Primary Care Practice Interventions Helped Maintain Adherence to Opioid Prescription Guidelines

MedicalResearch.com Interview with:

Jane M. Liebschutz, MD, MPH Associate Professor of Medicine Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts

Dr. Liebschutz

Jane M. Liebschutz, MD, MPH
Associate Professor of Medicine
Section of General Internal Medicine
Boston University School of Medicine
Boston, Massachusetts

MedicalResearch.com: What is the background for this study?

Response: The number of patients receiving opioids for chronic pain has risen over the past 2 decades in the US, in parallel with an increase in opioid use disorder. The CDC and professional medical societies have created clinical guidelines to improve the safety of opioid prescribing, yet individual prescribers can find them onerous to implement.

We developed an intervention to change clinical practice to support primary care physicians who prescribe the majority of opioids for chronic pain. The intervention included 4 elements- a nurse care manager to help assess, educate and monitor patients, an electronic registry to keep track of patient data and produce physician level reports, an individualized educational session for the physician by an opioid prescribing expert based on the physician-specific practice information and online resources to help with decision-making for opioid prescribing (www.mytopcare.org). We tested whether the intervention would improve adherence to guidelines, decrease opioid doses and decrease early refills, as a marker of potential prescription opioid misuse among 985 patients of 53 primary care clinicians in four primary care practices.

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American Academy of Family Physicians Foundation Launches Highlight on VACCINATIONS 4 TEENS to Help Address Teen Under-Vaccination

 

MedicalResearch.com Interview with:

Hughes Melton, MD, MBA, FAAFP AAFP Foundation president

Dr. Melton

S. Hughes Melton, MD, MBA, FAAFP
AAFP Foundation president

MedicalResearch: What is the background for this initiative? What are the main vaccinations that teens should have?

 Response: The Centers for Disease Control and Prevention (CDC) recommends adolescents receive four immunizations – two of which are administered as multi-dose series – to help protect against meningococcal meningitis caused by serogroups A, C, W and Y; human papillomavirus (HPV); tetanus, diphtheria and pertussis (Tdap); and influenza (flu).1 Despite these recommendations, millions of teens remain vulnerable to serious infectious disease.2,3

Family physicians are well equipped to immunize their patients against a host of common infectious diseases and improve public health. However, discussing teen vaccinations during annual appointments may present challenges due to other issues teens and their parents/guardians may be focused on at this age. The American Academy of Family Physicians Foundation (AAFP Foundation) launched Highlight on VACCINATIONS 4 TEENS to help remind family physicians and their care teams to make immunization a priority at these key appointments for teens.

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Why Is It So Hard To Attract and Retain Rural Primary Care Physicians?

MedicalResearch.com Interview with:

Matthew R. McGrail, PhD Monash University School of Rural Health Churchill, Victoria Australia

Dr. McGrail

Matthew R. McGrail, PhD
Monash University
School of Rural Health
Churchill, Victoria Australia

MedicalResearch.com: What is the background for this study?

Response: Rural populations continue to experience relative shortages of the supply of primary care physicians, with associated links to poorer health. Although considerable research has identified factors that facilitate or impede supply of physicians in rural areas, macro-level empirical evidence of observed rural mobility of physicians – notably, which are more likely to move and why – is limited.

Improved understanding of mobility and nonretention of rural physicians is important because of its impact on training and workforce policy, and resultant physician supply to both the origin area (ie, the location from which the physician moved) and to the destination area (ie, the location to which the physician has moved). The cost of mobility and staff turnover can be large, both in direct costs but also in terms of service quality and continuity to the community.

In our study, we aimed to describe the geographic mobility patterns of rural primary care physicians. This evidence will provide stronger understanding of the factors behind the observed mobility and nonretention of rural primary care physicians.

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May Be No Benefit To Statins For Primary Prevention in Older Adults

MedicalResearch.com Interview with:
Benjamin Han, MD, MPH
Assistant professor
Departments of Medicine-Division of Geriatric Medicine and Palliative Care, and Population Health
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are an increasing number of older adults being prescribed statins for primary prevention, but the evidence for the benefit for older adults is unclear.

Our study finds that in the ALLHAT-LLT clinical trial, there were no benefits in either all-cause mortality or cardiovascular outcomes for older adults who did not have any evidence of cardiovascular disease at baseline.

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Age-related Macular Degeneration Underdiagnosed in Primary Care

MedicalResearch.com Interview with:

David C Neely, MD The University of Alabama at Birmingham

Dr. Neely

David C Neely, MD
The University of Alabama at Birmingham

MedicalResearch.com: What is the background for this study? What are the main
findings?

Response: This study examined the prevalence of eyes with age-related macular degeneration (AMD) in patients seen in primary eye care clinics who purportedly have normal macular health.

Approximately 25.0% of eyes deemed to be normal based on dilated eye examination by primary eye care providers had macular characteristics that indicated age-related macular degeneration. Continue reading

Hospital Based Primary Care Practices Provide More Low Value Services

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Assistant Professor of Medicine Division of General Internal Medicine and Health Services Research UCLA David Geffen School of Medicine Los Angeles, CA 90024 Affiliated Natural Scientist in Health Policy RAND Corporation 1776 Main St, Santa Monica, CA 90401

Dr. John Mafi

John N. Mafi, MD, MPH
Assistant Professor of Medicine
Division of General Internal Medicine and Health Services Research
UCLA David Geffen School of Medicine
Los Angeles, CA 90024
Affiliated Natural Scientist in Health Policy
RAND Corporation
1776 Main St, Santa Monica, CA 90401

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Between 10-30% of healthcare costs are due to low value care, or patient care that provides little to no benefit to patients, and can sometimes cause harm (e.g., radiation exposure from diagnostic imaging tests). In this study, we found that hospital-based primary care practice provide more low value care than community-based primary care practices across the United States. Understanding where and why low value care occurs is going to be essential if we want to get serious about eliminating it.

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Short Interventions By Primary Care Physicians Can Help Patients Lose Weight

MedicalResearch.com Interview with:

Paul Aveyard PhD MRCP FRCGP FFPH Professor of Behavioural Medicine Nuffield Department of Primary Care Health Sciences University of Oxford Radcliffe Primary Care Building Radcliffe Observatory Quarter Oxford

Prof. Paul Aveyard

Paul Aveyard PhD MRCP FRCGP FFPH
Professor of Behavioural Medicine
Nuffield Department of Primary Care Health Sciences
University of Oxford
Radcliffe Primary Care Building
Radcliffe Observatory Quarter
Oxford

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that opportunistic brief interventions by physicians can be effective, but there is no evidence that they are so for obesity. Physicians worry that broaching this topic will be offensive, time-consuming, and ineffective. We needed a randomised trial to assess whether physicians’ fears were justified, or in fact brief interventions could be as effective for patients who are overweight as they are for smoking or problem drinking and that’s what we did.

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US Task Force Recommends Primary Care Interventions to Support Breastfeeding

MedicalResearch.com Interview with:

Ann Kurth, Ph.D., C.N.M., R.N. USPSTF Task Force member Dean of the Yale School of Nursing

Dr. Ann Kurth

Ann Kurth, Ph.D., C.N.M., R.N.
USPSTF Task Force member
Dean of the Yale School of Nursing

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Breastfeeding is beneficial for both mothers and their babies, with the evidence showing that babies who are breastfed are less likely to get infections such as ear infections, or to develop chronic conditions such as asthma, obesity, and diabetes. For mothers, breastfeeding is associated with a lower risk for breast and ovarian cancer and type 2 diabetes. While breastfeeding rates have been rising in recent decades—with 80 percent of women starting to breastfeed and just over half still doing so at six months—they are still lower than the Healthy People 2020 targets and the Task Force wanted to review the latest evidence around how clinicians can best support breastfeeding.”

After balancing the potential benefits and harms, the Task Force found sufficient evidence to continue to recommend interventions during pregnancy and after birth to support breastfeeding. This recommendation includes the same types of interventions the Task Force recommended in 2008, such as education about the benefits of breastfeeding, guidance and encouragement, and practical help for how to breastfeed.

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Chronic Kidney Disease in Primary Care: Outcomes after Five Years in a Prospective Cohort Study

MedicalResearch.com Interview with:
Dr. Adam Shardlow

Derby Teaching Hospitals NHS Foundation Trust
UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Chronic Kidney Disease (CKD) is common in the general population, and many people are managed in primary care rather than by specialist nephrologists. This study was designed to investigate 5 year outcomes in people with mild to moderate CKD (CKD stage 3).

The main findings were that the majority of participants were stable, and progression to end stage renal disease was a rarity. Interestingly, and contrary to common thinking about CKD, we found that a significant minority no longer had evidence of CKD stage 3 at 5 years, which we have termed ‘CKD remission’.

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Targeted Case Finding Through EHR Starts More High Risk Patients On Treatment

MedicalResearch.com Interview with:

Tom Marshall, PhD, MRCGP, FFPH Professor of public health and primary care Institute of Applied Health Research University of Birmingham Edgbaston, Birmingham

Prof. Tom Marshall

Tom Marshall, PhD, MRCGP, FFPH
Professor of public health and primary care
Institute of Applied Health Research
University of Birmingham
Edgbaston, Birmingham

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Shortly before the Health Checks programme began, a programme of targeted case finding was set up in Sandwell in the West Midlands. In general practices in the area a programme nurse searched electronic medical records to identify untreated patients at high risk of cardiovascular disease. The nurse then invited high risk patients for assessment in the practice and those who needed treatment were referred to their GP for further action.

This was implemented in stages across 26 general practices, allowing it to be evaluated as a stepped wedge randomised controlled trial. The programme was successful, resulting in a 15.5% increase in the number of untreated high risk patients started on either antihypertensives or statins.

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