primary care

I thoughtful, evidence-based set of recommendations for improving the care of patients with depression in primary care settings. James W. Mold, MD, MPH

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In this Viewpoint, we respond to the 2022 Lancet–World Psychiatric Association Commission’s call for united action on depression. We present primary care-focused recommendations synthesised from key outcomes of 16 observational cohorts of adults with depression in primary care, representing more than 26 000 individuals from 26 countries. Identified areas for action included prediction of the depression severity trajectory, the complexity of the depressive experience, and the need for tailored yet holistic depression-care plans. Personal resilience and reductions in social burden were identified as powerful predictors of improved depression outcomes. Aimed at policy makers in primary care, researchers, and primary care providers, our recommendations emphasise a generalist model of care that is person focused and trauma informed. We advocate for increased primary care capacity for depression risk prediction, social support integration, care navigation, and continuity of care. By bridging the gap between primary care and psychiatric knowledge, our recommendations provide actionable guidance for reducing the global burden of depression.

Author/s:

Alison Flehr, Christopher Dowrick, Catherine Kaylor-Hughes, Jane Gunn

How can healthcare professionals provide guidance and support to parents of adolescents? Results from a primary care-based study

Bethie Seay — Thu, 08 Jul 2021 05:00:00 +0000

Date Added:

July 8, 2021

Type:

Clinical Research Results

DOI (1):

10.1186/s12913-021-06200-1

PMID (1):

33743664

MeSH

delivery of health care

health personnel

Humans

Parenting

A list of topics parents of adolescents hope their primary care clinicians will discuss with their child.

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Background: This study explored the rewards and difficulties of raising an adolescent and investigated parents' level of interest in receiving guidance from healthcare providers on parenting and adolescent health topics. Additionally, this study investigated whether parents were interested in parenting programs in primary care and explored methods in which parents want to receive guidance.

Methods: Parents of adolescents (ages 12-18) who attended an outpatient pediatric clinic with their adolescent were contacted by telephone and completed a short telephone survey. Parents were asked open-ended questions regarding the rewards and difficulties of parenting and rated how important it was to receive guidance from a healthcare provider on certain parenting and health topics. Additionally, parents reported their level of interest in a parenting program in primary care and rated how they would like to receive guidance.

Results: Our final sample included 104 parents, 87% of whom were interested in a parenting program within primary care. A variety of parenting rewards and difficulties were associated with raising an adolescent. From the list of parenting topics, communication was rated very important to receive guidance on (65%), followed by conflict management (50%). Of health topics, parents were primarily interested in receiving guidance on sex (77%), mental health (75%), and alcohol and drugs (74%). Parents in the study wanted to receive guidance from a pediatrician or through written literature.

Conclusions: The current study finds that parents identify several rewarding and difficult aspects associated with raising an adolescent and are open to receiving guidance on a range of parenting topics in a variety of formats through primary care settings. Incorporating such education into healthcare visits could improve parents' knowledge. Healthcare providers are encouraged to consider how best to provide parenting support during this important developmental time period.

Keywords: Adolescents; Parenting support; Parents; Primary care.

Author/s:

Jones, L. D., Grout, R. W., Gilbert, A. L., Wilkinson, T. A., Garbuz, T., Downs, S. M., Aalsma, M. C.

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Devin Evans — Wed, 24 Feb 2021 06:00:00 +0000

Date Added:

February 24, 2021

Journal/Publication:

Journal of the American Medical Association Network Open

Publication Date:

February 1, 2021

Issue:

Volume:

URL:

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.37371

Keywords

PMID (1):

33591367

MeSH

Patients with acute low back pain are more likely to progress to chronic low back pain if they are prescribed opioids or referred for imaging studies or subspecialists (after controlling for other risk factors). James W. Mold, MD, MPH

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Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP.

Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care.

Design, setting, and participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020.

Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral).

Main outcomes and measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records.

Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001).

Conclusions and relevance: In this cohort study, the transition rate to chronic LBP was substantial

Author/s:

Stevans, Joel M., Delitto, Anthony, Khoja, Samannaaz, Patterson, Charity G., Smith, Clair N., Schneider, Michael J., Freburger, Janet K., Greco, Carol M., Freel, Jennifer A., Sowa, Gwendolyn A., Wasan, Ajay D., Brennan, Gerard P., Hunter, Stephen J., Minick, Kate I., Wegener, Stephen T., Ephraim, Patti L., Friedman, Michael", Jason M., Robert B.

APOE ɛ4 Allele Testing and Risk of Alzheimer Disease

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

The Journal of the American Medical Association

Publication Date:

January 14, 2021

URL:

APOE ɛ4 Allele Testing and Risk of Alzheimer Disease

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1001/jama.2020.15085

Keywords

PMID (1):

33443531

MeSH

A brief review of the interpretation of APOE tests for diagnosing and predicting dementia of the Alzheimer’s type. James W. Mold, MD, MPH

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A 64-year-old man presented with concern about an abnormal genetic test result for apolipoprotein E (APOE) obtained through his primary care physician. He reported forgetfulness and word-finding difficulties for 3 years but performed all activities of daily living independently and was generally healthy. His father and maternal great aunt developed dementia in their 70s. Physical (including neurologic) examination, basic laboratory studies, and brain magnetic resonance imaging results were normal. The Short Test of Mental Status (STMS) score was 33 (maximal attainable score of 38 indicates best performance). Neuropsychological assessment showed average to above-average performance in all cognitive domains, accounting for age and education. Results of his genetic testing for APOE were reported as follows: “This individual possesses an apolipoprotein E genotype (3 and 4) that indicates, with high specificity, that Alzheimer’s disease is the cause of or a contributor to the observed dementia.”

Author/s:

Choudhury, Parichita, Ramanan, Vijay K., Boeve, Bradley F.

Patient Education Resources at FamilyDoctor.org

Tracy Ashby — Fri, 01 Feb 2019 06:00:00 +0000

Date Added:

February 1, 2019

Publisher:

American Academy of Family Physicians

URL:

Patient Education Resources at FamilyDoctor.org

Type:

Patient Education Materials

Format:

Web Page

Keywords

MeSH

education of patients

primary care

A great set of patient education materials relevant to primary care.

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Familydoctor.org is the AAFP’s award-winning consumer website, featuring physician-reviewed patient education materials.

Partnering to Catalyze Comprehensive Community Wellness

Tracy Ashby — Fri, 02 Nov 2018 05:00:00 +0000

Date Added:

November 2, 2018

Publisher:

Public Health Leadership Forum

URL:

Partnering to Catalyze Comprehensive Community Wellness

Type:

Public Health Announcements

Format:

Article

Keywords

MeSH

This may be an opportunity to help bridge the gap between primary care and public health in Oklahoma

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The Public Health Leadership Forum (PHLF) at RESOLVE teamed with the Health Care Transformation Task Force (HCTTF) to develop a framework that supports enhanced collaboration between health care and public health entities. Join a webinar on November 27th at 1pm CST to learn more about essential elements of the framework: Partnering to Catalyze Comprehensive Community Wellness: An Actionable Framework for Health Care and Public Health Collaboration. Register here

Author/s:

Gerd, Dilley, Abby, Katie, Hines, Mason, Heise, Georgia, Im, Ji, Kaiman, Sherry, Levi, Jeffrey, Moerhle, Carole, Pierce-Wrobel, Clare, Schoof, Bellinda, Wiesman, John, Fraser, Michael

Approaches to Behavioral Health Integration at High Performing Primary Care Practices

Jeffrey Wilson — Wed, 03 Oct 2018 16:11:10 +0000

Date Added:

October 3, 2018

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

September 1, 2018

Issue:

Volume:

Pages:

691-701

URL:

Approaches to Behavioral Health Integration at High Performing Primary Care Practices

Format:

Article

DOI (1):

10.3122/jabfm.2018.05.170468

Keywords

behavioral medicine

primary care

PMID (1):

30201665

MeSH

behavioral medicine

primary care

Integration of behavioral health and primary care can be extremely helpful to both patients and clinicians. This article summarizes lessons learned from those who have accomplished it.

INTRODUCTION:

Behavioral health (BH) integration has been proposed as an important strategy to help primary care practices meet the needs of their patient population, but there is little research on the ways in which practices are integrating BH services. This article describes the goals for BH integration at 30 high-performing primary care practices and strategies to operationalize these goals.

METHODS:

We conducted a qualitative analysis of BH integration at 30 US primary care practices that had been selected for the Learning from Effective Ambulatory Practices (LEAP) project following an interview-based assessment and rating process. Data collection included formal and informal interviews with practice leaders and staff, as well as observations of clinical encounters. We used a template analysis approach to thematically analyze data.

RESULTS:

Most LEAP practices looked to BH integration to help them provide timely BH care for all patients, share the work of providing BH-related care, meet the full spectrum of patient needs, and improve the capacity and functioning of care teams. Practices operationalized these goals in various ways, including universal BH screening and involving BH specialists in chronic illness care. As they worked toward their BH integration goals, LEAP practices faced common challenges related to staffing, health information technology, funding, and community resources.

DISCUSSION:

High-performing primary care practices share common goals for BH integration, as well as common challenges operationalizing these goals. As US residents increasingly receive BH services in primary care, it is critical to remove barriers to BH integration and support primary care practices in meeting a full spectrum of patient needs.

Author/s:

Blasi, Paula R., Cromp, DeAnn, McDonald, Sarah, Hsu, Clarissa, Coleman, Katie, Flinter, Margaret, Wagner, Edward H.

From Our Practices to Yours: Key Messages for the Journey to Integrated Behavioral Health

Jeffrey Wilson — Wed, 03 Oct 2018 16:07:08 +0000

Date Added:

October 3, 2018

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

January 1, 2017

Issue:

Volume:

Pages:

25-34

URL:

From Our Practices to Yours: Key Messages for the Journey to Integrated Behavioral Health

Type:

Practice Management Research Results

Format:

Article

DOI (1):

10.3122/jabfm.2017.01.160100

Keywords

behavioral medicine

primary care

PMID (1):

28062814

MeSH

behavioral medicine

primary care

Integration of behavioral health and primary care can be extremely helpful to both patients and clinicians. This article summarizes lessons learned from those who have accomplished it.

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BACKGROUND:

The historic, cultural separation of primary care and behavioral health has caused the spread of integrated care to lag behind other practice transformation efforts. The Advancing Care Together study was a 3-year evaluation of how practices implemented integrated care in their local contexts; at its culmination, practice leaders ("innovators") identified lessons learned to pass on to others.

METHODS:

Individual feedback from innovators, key messages created by workgroups of innovators and the study team, and a synthesis of key messages from a facilitated discussion were analyzed for themes via immersion/crystallization.

RESULTS:

Five key themes were captured: (1) frame integrated care as a necessary paradigm shift to patient-centered, whole-person health care; (2) initialize: define relationships and protocols up-front, understanding they will evolve; (3) build inclusive, empowered teams to provide the foundation for integration; (4) develop a change management strategy of continuous evaluation and course-correction; and (5) use targeted data collection pertinent to integrated care to drive improvement and impart accountability.

CONCLUSION:

Innovators integrating primary care and behavioral health discerned key messages from their practical experience that they felt were worth sharing with others. Their messages present insight into the challenges unique to integrating care beyond other practice transformation efforts.

Author/s:

Gold, Stephanie B., Green, Larry A., Peek, C.J.