Brief Psychotherapy in Primary Care

Overview Overview Case Thread Goals Acknowledgement Rationale Background ‘theory’ Framework(s) Practical application

Improving the Implementation of Home Blood Pressure Monitoring

Introduction: Home blood pressure monitoring (HBPM) has been shown to outperform traditional office readings in its association with cardiovascular disease (CVD) risk and ability to identify patients with white coat or masked hypertension. For these reasons, the 2017 ACC/AHA Guidelines included HBPM as part of its recommendations for hypertension management. Our project focused on improving the implementation of HBPM in an urban primary care practice with an end goal of increasing the number of patients that actively use home blood pressure cuffs and have access to them for future telemedicine visits. Methods: A patient outreach process to increase HBPM uptake and improve hypertension control was developed and evaluated using a remote PDSA cycle approach. Outreach candidates consisted of Jefferson Family Medicine Associates (JFMA) patients ages 16-85 with active hypertension diagnoses who were insured by Keystone First or Keystone VIP. Candidates received an automated blood pressure cuff that was able to transmit home readings to their electronic medical record (EMR) in real time. Outcome and process measures were calculated using demographic and blood pressure data stored in each patient’s EMR. Results: The first wave of outreach produced 54 patient recruits from 253 attempts (21.3%) with 24 patients being full participants, defined as reporting 10 or more HBPM readings. Patient recruits were predominantly black (79.6%), female (66.7%), and ages 45 – 64 (55.5%). Patient recruits aged 65 and older had the highest rate of full participation (83.3%) followed by ages 30 – 49 (63.2%), 50 – 64 (25.0%), and 16 – 29 (20.0%). Rates for non-participation, defined as no HBPM reading recorded, among men and women were 27.8% and 33.3%, respectively. Conclusion: Analysis of the first patient outreach PDSA cycle revealed differences in full-participation based on age and sex. Future PDSA cycles will focus on improving follow-up efforts with patient groups that have lower rates of full-participation. This project was limited to patients insured by Keystone First or Keystone VIP due to their eligibility for low-cost HBPM coverage

Improving Blood Pressure Control Through Blood Pressure Measurement in an Ambulatory Urban Family Medicine Clinic

Aim Statement: To increase the percentage of patients over the age of 18 with BP controlled to a goal of \u3c140/90 from a baseline of 58% to 68% by April 2020

Identifying Barriers to Statin Therapy in Diabetic Patients in a Large Ambulatory Practice

Aim 1: To understand the root cause(s) for gaps in statin therapy within a large ambulatory care practice. Aim 2: To improve provider awareness of indications for statin therapy, as recommended by the ACC/AHA guidelines. Aim 3: To increase the proportion of patients with diabetes at our practice that are on statin therapy

A video-based educational intervention for providers regarding colorectal cancer screening

Methods: Email sent to providers asking them to complete a 7 question survey regarding knowledge and self-reported comfort in screening for colorectal cancer using a shared decision-making approach.https://jdc.jefferson.edu/patientsafetyposters/1045/thumbnail.jp

Primary Care Physicians’ Experience and Confidence with Genetic Testing and Perceived Barriers to Genomic Medicine

Purpose: Genetic testing is progressing towards use of patients’ genomes for personalized medicine. Primary care physicians (PCPs) may use genetic tests to screen and assess risk. However, PCPs’ current preparedness for the expanding integration of genetics into practice is uncharacterized. We examined primary care physicians’ perceptions of and experience with genetic testing. Methods: An anonymous survey was mailed to PCPs across three regional health networks querying opinions of, experience with, confidence in, and perceived barriers to genetic testing. Results: The survey response rate was 37.8%. Respondents believed learning about new genetic advances was important to clinical practice (67.0%). A minority (19.0%) had ordered genetic testing in six months, with cancer risk testing the most frequently ordered. Respondents were not confident in the skills required for using genetic testing in practice. Few respondents felt that they had time to counsel about genetic risk (9.5%) or that most patients could comprehend the concept of risk (27.0%). Conclusions: Primary care physicians had a high opinion of using genetic testing in medicine, but reported little experience or confidence incorporating genetic testing into practice. A majority perceived time constraints and patient comprehension as barriers. These data demonstrate a need for genetics educational resources for physicians and patients

Implementation of Technology-based Patient Engagement Strategies within Practice-Based Research Networks (Poster)

Careyva, B. Shaak, K. Mills, G. Johnson, M. Goodrich, S. Stello, B. Wallace, L. (2016, Nov). Implementation of Technology-Based Patient Engagement Strategies within Practice-Based Research Networks. Poster Presented at: North American Primary Care Research Group, Colorado Springs, CO

The Fisheries Co-Management Guidebook: Emerging research for the effective management of small-scale fisheries

Small-scale fisheries account for 40% of global fish catch and employ more than 90% of the world’s fishers, defining the livelihoods, nutrition, and culture of a substantial and diverse segment of humankind. In recent decades collaborative forms of fisheries management, including co-management, have gained popularity as the most appropriate, fair, and effective form of governance for small-scale fisheries. Fisheries co-management is envisioned as a process by which to reverse the interconnected crises of hunger, poverty, and biodiversity loss, transforming small-scale fisheries into engines of prosperity, inclusion, and sustainability. Yet co-management can succeed or fail, and implementation does not mean positive impacts for food security, nutrition, livelihoods, or biodiversity. Nor does it imply programs will respect human rights, gender equality, or principles of justice and equity. Fewer management programs implemented well might achieve far more than many implemented poorly, and poorly implemented co-management can be worse than no management. This guide was designed to assist practitioners in understanding the latest research on what constitutes successful fisheries co-management, and how to reach this objective. The aim is to synthesize emerging research that, if adopted, would substantially improve impacts across both ecological and social dimensions. The guide is presented as an infographic series with each infographic summarizing a substantial body of research from a particular field. This work was undertaken through a growing partnership between the Wildlife Conservation Society and WorldFish, aiming to increase collaboration between conservation and development sectors. This partnership represents a milestone towards integrated approaches for the benefit of both ecosystems and local communities