US asthma prevalence increased by five million in the last decade and health care spending for the disease increased from $53 billion to $56 billion. Children are more likely than adults to have an asthma attack and its estimated that 1-in-10 youth has asthma. Despite initiatives to promote adherence to practice guidelines, childhood asthma emergency room) visits, and hospitalizations remain steady while the number of asthma deaths have increased over a 17-year period. Preliminary studies find the majority of adolescents prefer smartphones as a means of education and guidance. A modified Technology Acceptance Model (TAM) survey was comprised of 15 statements that explored providers' acceptance of smartphone applications (apps) as an adjunct strategy for management of asthma among adolescents in the outpatient setting. Current insight in adolescent asthma demonstrates multifaceted disparities in care stemming from biological and developmental transitions unique to adolescents. The quantitative, descriptive design of the project assessed two factors integral to the TAM related to provider acceptance and perception: 1) Perceived use (PU), and 2) Perceived ease of use (PEU). The survey sample consisted of 18 providers. Overwhelmingly, the majority of providers surveyed favored use of a smartphone app for adolescent asthma and believed apps had the potential to improve the quality of adolescent asthma management. Most participants agreed; smartphone apps might help accomplish benchmarks for adolescent asthma management. Numerous studies demonstrate adolescents’ preference for technological interventions for self-management of their asthma symptoms. The survey results reinforce the willingness of providers to accept asthma smartphone apps as a potential adjunct management strategy for adolescent asthma. Additional studies involving providers are required to further explore provider attitudes of acceptance and rejection relating to smartphone apps for chronic health conditions.

Purpose: The United State health system is fractionated: most patients travel from location to location to see various clinicians about specific aspects of their health. The poor outcomes and high cost we currently see in the United States health system has challenged clinicians to explore better processes. This study sought to identify the potential impact of utilizing interprofessional transitional care (IPTC) teams in the primary care setting following hospitalization. One outcome measured was the relationship between pharmacist’s participation and number of medications a patient was taking after their IPTC visit. Electronic Health Records were utilized to extract patient data and it was analyzed using SPSS and R programming to examine relationships between patient populations, disease states, number of medications, and pharmacist intervention. This study was conducted as part of an overall investigation into benefits of IPTC teams in Primary Care. We expect that the number of the medications to be reduced for patients that had a pharmacist involved in their transitional care visit.

Bakgrund Världshälsoorganisationen (WHO) klassar våld i nära relationer som ett folkhälsoproblem. Även om både män och kvinnor är utsatta så är det främst kvinnor som utsätts för den här typen av våld och enligt Nationellt centrum för kvinnofrid (NCK) är kvinnor nästan tre gånger mer utsatta än män. Hälso- och sjukvården behöver utveckla sitt arbete för att upptäcka våldsutsatta patienter men det finns begränsad forskning om hur fysioterapeuter arbetar med detta ämne. Syfte Att utforska fysioterapeuters upplevelser och erfarenheter av att möta kvinnor som blivit utsatta för våld i nära relation. Metod I studien användes en kvalitativ design med en semistrukturerad intervjuguide. Sex fysioterapeuter, som samtliga arbetade på antingen privat eller offentlig vårdcentral inom primärvården i Region Uppsala, intervjuades. Resultat Deltagarnas erfarenheter varierade i stor grad. Ingen av deltagarna ställde frågan om våldsutsatthet som en standardiserad fråga vid nybesök. Tvärtom uttryckte flera att de upplevde sig behöva skapa en relation med patienten innan de kunde ställa frågan. Deltagarna tog till olika åtgärder vid våldsutsatthet, framförallt hänvisade de vidare till kurator och/eller gav vidare information om kvinnofridslinjen. Samtliga upplevde ett behov av djupare kunskap och förståelse om ämnet. Konklusion Mer praktisk och teoretisk kunskap samt medvetenhet hos fysioterapeuter behövs för att de ska kunna arbeta mer effektivt med kvinnor som utsätts för våld i nära relation. / Background The World Health Organization (WHO) classifies intimate partner violence as a global health problem. Even if both men and women are affected, data from National Centre for Knowledge on Men’s Violence against Women (NCK) shows that almost three times more women than men have been affected. The Swedish health care needs to improve on how they work on finding these patients but there is little research of how physiotherapists work regarding this matter. Objective To explore how physiotherapists investigate and examine female patients who are or have been a victim of intimate partner violence. Methods This survey used a qualitative method with a semi structured interview guide. Six interviews were carried through with physiotherapists who worked in Uppsala’s primary care, either in public or private health centers. Results The survey showed various experiences within the partakers. None of the physiotherapists asked about intimate partner violence as a standardized question at all new visits. On the contrary, several informants expressed that they felt a need to create a relationship with the patients before asking such questions. The physiotherapist took different actions when detecting intimate partner violence; mainly referring the patients to a curator and/or giving information of the women’s peace line. All partakers felt the need of a deeper knowledge and understanding of this issue. Conclusion Physiotherapists need more awareness as well as practical and theoretical knowledge to be able to work more efficiently with women that are affected by intimate partner violence.

Retail clinics are walk-in clinics designed for convenience and for servicing minor health issues and certain acute conditions. The model began as a way of bringing both convenience and care to areas that have lower levels of access to primary care resources. With the implementation of Affordable Care Act (ACA) in March 2010, populations that were previously uninsured were now required to have access to some level of health insurance. These populations presented a potential new market for retail clinics. This research shows that post implementation of the ACA, retail clinics tend to locate in areas with higher incomes and, generally, greater access to primary care.

Skin cancer rates continue to rise affecting millions of individuals annually. While cutaneous malignant melanoma comprises a fraction of total skin cancers diagnosed, melanoma is associated with a poor prognosis and higher mortality rate when compared to other forms of skin cancer. The greatest risk factor for skin cancer is the amount of ultraviolet light exposure making skin cancer the most common preventable form of cancer. In conjunction with primary prevention, part of secondary prevention measures involves performing routine skin examinations. According to data from the National Health Interview Survey, only 8% of individuals who had seen a primary care provider in the previous 12 months had a skin examination performed (Johnson et al., 2017). A low rate of skin examination can largely be attributed to current professional guidelines from the United States Preventative Services Task Force (2016) not supporting routine skin screening of all patients. Despite the recommendation, primary care providers are consistently faced with the need to evaluate skin lesions. Other barriers identified include lack of training and practical screening methods. Dermoscopy is a noninvasive technique for identifying skin lesions. Based on the need for improved screening practices and identified barriers, a brief educational session and resource on skin cancer and dermoscopy was presented to primary care providers at an urban family practice clinic in eastern North Dakota. Following the educational session, a three-month implementation period provided time for providers to implement their knowledge and dermoscopy skills in practice. The purpose of the project was to increase knowledge, improve accuracy of identifying skin lesions, and increase provider confidence using dermoscopy. Evaluation using a pre-implementation survey of providers in the clinic found the primary care providers felt comfortable with their baseline knowledge of skin cancer but did not feel confident in their ability to use a dermoscope. Most of the participating providers deemed their level of knowledge regarding dermoscopy to be at a novice level. Results of the post-implementation found providers felt more comfortable using dermoscopy and knowledge in dermoscopy overall improved from novice to advanced beginner or competent.

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Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

Continuity of Care has long been known to be of critical importance in primary care and is a major component in the Patient Centered Medical Home. With the increasing importance of scheduling availability and Patient Centered Medical Home access requirements, it is important to determine to what degree patients are able to schedule appointments with Primary Care Providers (PCPs) - Family Physicians and Nurse Practioners - and what moveable barriers restrict access. Objectives: 1. Determine the frequency appointments are initially scheduled with Primary Care Provider. 2. Determine any systematic difference for patients unable to schedule with identified Primary Care Provider. 3. Use the findings of the study to plan a future intervention to increase access to PCPs. Human Subjects Review: Database analysis only, not considered human subjects research. Design: Clinic Electronic Health Record (EHR) review. Setting: appointments made in four rural South-Central Appalachian primary care clinics. Patients or Other Participants: all appointments recorded in clinic EHR databases for 2010 and 2011. Intervention/Instrument: database analysis from eClinical works, AllScripts, and Centricity EHRs. Outcome Measures: Summary assessment of Primary Care Provider accessibility. Anticipated Results: 1. It is expected that the frequency of appointments initially scheduled with PCP will be under 60% based upon preliminary data from one clinic. 2. It is anticipated that patients may have been unable to schedule with a PCP because appointments were not available or because there was no PCP identified. 3. Identification of systematic barriers to Primary Care Provider Access in order to improve same day appointment availability. Conclusions- An accurate picture of ability to schedule appointments with Primary Care Providers would be useful in ensuring continuity of care and success of a Patient Centered Medical Home.

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No description available.