormone testing, phosphate testing, achieving a hemoglobin A1c target<7, documentation of avoidance of nonsteroidal anti-inflammatory drugs, use of an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker and vaccination for annual influenza and 5-year pneumococcus. (more…)
Author Interviews, BMJ, Primary Care, Pulmonary Disease / 13.02.2014

Professor Chris van Weel Emeritus Professor of Family Medicine/General Practice Radboud University Nijmegen, The Netherlands Professor of Primary Health Care Research, Australian National University, Canberra Past President of WoncaMedicalResearch.com: Interview with: Professor Chris van Weel Emeritus Professor of Family Medicine/General Practice Radboud University Nijmegen, The Netherlands Professor of Primary Health Care Research, Australian National University, Canberra Background from Professor Chris van Weel Thank you for the opportunity to respond to your questions.  My paper was a commentary to the study of Jones and colleagues, Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK: a retrospective study of a clinical cohort looking at the implications of the study findings. MedicalResearch.com: What are the main findings of the study? Answer: Jones and colleagues reported that in the UK, there are many missed opportunities to diagnose COPD. My comments are that this is not a unique UK problem, but a universal one: under-diagnosis or late diagnosis of COPD is a universal problem in most if not all countries in the world. To understand it, it is important to analyse more in-depth the diagnostic challenge in primary care, for general practitioners(GP)/family physicians (FP). The paper of Jones highlights this diagnostic problem - symptoms of COPD are initially insidious and may fluctuate over time. And from my earlier research it is also clear that patients 'adept' their daily activities (less physical activities) and therefore may underplay or even become unaware of, their symptoms. At the same time, this is a problem for the physician, when encountering these symptoms. As I highlighted in my commentary, GPs/FPs have to pay attention to other possible diseases that might cause these symptoms: pneumonia, heart failure, lung cancer. The 'low key symptoms' and the need of applying a broad diagnostic scope together cause what Jones and his colleagues called the 'missed opportunities' to diagnose COPD. (more…)
Author Interviews, Health Care Systems, JAMA, Primary Care / 26.01.2014

Dr. Lyndonna Marrast MD Fellow in General Internal Medicine Cambridge Health Alliance 1493 Cambridge Street Cambridge, MA 02139 MedicalResearch.com Interview with: Dr. Lyndonna Marrast MD Fellow in General Internal Medicine Cambridge Health Alliance Cambridge, MA 02139 MedicalResearch.com:   What are the main findings of the study? Dr. Marrast: We found that disadvantaged patients (categorized as racial and ethnic minorities, non-English home language speakers, being low income, having Medicaid, or reporting fair or poor health) were more likely than other patients to be cared for by a minority physician. A majority, 54%, of black, Hispanic and Asian patients received care from a minority doctor and the vast majority, 70%, of those who report not speaking English at home got care from a minority physician. (more…)
Addiction, CMAJ, JAMA, Pharmacology, Primary Care / 19.09.2013

Richard Saitz, MD MPH Professor of Medicine and Epidemiology Boston University Schools of Medicine and Public Health Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MassachusettsMedicalResearch.com Interview with: Richard Saitz, MD MPH Professor of Medicine and Epidemiology Boston University Schools of Medicine and Public Health Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Dr. Saitz: Chronic care management in primary care did not improve health outcomes (abstinence from cocaine, opioids or heavy drinking; or any other clinical outcomes, like addiction consequences, emergency or hospital use, health-related quality of life, addiction severity) for people with alcohol or other drug dependence. (more…)
Primary Care / 15.08.2013

MedicalResearch.com Interview with: Dr. Richard Adair Medicine Clinic, 2800 Chicago Avenue South, #250, Minneapolis, MN 55407 MedicalResearch.com: What are the main findings of the study? Answer: Layperson "care guides" working in primary care offices can help chronic disease patients reach recommended care goals at a reasonable cost. (more…)