33 results on '"Baldwin, Laura-Mae"'
Search Results
2. Identifying Barriers to Collaboration Between Primary Care and Public Health : Experiences at the Local Level
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Pratt, Rebekah, Gyllstrom, Beth, Gearin, Kim, Lange, Carol, Hahn, David, Baldwin, Laura-Mae, VanRaemdonck, Lisa, Nease, Don, and Zahner, Susan
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- 2018
3. Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices
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Shoemaker-Hunt, Sarah J., Evans, Leigh, Swan, Holly, Bacon, Olivia, Ike, Brooke, Baldwin, Laura-Mae, and Parchman, Michael L.
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- 2020
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4. Medication treatment for opioid use disorder among rural primary care patients.
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Hser, Yih‐Ing, Zhu, Yuhui, Baldwin, Laura‐Mae, Mooney, Larissa J., and Saxon, Andrew J.
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NARCOTICS ,CHRONIC pain ,PILOT projects ,NALTREXONE ,SUBSTANCE abuse ,CONFIDENCE intervals ,PSYCHOLOGY of drug abusers ,BUPRENORPHINE ,PRIMARY health care ,COMPARATIVE studies ,PATIENTS' attitudes ,DESCRIPTIVE statistics ,DISEASE prevalence ,QUESTIONNAIRES ,RESEARCH funding ,ELECTRONIC health records ,LOGISTIC regression analysis ,ODDS ratio ,RURAL health clinics ,SECONDARY analysis ,MENTAL illness - Abstract
Purpose: To investigate the prevalence of opioid use disorder (OUD) and medication treatment for OUD (MOUD) receipt in rural primary care settings and identify characteristics associated with MOUD among patients with OUD. Methods: Secondary analyses based on electronic health records of all adult patients who visited 1 of the 6 rural primary care clinic sites from October 2019 to January 2021. Mixed effects logistic regression was conducted to assess MOUD receipt (Y/N) in relation to patient characteristics (eg, demographics, other substance use disorders [SUDs], mental health disorders, and chronic pain) and the number of MOUD prescribers per clinic. Findings: The prevalence of OUD varied from 0.7% to 8.2% (Mean [SD] = 3.3% [95% CI: 0.4, 6.1]) among 36,762 primary care patients across 6 clinic sites. Among 1,164 patients with OUD, on average 50.1% received MOUD (95% CI: 28.0, 72.3). Patients in clinics with more than 3 MOUD prescribers had more than 3 times the odds of receiving MOUD (OR = 3.42; 95% CI, 1.22‐9.62) as those in clinics with fewer than 3 prescribers. MOUD was positively associated with younger age (18‐30 [OR = 6.97; 95% CI, 3.37‐14.42], 31‐64 [OR = 5.03; 95% CI, 2.64‐9.57], relative to those 65 and older), having other co‐occurring SUDs (OR = 3.77; 95% CI, 2.57‐5.52), being male (OR = 1.50; 95% CI, 1.12‐2.01), and negatively associated with having chronic pain disorders (OR = 0.69; 95% CI, 0.50‐0.94). Conclusions: The prevalence of OUD and MOUD are high but vary considerably across rural primary care clinics; primary care MOUD prescribers play a key role on MOUD access in rural settings. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Identifying patients with opioid use disorder using International Classification of Diseases (ICD) codes: Challenges and opportunities.
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Osterhage, Katie P., Hser, Yih‐Ing, Mooney, Larissa J., Sherman, Seth, Saxon, Andrew J., Ledgerwood, Maja, Holtzer, Caleb C., Gehring, Margaret A., Clingan, Sarah E., Curtis, Megan E., and Baldwin, Laura‐Mae
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SUBSTANCE abuse diagnosis ,CHRONIC pain ,SUBSTANCE abuse ,NOSOLOGY ,SCIENTIFIC observation ,RURAL health services ,PSYCHOLOGY of drug abusers ,CROSS-sectional method ,PRIMARY health care ,DESCRIPTIVE statistics ,RESEARCH funding ,OPIOID analgesics ,ELECTRONIC health records - Abstract
Background and Aims: International Classification of Diseases (ICD) diagnosis codes are often used in research to identify patients with opioid use disorder (OUD), but their accuracy for this purpose is not fully evaluated. This study describes application of ICD‐10 diagnosis codes for opioid use, dependence and abuse from an electronic health record (EHR) data extraction using data from the clinics' OUD patient registries and clinician/staff EHR entries. Design: Cross‐sectional observational study. Setting: Four rural primary care clinics in Washington and Idaho, USA. Participants: 307 patients. Measurements This study used three data sources from each clinic: (1) a limited dataset extracted from the EHR, (2) a clinic‐based registry of patients with OUD and (3) the clinician/staff interface of the EHR (e.g. progress notes, problem list). Data source one included records with six commonly applied ICD‐10 codes for opioid use, dependence and abuse: F11.10 (opioid abuse, uncomplicated), F11.20 (opioid dependence, uncomplicated), F11.21 (opioid dependence, in remission), F11.23 (opioid dependence with withdrawal), F11.90 (opioid use, unspecified, uncomplicated) and F11.99 (opioid use, unspecified with unspecified opioid‐induced disorder). Care coordinators used data sources two and three to categorize each patient identified in data source one: (1) confirmed OUD diagnosis, (2) may have OUD but no confirmed OUD diagnosis, (3) chronic pain with no evidence of OUD and (4) no evidence for OUD or chronic pain. Findings F11.10, F11.21 and F11.99 were applied most frequently to patients who had clinical diagnoses of OUD (64%, 89% and 79%, respectively). F11.20, F11.23 and F11.90 were applied to patients who had a diagnostic mix of OUD and chronic pain without OUD. The four clinics applied codes inconsistently. Conclusions: Lack of uniform application of ICD diagnosis codes make it challenging to use diagnosis code data from EHR to identify a research population of persons with opioid use disorder. [ABSTRACT FROM AUTHOR]
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- 2024
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6. A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions.
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Littenberg, Benjamin, Clifton, Jessica, Crocker, Abigail M., Baldwin, Laura-Mae, Bonnell, Levi N., Breshears, Ryan E., Callas, Peter, Chakravarti, Prama, Clark/Keefe, Kelly, Cohen, Deborah J., deGruy, Frank V., Eidt-Pearson, Lauren, Elder, William, Fox, Chester, Frisbie, Sylvie, Hekman, Katie, Hitt, Juvena, Jewiss, Jennifer, Kaelber, David C., and Kelley, Kairn Stetler
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CLUSTER randomized controlled trials ,CHRONIC diseases ,PRIMARY care ,MENTAL health services - Abstract
PURPOSE Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities. METHODS We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration. RESULTS Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P = .05) compared with other active practices (n = 7). CONCLUSION Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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7. Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single‐arm, multisite feasibility study.
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Hser, Yih‐Ing, Mooney, Larissa J., Baldwin, Laura‐Mae, Ober, Allison, Marsch, Lisa A., Sherman, Seth, Matthews, Abigail, Clingan, Sarah, Fei, Zhe, Zhu, Yuhui, Dopp, Alex, Curtis, Megan E., Osterhage, Katie P., Hichborn, Emily G., Lin, Chunqing, Black, Megan, Calhoun, Stacy, Holtzer, Caleb C., Nesin, Noah, and Bouchard, Denise
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EVALUATION of human services programs ,NARCOTICS ,RESEARCH ,PILOT projects ,EVALUATION of medical care ,SUBSTANCE abuse ,PRIMARY health care ,PRE-tests & post-tests ,MEDICAL care use ,INTERPROFESSIONAL relations ,MEDICAL referrals ,RESEARCH funding ,PATIENT compliance ,RURAL health clinics ,TELEMEDICINE - Abstract
Purpose: The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM‐delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings. Methods: The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID‐19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre‐/post‐intervention design (N = 6) was used to assess the clinic‐level outcome as patient‐days on MOUD based on patient electronic health records. Findings: All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient‐days on MOUD during the intervention period compared to the 6‐month period before the intervention (mean increase per 1,000 patients: 132 days, P =.08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period. Conclusions: To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Continuity of Care and Cancer Screening among Health Plan Enrollees
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Fenton, Joshua J., Franks, Peter, Reid, Robert J., Elmore, Joann G., and Baldwin, Laura-Mae
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- 2008
9. Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey
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Kadivar, Hajar, Goff, Barbara A., Phillips, William R., Andrilla, C. Holly A., Berg, Alfred O., and Baldwin, Laura-Mae
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- 2014
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10. Early Response of Primary Care Practices to COVID-19 Pandemic.
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Keppel, Gina, Cole, Allison M., Ramsbottom, Mary, Nagpal, Stuti, Hornecker, Jaime, Thomson, Claire, Nguyen, Viet, and Baldwin, Laura-Mae
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INDUSTRIAL safety ,CROSS-sectional method ,MEDICAL care ,COMMUNITY health services ,PRIMARY health care ,SURVEYS ,RESEARCH funding ,COVID-19 pandemic ,TELEMEDICINE ,PATIENT safety ,PSYCHOLOGICAL resilience - Abstract
Introduction: The emergence of the COVID-19 pandemic and subsequent public health mitigation strategies resulted in rapid and significant changes to delivery of primary care. The field of primary care faced an unprecedented dual challenge of providing routine care to patients while ensuring patient and staff safety and managing patients with a highly transmissible disease. This study describes how a diverse group of primary care practices addressed these challenges at the start of the COVID-19 pandemic, in Spring 2020. Methods: A cross-sectional electronic survey of representatives from primary care practices in the WWAMI region Practice and Research Network (WPRN). Survey topics included clinical workforce, operations, and use of telemedicine in the first 3 months of the COVID-19 pandemic. Results: To safely manage patients with COVID-19 symptoms all clinics modified operations; 81.3% diverted patients with respiratory symptoms to a telemedicine evaluation, 68.8% diverted these patients to be seen in-person at another location, and 75% made in-clinic changes to maintain safety. The set of operational changes employed by clinics was diverse. To continue to provide routine patient care, all clinics employed telemedicine. Over 80% of clinics had never used telemedicine prior to March 2020. Conclusions: A diverse group of primary care clinics all rapidly implemented a variety of operational adaptations to address patient needs and maintain patient and staff safety at the onset of the COVID- 19 pandemic. Telemedicine, together with other measures, provided critical pathways for maintaining delivery of care. [ABSTRACT FROM AUTHOR]
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- 2022
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11. Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
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Parchman, Michael L., Ike, Brooke, Osterhage, Katherine P, Baldwin, Laura-Mae, Stephens, Kari A, and Sutton, Sarah
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RURAL health clinics ,PRIMARY care ,MEDICAL personnel ,JOB stress ,MEDICATION therapy management ,OPIOIDS ,RURAL children - Abstract
Background: Opioids are more commonly prescribed for chronic pain in rural settings in the USA, yet little is known about how the rural context influences efforts to improve opioid medication management. Methods: The Six Building Blocks is an evidence-based program that guides primary care practices in making system-based improvements in managing patients using long-term opioid therapy. It was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. To gain further insight about their experience with implementing the program, interviews and focus groups were conducted with staff and clinicians at the six organizations at the end of the 15 months and transcribed. Team members used a template analysis approach, a form of qualitative thematic analysis, to code these data for barriers, facilitators, and corresponding subcodes. Results: Facilitators to making systems-based changes in opioid management within a rural practice context included a desire to help patients and their community, external pressures to make changes in opioid management, a desire to reduce workplace stress, external support for the clinic, supportive clinic leadership, and receptivity of patients. Barriers to making changes included competing demands on clinicians and staff, a culture of clinician autonomy, inadequate data systems, and a lack of patient resources in rural areas. Discussion: The barriers and facilitators identified here point to potentially unique determinants of practice that should be considered when addressing opioid prescribing for chronic pain in the rural setting. [ABSTRACT FROM AUTHOR]
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- 2020
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12. Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network.
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Baldwin, Laura-Mae, Mollis, Brenda, Witwer, Elizabeth, Halladay, Jacqueline R., Ludden, Tom, Elder, Nancy, Tapp, Hazel, Donahue, Katrina E., Johnson, Deborah, Mottus, Kathleen, Olson, Ardis L., Waddell, Elizabeth Needham, and Dolor, Rowena J.
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DRUG abuse treatment , *SUBSTANCE-induced disorders , *PRIMARY care , *ELECTRONIC health records , *CLINICAL trials , *OPIOIDS - Abstract
The National Drug Abuse Treatment Clinical Trials Network (CTN) called for its national nodes to promote the translation of evidence-based interventions from substance use disorder (SUD) research into clinical practices. This collaborative demonstration project engaged CTN-affiliated practice-based research networks (PBRNs) in research that describes aspects of opioid prescribing in primary care. Six PBRNs queried electronic health records from a convenience sample of 134 practices (84 participants) to identify the percent of adult patients with an office visit who were prescribed an opioid medication from October 1, 2015, to September 30, 2016, and, of those, the percent also prescribed a sedative in that year. Seven PBRNs sent an e-mail survey to a convenience sample of 108 practices (58 participants) about their opioid management policies and procedures during the project year. Of 561,017 adult patients with a visit to one of the 84 clinics in the project year, 22.9% (PBRN range 3.1%–25.4%) were prescribed opioid medications, and 52.1% (PBRN range 8.5%–60.6%) of those were prescribed a sedative in the same year. Of the 58 practices returning a survey (45.3% response rate), 98.1% had formal written treatment agreements for chronic opioid therapy, 68.5% had written opioid prescribing policies, and 43.4% provided reports to providers with feedback on opioid management. Only 24.1% were providing buprenorphine for OUD. CTN-affiliated PBRNs demonstrated their ability to collaborate on a project related to opioid management; results highlight the important role for PBRNs in OUD treatment, research, and the need for interventions and additional policies addressing opioid prescribing in primary care practice. • Practice-based research networks successfully recruited clinics to study opioid prescribing. • Clinic electronic health records provided data on 561,017 adult patients with primary care visits. • Nearly a quarter of the patients were prescribed opioid medications in the study year. • Over half of patients prescribed opioid medications were prescribed a sedative in the same year. • PBRNs are important collaborators for substance use disorder research. [ABSTRACT FROM AUTHOR]
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- 2020
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13. Use of electronic health record data from diverse primary care practices to identify and characterize patients' prescribed common medications.
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Cole, Allison M, Stephens, Kari A, West, Imara, Keppel, Gina A, Thummel, Ken, and Baldwin, Laura-Mae
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HEMORRHAGE risk factors ,DATABASE management ,DRUGS ,DRUG prescribing ,DRUG side effects ,MUSCLE diseases ,PRIMARY health care ,RESEARCH funding ,WARFARIN ,PHYSICIAN practice patterns ,STATINS (Cardiovascular agents) ,ELECTRONIC health records ,DISEASE risk factors - Abstract
We use prescription of statin medications and prescription of warfarin to explore the capacity of electronic health record data to (1) describe cohorts of patients prescribed these medications and (2) identify cohorts of patients with evidence of adverse events related to prescription of these medications. This study was conducted in the WWAMI region Practice and Research Network (WPRN)., a network of primary care practices across Washington, Wyoming, Alaska, Montana and Idaho DataQUEST, an electronic data-sharing infrastructure. We used electronic health record data to describe cohorts of patients prescribed statin or warfarin medications and reported the proportions of patients with adverse events. Among the 35,445 active patients, 1745 received at least one statin prescription and 301 received at least one warfarin prescription. Only 3 percent of statin patients had evidence of myopathy; 51 patients (17% of those prescribed warfarin) had a bleeding complication. Primary-care electronic health record data can effectively be used to identify patients prescribed specific medications and patients potentially experiencing medication adverse events. [ABSTRACT FROM AUTHOR]
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- 2020
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14. Extracting Electronic Health Record Data in a Practice-Based Research Network: Processes to Support Translational Research across Diverse Practice Organizations
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Cole, Allison M., Stephens, Kari A., Keppel, Gina A., Estiri, Hossein, and Baldwin, Laura-Mae
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primary care ,electronic health records ,governance ,ComputingMilieux_COMPUTERSANDSOCIETY ,Articles - Abstract
Context: The widespread adoption of electronic health records (EHRs) offers significant opportunities to conduct research with clinical data from patients outside traditional academic research settings. Because EHRs are designed primarily for clinical care and billing, significant challenges are inherent in the use of EHR data for clinical and translational research. Efficient processes are needed for translational researchers to overcome these challenges. The Data QUEST Coordinating Center (DQCC), which oversees Data Query Extraction Standardization Translation (Data QUEST) – a primary-care, EHR data-sharing infrastructure – created processes that guide EHR data extraction for clinical and translational research across these diverse practices. We describe these processes and their application in a case example. Case Description: The DQCC process for developing EHR data extractions not only supports researchers’ access to EHR data, but supports this access for the purpose of answering scientific questions. This process requires complex coordination across multiple domains, including the following: (1) understanding the context of EHR data; (2) creating and maintaining a governance structure to support exchange of EHR data; and (3) defining data parameters that are used in order to extract data from the EHR. We use the Northwest-Alaska Pharmacogenomics Research Network (NWA-PGRN) as a case example that focuses on pharmacogenomic discovery and clinical applications to describe the DQCC process. The NWA-PGRN collaborates with Data QUEST to explore ways to leverage primary-care EHR data to support pharmacogenomics research. Findings: Preliminary analysis on the case example shows that initial decisions about how researchers define the study population can influence study outcomes. Major Themes and Conclusions: The experience of the DQCC demonstrates that coordinating centers provide expertise in helping researchers understand the context of EHR data, create and maintain governance structures, and guide the definition of parameters for data extractions. This expertise is critical to supporting research with EHR data. Replication of these strategies through coordinating centers may lead to more efficient translational research. Investigators must also consider the impact of initial decisions in defining study groups that may potentially affect outcomes.
- Published
- 2016
15. A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care.
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Parchman, Michael L., Anderson, Melissa L., Dorr, David A., Fagnan, Lyle J., O'Meara, Ellen S., Tuzzio, Leah, Penfold, Robert B., Cook, Andrea J., Hummel, Jeffrey, Conway, Cullen, Cholan, Raja, and Baldwin, Laura-Mae
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TRIAL practice ,PRIMARY care ,DISEASE risk factors ,BLOOD pressure ,RANDOMIZED controlled trials - Abstract
Purpose: We conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance.Methods: Primary care practices across Washington, Oregon, and Idaho were eligible if they had fewer than 10 full-time clinicians. Practices were randomized to practice facilitation only, practice facilitation and shared learning, practice facilitation and educational outreach visits, or practice facilitation and both shared learning and educational outreach visits. All practices received up to 15 months of support. The primary outcome was the CQM for blood pressure control. Secondary outcomes were CQMs for appropriate aspirin therapy and smoking screening and cessation. Analyses followed an intention-to-treat approach.Results: Of 259 practices recruited, 209 agreed to be randomized. Only 42% of those offered educational outreach visits and 27% offered shared learning participated in these enhanced supports. CQM performance improved within each study arm for all 3 cardiovascular disease CQMs. After adjusting for differences between study arms, CQM improvements in the 3 enhanced practice support arms of the study did not differ significantly from those seen in practices that received practice facilitation alone (omnibus P = .40 for blood pressure CQM). Practices randomized to receive both educational outreach visits and shared learning, however, were more likely to achieve a blood pressure performance goal in 70% of patients compared with those randomized to practice facilitation alone (relative risk = 2.09; 95% CI, 1.16-3.76).Conclusions: Although we found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation. [ABSTRACT FROM AUTHOR]- Published
- 2019
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16. Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing.
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Parchman, Michael L., Penfold, Robert B., Ike, Brooke, Tauben, David, Von Korff, Michael, Stephens, Mark, Stephens, Kari A., and Baldwin, Laura-Mae
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MEDICATION therapy management ,PRIMARY care ,STATISTICAL hypothesis testing ,HEALTH planning ,CLINICS - Abstract
Purpose: Six key elements of opioid medication management redesign in primary care have been previously identified. Here, we examine the effect of implementing these Six Building Blocks on opioid-prescribing practices.Methods: Six rural-serving organizations with 20 clinic locations received support for 15 months during the period October 2015 to May 2017 to implement the Six Building Blocks. Patients undergoing long-term opioid therapy (LtOT) at these study sites were compared with patients undergoing LtOT enrolled in a regional health plan who did not receive care at the study sites but who resided in the same primary care service areas (control group). Outcomes were monthly trend in the proportion of patients undergoing LtOT prescribed a ≥100 morphine equivalent dose (MED) of opioids daily and the total number of patients receiving an opioid prescription. An interrupted time series using difference-indifference analysis was used for tests of significance.Results: The proportion of patients prescribed a ≥100 MED of opioids daily decreased 2.2% (11.8% to 9.6%) among patients at the intervention clinics and 1.3% (14.0% to 12.7%) among patients in the control group. The rate of decrease was significantly greater among study patients than among patients in the control group (P = .018). The rate of decrease in the number of patients on LtOT at intervention clinics increased during the intervention period compared with the preintervention period (P <.001).Conclusions: Efforts to redesign opioid medication management in primary care resulted in a significant decrease in opioid prescribing. Future research is needed to determine if these results are generalizable to other settings and to assess implications for patient-reported outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2019
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17. Study protocol for "Healthy Hearts Northwest": a 2 × 2 randomized factorial trial to build quality improvement capacity in primary care.
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Parchman, Michael L., Fagnan, Lyle J., Dorr, David A., Evans, Peggy, Cook, Andrea J., Penfold, Robert B., Hsu, Clarissa, Cheadle, Allen, Baldwin, Laura-Mae, and Tuzzio, Leah
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CARDIOVASCULAR disease diagnosis ,PRIMARY care ,PRIMARY health care ,HEALTH facility management ,VISUALIZATION - Abstract
Background: Little attention has been paid to quality improvement (QI) capacity within smaller primary care practices which comprise nearly half of all primary care settings. Strategies for external support to build such capacity include practice facilitation (PF), shared learning opportunities, and educational outreach. Although PF has proven effectiveness, little is known about the comparative effectiveness of combining these strategies. Here, we describe the protocol of the "Healthy Hearts Northwest" (H2N) study, a randomized trial designed to address these questions while improving risk factors for cardiovascular disease. Methods/design: The targeted enrollment is 250 smaller primary care practices across Washington, Oregon, and Idaho. The study is utilizing a two-by-two factorial design to assess four different combinations of practice support: PF alone, PF with educational outreach, PF with shared learning opportunities, or PF with both. A mixed methods approach is being used for evaluation and will include data from (1) baseline and follow-up practice and staff surveys; (2) baseline and quarterly clinical performance measurement from each practice on four cardiovascular risk factors: appropriate aspirin use, blood pressure control, lipid management and smoking cessation support; and (3) a quality improvement capacity assessment (QICA) survey used by external practice facilitators to guide improvement efforts. Discussion: Results from this study will inform future large-scale practice improvement initiatives by providing comparisons of promising external practice support strategies and advance our understanding of how to build QI capacity in primary care. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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18. Extracting Electronic Health Record Data in a Practice-Based Research Network: Lessons Learned from Collaborations with Translational Researchers.
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Cole, Allison M., Stephens, Kari A., Keppel, Gina A., Estiri, Hossein, and Baldwin, Laura-Mae
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MANAGEMENT of electronic health records ,TRANSLATIONAL research ,MEDICAL care - Abstract
Context: The widespread adoption of electronic health records (EHRs) offers significant opportunities to conduct research with clinical data from patients outside traditional academic research settings. Because EHRs are designed primarily for clinical care and billing, significant challenges are inherent in the use of EHR data for clinical and translational research. Efficient processes are needed for translational researchers to overcome these challenges. The Data QUEST Coordinating Center (DQCC), which oversees Data QUEST - a primary care EHR data sharing infrastructure - created processes that that guide EHR data extraction for clinical and translational research across these diverse practices. We describe these processes and their application in a case example. Case Description: The DQCC process for developing EHR data extractions not only supports researchers access to EHR data, but supports this access for the purpose of answering scientific questions. This process requires complex coordination across multiple domains, including: 1) understanding the context of EHR data; 2) creating and maintaining a governance structure to support exchange of EHR data; and 3) defining data parameters that are used in order to extract data from the EHR.1,2,3,4We use the Northwest-Alaska Pharmacogenomics Research Network (NWA-PGRN) as a case example that focuses on pharmacogenomic discovery and clinical applications to describe the DQCC process. The NWA-PGRN collaborates with Data QUEST to explore ways to leverage primary care EHR data to support pharmacogenomics research. Findings: Preliminary analysis on the case example shows that initial decisions about how researchers define the study population can influence study outcomes. Major Themes and Conclusions: The experience of the DQCC demonstrates that Coordinating Centers provide expertise in helping researchers understand the context of EHR data, create and maintain governance structures, and guide the definition of parameters for data extractions. This expertise is critical to support research with EHR data. Replication of these strategies through Coordinating Centers may lead to more efficient translational research. Investigators must also consider the impact of initial decisions in defining study groups that may potentially affect outcomes. Acknowledgements We acknowledge the Northwest Alaska Pharmacogenomics Research Network group for supporting the infrastructure and data collection, and Imara West for her assistance in data cleaning and analysis. This project was funded by the National Institute of General Medical Science (U01 GM092676) and the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR000423). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health [ABSTRACT FROM AUTHOR]
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- 2016
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19. Evaluating the Development, Implementation and Dissemination of a Multisite Card Study in the WWAMI Region Practice and Research Network.
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Cole, Allison, Keppel, Gina A., Linares, Adriana, Alto, William, Kriegsman, William, Reed, Alex, Holmes, John, Mohanachandran, Mathini, and Baldwin, Laura‐Mae
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PRIMARY care ,WEIGHT loss ,ACQUISITION of data ,TRANSLATIONAL research ,RESEARCH methodology - Abstract
Background: Practice-based research networks (PBRNs) promote the conduct of research in real-world settings by engaging primary care clinicians as champion research collaborators. Card studies are brief surveys administered to patients or clinicians at the point of care. The objective of this paper is to describe the design and evaluation of a card study methodology that the WWAMI Region Practice and Research Network (WPRN) used to develop research partnerships across multiple member sites. Methods: We used a collaborative model to develop, implement and disseminate the results of a network-wide card study to assess patient preferences for weight loss in primary care. After the card study data collection was completed, we conducted individual and focus group interviews and a brief survey of participating practice champions. Results: Increased research engagement and personal and professional developments were the primary motivators for participating in the development of the card study. Increasing research activity at practices and learning information about patients were motivators for implementing the study. Their participation resulted in champions reporting increased confidence in collaborating on research projects as well as the development of new clinical services for patients. Discussion: This collaborative model positively influenced research capacity in the WPRN and may be a useful strategy for helping PBRNs conducted translational research. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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20. Implementation of a Health Data-Sharing Infrastructure Across Diverse Primary Care Organizations.
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Cole, Allison M., Stephens, Karl A., Keppel, Gina A., Ching-Ping Lin, and Baldwin, Laura-Mae
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ELECTRONIC data interchange ,INFORMATION storage & retrieval systems ,MEDICAL databases ,INFORMATION technology ,MEDICAL records ,PRIMARY health care - Abstract
Practice-based research networks bring together academic researchers and primary care clinicians to conduct research that improves health outcomes in real-world settings. The Washington, Wyoming, Alaska, Montana, and Idaho region Practice and Research Network implemented a health data-sharing infrastructure across 9 clinics in 3 primary care organizations. Following implementation, we identified challenges and solutions. Challenges included working with diverse primary care organizations, adoption of health information data-sharing technology in a rapidly changing local and national landscape, and limited resources for implementation. Overarching solutions included working with a multidisciplinary academic implementation team, maintaining flexibility, and starting with an established network for primary care organizations. Approaches outlined may generalize to similar initiatives and facilitate adoption of health data sharing in other practice-based research networks. [ABSTRACT FROM AUTHOR]
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- 2014
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21. Barriers to Primary Care Physicians Prescribing Buprenorphine.
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Hutchinson, Eliza, Catlin, Mary, Andrilla, C. Holly A., Baldwin, Laura-Mae, and Rosenblatt, Roger A.
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BUPRENORPHINE ,PRIMARY care ,OUTPATIENT medical care ,DRUG prescribing ,GENERAL practitioners - Abstract
PURPOSE Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010-2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice. METHODS We interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents. RESULTS Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine. CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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22. How are symptoms of ovarian cancer managed?
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Goff, Barbara A., Matthews, Barbara, Andrilla, C. Holly A., Miller, Jacqueline W., Trivers, Katrina F., Berry, Donna, Lishner, Denise M., and Baldwin, Laura-Mae
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OVARIAN cancer ,SYMPTOMS ,CANCER patients ,TOMOGRAPHY ,PRIMARY care - Abstract
BACKGROUND: A study was undertaken to identify the diagnostic approaches that primary care physicians and gynecologists undertake in women with symptoms associated with ovarian cancer. METHODS: A vignette-based survey was mailed to 3200 primary care physicians from the American Medical Association Physician Masterfile. The vignette described a 55-year-old woman with symptoms associated with ovarian cancer, although ovarian cancer was never mentioned. The authors evaluated patient, physician, and practice characteristics associated with a workup that could detect ovarian cancer. RESULTS: The survey response rate was 61.7%. After exclusions, 1532 physicians were included. Overall, 89.5% of physicians reported that they would recommend testing that can detect ovarian cancer (71.2% ultrasound; 25.4% pelvic computed tomography; 26.5% CA125). In adjusted analysis, the only patient factor associated with ovarian cancer testing was symptom type, genitourinary versus gastrointestinal (risk ratio, 1.07; 95% confidence interval, 1.03-1.11). Physician and practice characteristics associated with recommending of ovarian cancer testing included specialty (gynecologists > family physicians and internists); type of practice (group > solo); clinical teaching (yes > no); and within Census division, location of practice, with all Central (East, West, North, and South) and Atlantic (Middle and South) areas having a lower likelihood than New England. CONCLUSIONS: On the basis of a vignette in which a woman reported symptoms associated with ovarian cancer, the majority of primary care physicians and gynecologists would not recommend CA125, but would recommend imaging of the pelvis. Gynecologists, physicians involved with clinical teaching, and those in group practices were significantly more likely to recommend testing that could lead to an ovarian cancer diagnosis. Cancer 2011;. © 2011 American Cancer Society. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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23. The role of gynecologists in providing primary care to elderly women.
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Fink, Kenneth S., Baldwin, Laura-Mae, Lawson, Herschel W., Chan, Leighton, Rosenblatt, Roger A., Hart, L. Gary, Fink, K S, Baldwin, L M, Lawson, H W, Chan, L, Rosenblatt, R A, and Hart, L G
- Subjects
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OBSTETRICIANS , *GYNECOLOGISTS , *PRIMARY care , *PHYSICIANS , *PATIENTS - Abstract
Background: Federal legislation has recently been proposed to designate obstetrician-gynecologists (OBGs) as primary care physicians. The Institute of Medicine identifies care unrestricted by problem or organ system as an essential characteristic of primary care. We examined the degree to which OBGs in the state of Washington offer this aspect of primary care to their elderly patients by investigating the type and amount of nongynecologic care they provide.Methods: Using 1994 Part B Medicare claims data for Washington residents, we identified visits made by women aged 65 years and older to OBGs (N=10,522) and 9 other types of specialists. Diagnoses were classified as in or out of the domain of care traditionally provided by each specialty. Visit volumes, proportion of out of domain visits, and the frequency of diagnoses were reported.Results: Of the patient visits to obstetrician-gynecologists, 12.2% had nongynecologic diagnoses. The median percentage of nongynecologic visits for individual OBGs was 6.7%. Patients who saw OBGs received 15.4% of their overall health care from an OBG; patients who saw family physicians received 42.9% of their total health care from a family physician.Conclusions: In 1994, a small amount of the care that Washington OBGs provided to their elderly patients was for nongynecologic conditions. Studies are needed to evaluate how the practices of OBGs have changed since the 1996 implementation of a primary care requirement in obstetrics-gynecology residencies, and if adopted, how legislation designating OBGs as primary care physicians affects the health care received by elderly women. [ABSTRACT FROM AUTHOR]- Published
- 2001
24. Communicating health information and improving coordination with primary care (CHIIP): Rationale and design of a randomized cardiovascular health promotion trial for adult survivors of childhood cancer.
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Chow, Eric J., Baldwin, Laura-Mae, Hagen, Anna M., Hudson, Melissa M., Gibson, Todd M., Kochar, Komal, McDonald, Aaron, Nathan, Paul C., Syrjala, Karen L., Taylor, Sarah L., Tonorezos, Emily S., Yasui, Yutaka, Armstrong, Gregory T., and Oeffinger, Kevin C.
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- *
CHILDHOOD cancer , *CANCER patients , *CANCER relapse , *HEALTH promotion , *PRIMARY care - Abstract
Long-term survival for children diagnosed with cancer exceeds 80%. Notably, premature cardiovascular disease has become the leading non-cancer cause of late mortality among these survivors. This randomized controlled trial (RCT; NCT03104543) focuses on adult participants in the Childhood Cancer Survivor Study identified as high risk for ischemic heart disease or heart failure due to their cancer treatment. Participants undergo a home-based evaluation of blood pressure and laboratory tests to determine the prevalence of undiagnosed and/or undertreated hypertension, dyslipidemia, and diabetes. Those with abnormal values are then enrolled in an RCT to test the efficacy of a 12-month personalized, remotely delivered survivorship care plan (SCP) intervention designed to reduce undertreatment of these three target conditions. The intervention approximates a clinical encounter and is based on chronic disease self-management strategies. With a goal of 750, currently 342 out of 742 eligible participants approached have enrolled (46.1%). Initially, we randomized participants to different recruitment strategies, including shorter approach packets and a tiered consent, but did not find significant differences in participation rates (40.7% to 42.9%; p =.95). Subsequently, slightly greater participation was seen with larger upfront unconditional incentive checks ($50 vs. $25: 50.7% vs. 44.1%; p =.10). Overall, the financial impact of the $50 upfront incentive was cost neutral, and possibly cost-saving, vs. a $25 upfront incentive. The overall study will determine if a National Academy of Medicine-recommended SCP intervention can improve cardiovascular outcomes among long-term survivors of childhood cancer. Modifications to the recruitment strategy may improve participation rates over time. [ABSTRACT FROM AUTHOR]
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- 2020
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25. W105 - Exploring the Impact of the COVID-19 Pandemic on MOUD Retention in a Sample of Rural Primary Care Patients.
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Calhoun, Stacy, Guo, Huiying, Fei, Zhe, Baldwin, Laura-Mae, Ober, Allison, Black, Megan, Clingan, Sarah, Kan, Emily, Lin, Chunqing, Pham, Huyen, Zhu, Yuhui, Mooney, Larissa, and Hser, Yih-Ing
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- *
COVID-19 pandemic , *PRIMARY care , *PATIENT care - Published
- 2024
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26. Barriers to Implementing Cardiovascular Risk Calculation in Primary Care: Alignment With the Consolidated Framework for Implementation Research.
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Tuzzio, Leah, O'Meara, Ellen S., Holden, Erika, Parchman, Michael L., Ralston, James D., Powell, Jennifer A., and Baldwin, Laura-Mae
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PRIMARY care , *RESEARCH implementation , *PREVENTIVE medicine , *CARDIOVASCULAR diseases , *STATINS (Cardiovascular agents) - Abstract
Introduction: Cardiovascular disease risk calculators can inform and guide preventive strategies and treatment decisions by clinicians and patients. However, their uptake in primary care has been slow despite the recommendation in national cardiovascular disease prevention guidelines. Identifying the barriers to the implementation of cardiovascular disease risk calculators is essential for promoting their adoption.Methods: The authors qualitatively analyzed structured physician educator notes written during an outreach education intervention with 44 small- and medium-sized primary care clinics that participated in the Agency for Healthcare Research and Quality‒funded EvidenceNOW Healthy Hearts Northwest trial. The authors coded barriers to the implementation of cardiovascular disease risk calculation and aligned them to the Consolidated Framework for Implementation Research.Results: The authors identified 13 barriers from the physician educators' notes. The majority (n=8, 62%) mapped to the framework's Inner Setting domain. The 5 most commonly noted barriers were (1) time constraints to use a calculator (N=23 clinics), (2) limitations to accessing a calculator or the necessary information to use a calculator (N=22 clinics), (3) no or minimal buy-in from clinicians or staff to use a calculator (N=19 clinics), (4) reported patient fear of side effects from statin medications or patient dislike of taking medications per the guidelines (N=17 clinics), and (5) lack of documented clinic workflow for using a calculator (N=16 clinics).Conclusions: To improve the uptake of cardiovascular disease risk calculation in primary care, future cardiovascular disease prevention and implementation research should consider tailoring interventions to the common barriers to implementing cardiovascular disease risk calculation.Trial Registration: This study is registered at www.clinicaltrials.gov NCT02839382. [ABSTRACT FROM AUTHOR]- Published
- 2021
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27. Long-Term Courses of Sepsis Survivors: Effects of a Primary Care Management Intervention.
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Schmidt, Konrad FR, Schwarzkopf, Daniel, Baldwin, Laura-Mae, Brunkhorst, Frank M, Freytag, Antje, Heintze, Christoph, Reinhart, Konrad, Schneider, Nico, von Korff, Michael, Worrack, Susanne, Wensing, Michel, Gensichen, Jochen, and SMOOTH Study Group
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INTENSIVE care units , *PRIMARY care , *SEPSIS , *SEPTIC shock , *POST-traumatic stress , *PREVENTION of post-traumatic stress disorder , *RESEARCH , *RESEARCH methodology , *EVALUATION research , *MEDICAL cooperation , *PRIMARY health care , *COMPARATIVE studies ,ADMISSION & discharge - Abstract
Background: Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare.Methods: This study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German intensive care units. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews.Results: One hundred eighty-six (63.9%, 98 intervention, 88 control) of 291 patients completed the 24-month follow-up, showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (difference between baseline and 24-months follow-up values, mean [standard deviation] 3.7 [11.8] control vs -0.7 [12.1] intervention; P = .016). There were no significant differences in all other outcomes between the intervention and control groups.Conclusions: Twelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms. [ABSTRACT FROM AUTHOR]- Published
- 2020
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28. Service utilization and chronic condition outcomes among primary care patients with substance use disorders and co-occurring chronic conditions.
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Stephens, Kari A, West, Imara I, Hallgren, Kevin A, Mollis, Brenda, Ma, Kris, Donovan, Dennis M, Stuvek, Brenda, and Baldwin, Laura-Mae
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- *
SUBSTANCE abuse treatment , *THERAPEUTIC use of narcotics , *SUBSTANCE abuse , *ANALGESICS , *CHRONIC diseases , *PRIMARY health care , *RESEARCH funding - Abstract
Background: Patients with a substance use disorder (SUD) often present with co-occurring chronic conditions in primary care. Despite the high co-occurrence of chronic medical conditions and SUD, little is known about whether chronic condition outcomes or related service utilization in primary care varies between patients with versus without documented SUDs. This study examined whether having a SUD influenced the use of primary care services and common chronic condition outcomes for patients with diabetes, hypertension, and obesity.Methods: A longitudinal cohort observational study examined electronic health record data from 21 primary care clinics in Washington and Idaho to examine differences in service utilization and clinical outcomes for diabetes, hypertension, and obesity in patients with and without a documented SUD diagnosis. Differences between patients with and without documented SUD diagnoses were compared over a three-year window for clinical outcome measures, including hemoglobin A1c, systolic and diastolic blood pressure, and body mass index, as well as service outcome measures, including number of encounters with primary care and co-located behavioral health providers, and orders for prescription opioids. Adult patients (N = 10,175) diagnosed with diabetes, hypertension, or obesity before the end of 2014, and who had ≥2 visits across a three-year window including at least one visit in 2014 (baseline) and at least one visit occurring 12 months or longer after the 2014 visit (follow-up) were examined.Results: Patients with SUD diagnoses and co-occurring chronic conditions were seen by providers more frequently than patients without SUD diagnoses (p's < 0.05), and patients with SUD diagnoses were more likely to be prescribed opioid medications. Chronic condition outcomes were no different for patients with versus without SUD diagnoses.Discussion: Despite the higher visit rates to providers in primary care, a majority of patients with SUD diagnoses and chronic medical conditions in primary care did not get seen by co-located behavioral health providers, who can potentially provide and support evidence informed care for both SUD and chronic conditions. Patients with chronic medical conditions also were more likely to get prescribed opioids if they had an SUD diagnosis. Care pathway innovations for SUDs that include greater utilization of evidence-informed co-treatment of SUDs and chronic conditions within primary care settings may be necessary for improving care overall for patients with comorbid SUDs and chronic conditions. [ABSTRACT FROM AUTHOR]- Published
- 2020
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29. Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network.
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Hallgren, Kevin A., Witwer, Elizabeth, West, Imara, Baldwin, Laura-Mae, Donovan, Dennis, Stuvek, Brenda, Keppel, Gina A., Mollis, Brenda, and Stephens, Kari A.
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OPIOID abuse , *ALCOHOLISM , *PRIMARY care , *RURAL health clinics , *DIAGNOSIS , *THERAPEUTICS , *SUBSTANCE abuse treatment , *THERAPEUTIC use of narcotics , *SUBSTANCE abuse diagnosis , *SUBSTANCE abuse , *ANALGESICS , *PRIMARY health care , *DISEASE prevalence , *RESEARCH funding - Abstract
Background: Most people with alcohol or opioid use disorders (AUD or OUD) are not diagnosed or treated for these conditions in primary care. This study takes a critical step toward quantifying service gaps and directing improvement efforts for AUD and OUD by using electronic health record (EHR) data from diverse primary care organizations to quantify the extent to which AUD and OUD are underdiagnosed and undertreated in primary care practices.Methods: We extracted and integrated diagnosis, medication, and behavioral health visit data from the EHRs of 21 primary care clinics within four independent healthcare organizations representing community health centers and rural hospital-associated clinics in the Pacific Northwest United States. Rates of documented AUD and OUD diagnoses, pharmacological treatments, and behavioral health visits were evaluated over a two-year period (2015-2016).Results: Out of 47,502 adult primary care patients, 1476 (3.1%) had documented AUD; of these, 115 (7.8%) had orders for AUD medications and 271 (18.4%) had at least one documented visit with a non-physician behavioral health specialist. Only 402 (0.8%) patients had documented OUD, and of these, 107 (26.6%) received OUD medications and 119 (29.6%) had at least one documented visit with a non-physician behavioral health specialist. Rates of AUD diagnosis and AUD and OUD medications were higher in clinics that had co-located non-physician behavioral health specialists.Conclusions: AUD and OUD are underdiagnosed and undertreated within a sample of independent primary care organizations serving mostly rural patients. Primary care organizations likely need service models, technologies, and workforces, including non-physician behavioral health specialists, to improve capacities to diagnose and treat AUD and OUD. [ABSTRACT FROM AUTHOR]- Published
- 2020
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30. Referral of patients from rural primary care clinics to telemedicine vendors for opioid use disorder treatment: A mixed-methods study.
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Lin, Chunqing, Zhu, Yuhui, Mooney, Larissa J, Ober, Allison, Clingan, Sarah E, Baldwin, Laura-Mae, Calhoun, Stacy, and Hser, Yih-Ing
- Abstract
Rural primary care clinics can expand their medication treatment for opioid use disorder (MOUD) capacity by coordinating care with external telemedicine (TM) vendors specializing in addiction medicine. This study used mixed methods to identify factors that influence patient referrals from rural primary care clinics to TM vendors for MOUD.Between July/August 2020 and January/February 2021, 582 patients with OUD were identified across six primary care sites; that included 68 referred to an external TM vendor to receive MOUD. Mixed effects logistic regression identified individual and site-level factors associated with being referred to the TM vendor. Clinic providers and staff participated in in-depth interviews and focus groups to discuss their considerations for referring patients to the TM vendor.Patient referrals were positively associated with local household broadband coverage (OR = 2.55, p < 0.001) and negatively associated with local population density (OR = 0.01, p = 0.003) and the number of buprenorphine prescribers in the county (OR = 0.85, p < 0.001). Clinic personnel expressed appreciation for psychiatric expertise and the flexibility to access MOUD brought by the TM vendor. Perceived concerns about TM referral included a lack of trust with external providers, uncertainty about TM service quality, workflow delays, and patients’ technological and insurance challenges.This study revealed several clinic-level factors that may potentially influence patient referral to TM vendor services for MOUD. To facilitate the referral process and utilization of TM vendors, efforts should be made to foster open communication and trust between clinic providers and TM vendors, streamline workflows, and improve Internet access for patients. [ABSTRACT FROM AUTHOR]
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- 2024
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31. Stakeholder perspectives on a telemedicine referral and coordination model to expand medication treatment for opioid use disorder in rural primary care clinics.
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Ober, Allison J., Dopp, Alex R., Clingan, Sarah E., Curtis, Megan E., Lin, Chunqing, Calhoun, Stacy, Larkins, Sherry, Black, Megan, Hanano, Maria, Osterhage, Katie P., Baldwin, Laura-Mae, Saxon, Andrew J., Hichborn, Emily G., Marsch, Lisa A., Mooney, Larissa J., and Hser, Yih-Ing
- Subjects
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CLINICAL drug trials , *PILOT projects , *SUBSTANCE abuse , *STAKEHOLDER analysis , *RURAL conditions , *ATTITUDES of medical personnel , *BUPRENORPHINE , *INTERVIEWING , *SOCIAL stigma , *PRIMARY health care , *PATIENTS' attitudes , *MEDICAL referrals , *DESCRIPTIVE statistics , *PATIENT compliance , *CONTENT analysis , *THEMATIC analysis , *LOGISTIC regression analysis , *TELEMEDICINE - Abstract
Opioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD) are effective and can be delivered in primary care, but uptake has been limited in rural communities. Referral to and coordination with an external telemedicine (TM) vendor by rural primary care clinics for MOUD (TM-MOUD) may increase MOUD access for rural patients, but we know little about perspectives on this model among key stakeholders. As part of a TM-MOUD feasibility study, we explored TM-MOUD acceptability and feasibility among personnel and patients from seven rural primary care clinics and a TM-MOUD vendor. We conducted virtual interviews or focus groups with clinic administrators (n = 7 interviews), clinic primary care and behavioral health providers (8 groups, n = 30), other clinic staff (9 groups, n = 37), patients receiving MOUD (n = 16 interviews), TM-MOUD vendor staff (n = 4 interviews), and vendor-affiliated behavioral health and prescribing providers (n = 17 interviews). We asked about experiences with and acceptability of MOUD (primarily buprenorphine) and telemedicine (TM) and a TM-MOUD referral and coordination model. We conducted content analysis to identify themes and participants quantitatively rated acceptability of TM-MOUD elements on a 4-item scale. Perceived benefits of vendor-based TM-MOUD included reduced logistical barriers, more privacy and less stigma, and access to services not available locally (e.g., counseling, pain management). Barriers included lack of internet or poor connectivity in patients' homes, limited communication and trust between TM-MOUD and clinic providers, and questions about the value to the clinic of TM-MOUD referral to external vendor. Acceptability ratings for TM-MOUD were generally high; they were lowest among frontline staff. Rural primary care clinic personnel, TM-MOUD vendor personnel, and patients generally perceived referral from primary care to a TM-MOUD vendor to hold potential for increasing access to MOUD in rural communities. Increasing TM-MOUD uptake requires buy-in and understanding among staff of the TM-MOUD workflow, TM services offered, requirements for patients, advantages over clinic-based or TM services from clinic providers, and identification of appropriate patients. Poverty, along with patient hesitation to initiate treatment, creates substantial barriers to MOUD treatment generally; insufficient internet availability creates a substantial barrier to TM-MOUD. • Referral from primary care to a TM-MOUD vendor is generally acceptable to providers, staff and patients • Referral from primary care to a TM-MOUD vendor could increase access to MOUD in rural communities • Successful implementation of a TM-MOUD referral model requires time, investment, clear communication, and trust • Insufficient internet availability must be addressed to successfully improve TM- MOUD • TM-MOUD might be more appropriate for patients who are tech-savvy, have technology access, and are ready for treatment [ABSTRACT FROM AUTHOR]
- Published
- 2024
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32. Use of an electronic health record data sharing system for identifying current contraceptive use within the WWAMI region Practice and Research Network.
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Godfrey, Emily M., West, Imara I., Holmes, John, Keppel, Gina A., and Baldwin, Laura-Mae
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ELECTRONIC health records , *CONTRACEPTIVES , *ELECTRONICS , *PRIMARY care , *FAMILY medicine - Abstract
Objective: To evaluate the ability of electronic health record (EHR) data extracted into a data-sharing system to accurately identify contraceptive use.Study Design: We compared rates of contraceptive use from electronic extraction of EHR data via a data-sharing system and manual abstraction of the EHR among 142 female patients ages 15-49 years from a family medicine clinic within a primary care practice-based research network (PBRN). Cohen's kappa coefficient measured agreement between electronic extraction and manual abstraction.Results: Manual abstraction identified 62% of women as contraceptive users, whereas electronic extraction identified only 27%. Long acting reversible (LARC) methods had 96% agreement (Cohen's kappa 0.78; confidence interval, 0.57-0.99) between electronic extraction and manual abstraction. EHR data extracted via a data-sharing system was unable to identify barrier or over-the-counter contraceptives.Conclusions: Electronic extraction found substantially lower overall rates of contraceptive method use, but produced more comparable LARC method use rates when compared to manual abstraction among women in this study's primary care clinic.Implications: Quality metrics related to contraceptive use that rely on EHR data in this study's data-sharing system likely under-estimated true contraceptive use. [ABSTRACT FROM AUTHOR]- Published
- 2018
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33. Nonrecommended Breast and Colorectal Cancer Screening for Young Women: A Vignette-Based Survey
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Kadivar, Hajar, Goff, Barbara A., Phillips, William R., Andrilla, C. Holly A., Berg, Alfred O., and Baldwin, Laura-Mae
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BREAST cancer diagnosis , *COLON cancer diagnosis , *YOUNG women , *MEDICAL care surveys , *MEDICAL screening , *DISEASE prevalence , *GENERAL practitioners , *PRIMARY care , *DISEASES - Abstract
Background: Little is known about the prevalence of physicians offering nonrecommended breast or colorectal cancer screening for young women. Purpose: The goal of the current paper was to examine the percentage of primary care physicians nationally who self-report offering breast or colorectal cancer screening tests for young women, and physician/practice characteristics associated with such recommendations. Methods: Analysis was performed in 2011 on data from a 2008 cross-sectional survey presenting a vignette of a health maintenance visit by an asymptomatic woman aged 35 years. This study included surveys sent to 1546 U.S. family physicians, general internists, and obstetrician–gynecologists aged <65 years, randomly selected from the AMA Physician Masterfile (60.6% response rate). Relevant respondent subsamples were used for the breast (n=505) and colorectal (n=721) cancer screening analyses. Responses were weighted to represent physicians nationally. The main outcome was physician self-report of offering breast or colorectal cancer screening tests. Results: 75.3% (95% CI =71.0%, 79.2%) of physicians offered breast cancer screening tests; most commonly these physicians reported offering mammography alone (76.5%, 95% CI= 71.6%, 80.8%). A total of 39.3% (95% CI=35.5%, 43.2%) of physicians offered colorectal cancer screening tests; most commonly these physicians reported offering FOBT alone (43.3%, 95% CI=37.2%, 49.6%). In adjusted analysis, physician factors associated with offering breast and colorectal cancer screening tests were: estimating higher patient breast/colorectal cancer risk, and not listing the U.S. Preventive Services Task Force as a top influential organization. Conclusions: A high percentage of physicians report offering nonrecommended breast or colorectal cancer screening tests for young women. Physicians'' higher cancer-risk estimation accounted for some overscreening, but even physicians who estimated the patient to be at the same risk as the general population reported offering nonrecommended screening tests. [Copyright &y& Elsevier]
- Published
- 2012
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