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Primary care has changed in the past 40 years, and research performed within and by practice-based research networks (PBRN) needs to change to keep up with the current practice landscape. A key task for PBRNs is to connect with today's stakeholders, not only the traditional physicians, providers, office staff, and patients, but health systems, insurance companies, and government agencies. In addition to one-time externally funded engagement efforts, PBRNs must develop and report on sustainable, long-term strategies. PBRNs are also demonstrating how they use classic practice-based research techniques of practice facilitation and electronic health record (EHR) data extraction and reporting in new and important research areas, such as studying the opioid epidemic. PBRNs are adapting and transforming along with primary care., Competing Interests: Conflict of interest: none declared., (© Copyright 2019 by the American Board of Family Medicine.)

Background: Family medicine offices may play an important role in the transmission of common illnesses such as upper respiratory tract infections (URTIs). There has, however, been little study of whether physicians teach patients about URTI transmission and what their own actions are to prevent infection. The purpose of this study was to assess the quality of hand hygiene and the frequency with which family physicians and staff touch their eyes, nose, and mouth (the T-zone) as well as physician and staff self-reported behaviors and recommendations given to patients regarding URTI prevention., Methods: We observed family physicians and staff at 7 offices of the Cincinnati Area Research and Improvement Group (CARInG) practice-based research network for the quality of hand hygiene and number of T-zone touches. After observations, participants completed surveys about personal habits and recommendations given to patients to prevent URTIs., Results: A total of 31 clinicians and 48 staff participated. They touched their T-zones a mean of 19 times in 2 hours (range, 0-105 times); clinicians did so significantly less often than staff (P < .001). We observed 123 episodes of hand washing and 288 uses of alcohol-based cleanser. Only 11 hand washings (9%) met Centers for Disease Control and Prevention criteria for effective hand washing. Alcohol cleansers were used more appropriately, with 243 (84%) meeting ideal use. Participants who were observed using better hand hygiene and who touched their T-zone less report the same personal habits and recommendations to patients as those with poorer URTI prevention hygiene., Conclusions: Clinicians and staff in family medicine offices frequently touch their T-zone and demonstrate mixed quality of hand cleansing. Participants' self-rated URTI prevention behaviors were not associated with how well they actually perform hand hygiene and how often they touch their T-zone. The relationship between self-reported and observed behaviors and URTIs in family medicine office settings needs further study.

Background: The best ways to communicate test results in primary care to achieve patient satisfaction and assist patients to incorporate results into their personal health decision making are unknown. A study was conducted to determine the factors that patients believe are important in achieving those goals., Methods: Semistructured interviews were conducted with a convenience sample of 12 adults, at least half with a chronic disease requiring regular testing, who shared experiences about receiving test results from physicians' offices and how they used them in their health decision making. In addition, "think aloud" interviewing techniques were used to assess participants' satisfaction and stated understanding with six different formats for receiving a hypothetical test result (a mildly elevated lipid profile). The interviews were analyzed using the editing technique to determine important factors in test results notification., Findings: Three themes were found to be important in satisfaction with and stated understanding and use of test results: (1) the information shared (test result, clinician interpretation and guidance), (2) significance of the results (testing purpose, abnormal or normal result) and (3) personal preferences for communication (timeliness, interpersonal connection, and hard copy). Participants' stated understanding was highest, among several potential formats, for actual values with desired/normal values, a low-literacy description of the test's purpose, and a simple graph., Conclusions: A results notification algorithm includes (1) communication elements (the purpose of the test, the actual results with desired values, clinician guidance, and a graphical representation) and (2) appropriate choice of notification technique (phone/visit for diagnostic tests and all significantly abnormal results and mail/e-mail/Web for all others).

Purpose: We wanted to explore how patients' experiences with preventable problems in primary care have changed their behavioral interactions with the health care system., Methods: We conducted semistructured interviews with 24 primary care patients, asking them to describe their experiences with self-perceived preventable problems. We analyzed these interviews using the editing method and classified emotional and behavioral responses to experiencing preventable problems., Results: Anger was the most common emotional response, followed by mistrust and resignation. We classified participants' behavioral responses into 4 categories: avoidance (eg, stop going to the doctor), accommodation (eg, learn to deal with delays), anticipation (eg, attend to details, attend to own emotions, acquire knowledge, actively communicate), and advocacy (eg, get a second opinion)., Conclusions: Understanding how patients react to their experiences with preventable problems can assist health care at both the physician-patient and system levels. We propose an association of mistrust with the behaviors of avoidance and advocacy, and suggest that further research explore the potential impact these patient behaviors have on the provision of health care.

Background: Errors occur frequently in management of the testing process in primary care physicians' offices. These errors may result in significant harm to patients and lead to inefficient practice. Important issues are summarized for primary care clinicians and their offices toconsider in improving the management of the testing processes., Methods: To identify published efforts to improve management of the testing process, a literature search was performed and the references from the identified articles were checked for additional studies. Descriptive studies, expert opinion pieces, and controlled trials were all included. Unpublished results of ongoing studies in laboratory testing errors in primary care practice are presented., Results: A conceptual model of the testing process was developed, with identified general and specific errors that occur in the testing process. On the basis largely of descriptive studies, ways are described to reduce testing process errors and the harm resulting from these errors., Conclusions: Standardization of processes, computerized test tracking systems (especially those embedded in electronic medical records), and attention to human factors issues are likely to reduce errors and harm. These ideas need confirmation in well-designed randomized trials and quality improvement initiatives.

Objective: To describe and classify process errors and preventable adverse events that occur from medical care in outpatient primary care settings., Study Design: Systematic review and synthesis of the medical literature., Data Sources: We searched MEDLINE and the Cochrane Library from 1965 through March 2001 with the MESH term medical errors, modified by adding family practice, primary health care, physicians/family, or ambulatory care and limited the search to English-language publications. Published bibliographies and Web sites from patient safety and primary care organizations were also reviewed for unpublished reports, presentations, and leads to other sites, journals, or investigators with relevant work. Additional papers were identified from the references of the papers reviewed and from seminal papers in the field., Outcomes Measured: Process errors and preventable adverse events., Results: Four original research studies directly studied and described medical errors and adverse events in primary care, and 3 other studies peripherally addressed primary care medical errors. A variety of quantitative and qualitative methods were used in the studies. Extraction of results from the studies led to a classification of 3 main categories of preventable adverse events: diagnosis, treatment, and preventive services. Process errors were classified into 4 categories: clinician, communication, administration, and blunt end., Conclusions: Original research on medical errors in the primary care setting consists of a limited number of small studies that offer a rich description of medical errors and preventable adverse events primarily from the physician's viewpoint. We describe a classification derived from these studies that is based on the actual practice of primary care and provides a starting point for future epidemiologic and interventional research. Missing are studies that have patient, consumer, or other health care provider input.

Purpose: Research on primary care's role in a pandemic response has not adequately considered the day-to-day needs of clinicians in the midst of a crisis. We created an Oregon COVID-19 ECHO (Extension for Community Healthcare Outcomes) program, a telementoring education model for clinicians. The program was adapted for a large audience and encouraged interactivity among the hundreds of participants via the chat box. We assessed how chat box communications within the statewide program identified and ameliorated some of clinicians' needs during the pandemic.Methods: We conducted a qualitative analysis of chat box transcripts from 11 sessions.We coded transcripts using the editing method, whereby analysts generate categories predominantly from the data, but also from prior knowledge. We then explored the context of clinicians' needs in a pandemic, as conceptualized in Maslow's hierarchy of needs adapted for physicians: physiologic, safety, love and belonging, esteem, and self-actualization.Results: The mean number of chat box participants was 492 per session (range, 385 to 763). Participants asked 1,462 questions and made 819 comments throughout the program. We identified 3 key themes: seeking answers and trustworthy information, seeking practical resources, and seeking and providing affirmation and peer support. These themes mapped onto the Maslow's needs framework. We found that participants were able to create a virtual community in the chat box that supported many of their needs.Conclusions: Using a novel data source, we found sharing the experience of practicing in a rapidly changing environment via comments and questions in an ECHO program both defined and supported participants' needs. [ABSTRACT FROM AUTHOR]

The article presents a commentary on rapid deployment of a statewide COVID-19 Extension for Community Healthcare Outcomes (ECHO) Program for frontline clinicians. Topics include urgent need for the rapid dissemination of emerging public health and treatment best practices, scientific evidence, and available resources for rural clinicians; and ideal model for the rapid dissemination of pertinent information to rural clinicians during a crisis.