patient care

In this instructional video, Drs. Cynthia Armand and Elizabeth Loder discuss the clinical presentation and pathophysiology of migraine and treatment options for patients.

This video provides essential and useful information for any clinician caring for patients with this common condition. Newer acute and preventive therapies — including triptans, gepants, ditans, and injectable monoclonal antibodies — are discussed, as are the importance of a patient-centered approach and the need to tackle challenges of access to these newer agents.

Author/s:

Armand, C.E., Loder, E., Ropper, A. H.

Ten tips for advancing a culture of improvement in primary care

Brian Desmarais — Thu, 20 Jun 2019 13:12:16 +0000

Date Added:

June 20, 2019

Journal/Publication:

BMJ Quality and Safety

Publication Date:

October 31, 2018

URL:

Ten tips for advancing a culture of improvement in primary care

Type:

Practice Management Research Results

Format:

Article

DOI (1):

10.1136/bmjqs-2018-008451

Keywords

MeSH

Personal Satisfaction

Based upon their successful improvement efforts, this academic family practice identified 10 keys to success. James W. Mold, MD, MPH

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Embracing practice-based quality improvement (QI) represents one way for clinicians to improve the care they provide to patients while also improving their own professional satisfaction. But engaging in care redesign is challenging for clinicians. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. We reflect on our journey and offer 10 tipsto healthcare leaders seeking to advance a culture of improvement. Our organisation has developed a cadre of QI leaders, tracks a range of performance measures and has demonstrated sustained improvements in important areas of patient care. Success has required deep engagement with both patients and clinicians, a long-term vision, and requisite patience.

Author/s:

Kiran, T., 'Ramji, N.', Derocher, M.B., Girdhari, R., Davie, S., Lam-Antoniades M.

Screening for Pancreatic Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Tracy Ashby — Mon, 11 Feb 2019 06:00:00 +0000

Date Added:

February 11, 2019

Journal/Publication:

AHRQ Evidence Synthesis

Publisher:

U. S. Preventative Services Task Force

Publication Date:

February 1, 2019

Issue:

181

URL:

Screening for Pancreatic Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

The incidence of pancreatic cancer has been increasing significantly, possibly related to the increasing incidence of obesity. This is a summary of what was known about the risk factors and available screening tests as of 2015. The Abstract and pages 5-9 contain most of the useful information.

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Objective: We conducted a systematic evidence review to support the U.S. Preventive Services Task Force (USPSTF) in updating their recommendation on screening for pancreatic cancer. Our review addresses the following Key Questions (KQs):
1. Does screening for pancreatic adenocarcinoma improve cancer morbidity or mortality or all-cause mortality; and 1a) Does screening effectiveness vary by clinically relevant subpopulations (e.g., by age group, family history of pancreatic cancer, personal history of new-onset diabetes, or other risk factors)?
2. What is the diagnostic accuracy of screening tests for pancreatic adenocarcinoma?
3. What are the harms of screening for pancreatic adenocarcinoma?
4. Does treatment of screen-detected or asymptomatic pancreatic adenocarcinoma improve cancer mortality, all-cause mortality, or quality of life?
5. What are the harms of treatment of screen-detected pancreatic adenocarcinoma?
Data Sources: We searched Cochrane Central Register of Controlled Trials, Medline, and PubMed, and reference lists of relevant systematic reviews. We searched for articles published from 2002 to October 3, 2017, and updated our search on April 27, 2018. We also searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP), for relevant ongoing studies.
Study Selection: We reviewed 19,596 abstracts and 824 articles against specified inclusion criteria. Eligible studies included those written in English and conducted in adults age 18 years or older with or without risk factors for pancreatic cancer. For key questions on screening, we included imaging-based screening protocols. For key questions on treatment, we included studies of adults with screen-detected or asymptomatic pancreatic adenocarcinoma.

Data Analysis: We conducted dual, independent critical appraisal of all provisionally included studies and abstracted study details and results from fair- and good-quality studies. Because of the limited number of studies and the population heterogeneity, we provided a narrative synthesis of results and used summary tables to allow for comparisons across studies. After confirming that the yield of different imaging modalities was similar across studies, we calculated a pooled diagnostic yield across studies and produced forest plots to illustrate the range of effects seen across studies. For harms of screening (KQ3) and harms of treatment (KQ5), we stratified results by procedural and psychosocial harms.
Results: We included 13 unique prospective cohort screening studies (24 articles) reporting results for 1,317 people. Studies were conducted in the U.S., Canada, and Europe, and all screening populations except one small comparison group were exclusively in persons at elevated familial or genetic risk for pancreatic cancer. No studies reported on the effect of screening for pancreatic adenocarcinoma on cancer morbidity, mortality, or all-cause mortality (KQ1); and no studies reported on the effectiveness of treatment for screen-detected pancreatic adenocarcinoma (KQ4).

Thirteen fair quality studies reported on the diagnostic accuracy of screening tests for pancreatic adenocarcinoma (KQ2). Across these studies, 18 cases of pancreatic adenocarcinoma were detected.. Twelve of 18 cases (66.7%) were detected at stage I or II or classified as “resectable.” Pooled yield for all screening tests to detect pancreatic adenocarcinoma on initial screening in high-risk populations was 7.8 per 1000 (95% confidence interval, 3.6 to 14.7); and for total yield including both initial and repeat screening, it was 15.6 per 1000 (95% CI, 9.3 to 24.5).

Harms of screening for pancreatic adenocarcinoma
Procedural harms of screening were evaluated in eight screening studies (n=675); psychological harms were assessed in two studies (n=277). Details on the assessment of harms were variably reported. In two studies (n=277) in which 150 individuals received ERCP as a diagnostic followup test, 15 people (10%) reported acute pancreatitis, nine of which required hospitalization. No evidence of increased worry, distress, depression, or anxiety after screening was reported, compared to before screening.

Harms of treatment of screen-detected pancreatic adenocarcinoma
Of the 57 people who underwent surgery across all studies, six studies (n=32 people receiving surgery) assessed harms of treatment of screen-detected pancreatic adenocarcinoma (KQ5), with 7 harms detected in two studies. Methods of assessing harms were variably reported. Harms included one person experiencing stricture to the hepaticojejunal anastomosis at 11 months after surgery, one with unspecified post-operative complications, 2 with post-operative fistula and 3 cases of diabetes. In the two studies that systematically assessed harms in all surgical patients (n=12 people receiving surgery), no harms were reported.

Limitations: No randomized trials of screening were identified. The body of evidence includes observational screening studies with limited sample sizes and focused on populations with known familial risk, many with a substantial proportion of people with known genetic mutations. No studies included a clinical followup or unscreened comparison group, limiting assessment of diagnostic accuracy. Of those studies that reported harms of screening or treatment, limitations included inadequate description of the methods of assessing harms, including whether all participants were systematically assessed.

Conclusions: Imaging-based screening in groups at high familial risk can detect pancreatic adenocarcinoma with limited evidence of minimal harms. However, the clinical impact of screening is not well documented. There is insufficient evidence to assess benefits or harms of surgical intervention for screen-detected pancreatic adenocarcinoma.

Author/s:

Henrikson, Nora B., Bowles, Erin J. Aiello, Blasi, Paula R., Morrison, Caitlin C., Nguyen, Matt, Pillarisetty, Venu G., Lin, Jennifer S.

Guide to Enhancing Referrals and Consultations Between Physicians

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

Date Added:

February 1, 2019

Publisher:

The College of Family Physicians of Canada

Publication Date:

October 1, 2009

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

referral and consultation

patient care

physicians

MeSH

physicians, family

referral and consultation

patient care

This is a summary of consultation and referral best practices from the College of Family Physicians of Canada.

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Access to care is a challenge for many of our patients. The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (Royal College) recognize that every possible measure must be taken to help ensure access to timely and quality medical and other health care service.
As part of ongoing efforts, the CFPC and the Royal College released a conjoint paper in 2006, to address the issue of intra-professional relationships between physiciansi. This paper identifies a number of issues and recommendations to improve patient care and professional satisfaction. The referral-consultation process is chief among the areas addressed in follow up to this conjoint paper.
There is growing knowledge and many new approaches developing in various regions of the country to improve the referral-consultation processes of care between referring and consulting physicians.
This guide on enhancing referrals and consultations between physicians is not intended to replace instruments already in place. It is complementary and may also help fill gaps where there are few or no tools in place to support good referrals and consultations, both within as well as between community and hospital settings. It is hoped that physicians will find this reference to be a valuable addition to practice.

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Tracy Ashby — Fri, 07 Dec 2018 06:00:00 +0000

Date Added:

December 7, 2018

Journal/Publication:

AHRQ Comparative Effectiveness Reviews

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

February 16, 2016

URL:

Pharmacotherapy for Adults With Alcohol Use Disorder (AUD) in Outpatient Settings

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

alcohol use disorder

pharmacotherapy

patient care

PMID (1):

26937549

MeSH

alcoholism

caregivers

decision making

This is a summary of the current evidence on medication-assisted treatment of alcohol use disorder.

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Focus of This Summary

This is a summary of a systematic review evaluating the evidence regarding the efficacy, comparative effectiveness, and adverse effects of medications in adults with alcohol use disorder (AUD). The systematic review included 167 articles reporting on 135 eligible studies published from January 1, 1970, to October 11, 2013. This summary is provided to inform discussions with patients and/or caregivers of treatment options and to assist in decisionmaking along with consideration of a patient's values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Author/s:

John M. Eisenberg Center for Clinical Decisions and Communications Science

Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care

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

Date Added:

November 2, 2018

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

October 1, 2018

URL:

Six Building Blocks

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

This is an opportunity for your practice to earn $2,500 for participating in a project to improve management of opioids.

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Most patients taking opioids for chronic pain are managed by primary care providers and their staff. Many practices are looking for help in managing their patients using chronic opioid therapy. To meet this need, AHRQ funded the Six Building Blocks project through grant number R18HS0237850. Additional funding was provided by Washington State Department of Health subcontract (HED23124) of Cooperative U17CE002734, funded by the Centers for Disease Control and Prevention.