Dissertations / Theses on the topic 'Primary care (Medicine)'
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1
Bumgarner, D., K. Owens, J. Correll, W. T. Dalton, and Jodi Polaha. "Primary Behavioral Health Care in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6597.
2
Polaha, Jodi. "ADHD in Primary Care." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6690.
3
Polaha, Jodi. "Primary Care Behavioral Health." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6676.
4
Patel, Vaishal J. "MGH Internal Medicine Associates : primary care redesign." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/99015.
Abstract:
Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2015. In conjunction with the Leaders for Global Operations Program at MIT.Thesis: S.M., Massachusetts Institute of Technology, Engineering Systems Division, 2015. In conjunction with the Leaders for Global Operations Program at MIT.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 105-107).
Internal Medicine Associates (IMA) is the largest primary care practice at Massachusetts General Hospital (MGH) with over 40 attending physicians, 60 residents, and 80 support staff that deliver care to more than 30,000 patients. The IMA is structured into seven pods that act independently to serve patients. Each pod consists of patient care providers and support staff that work collaboratively in a team structure. In particular, providers and medical assistants work closely together during the clinical session to meet patient needs. A lack of standardization in the practice's operations has contributed to inefficiencies that add to a sense of overload and burnout with the medical assistant staff A detailed study of providers' clinical schedules revealed that individual clinical sessions are highly variable in terms of the number of concurrent clinical sessions per pod, session length, and number of patient appointments booked during this time. Providers in the IMA are part-time and create their clinical schedules based on personal preference and coordination with their other MGH related commitments. Variability in the schedule arises from many systematic, predictable, and unpredictable sources. Additionally, as part of a teaching hospital, IMA supports the educational training of over 60 Internal Medicine residents who hold a varying number of clinical sessions per week, depending on specific requirements of their residency program. Coordinating and supporting provider presence consumes many resources, impacts medical assistant workload, and adds to variability within the practice. The project develops an optimization model to level-load the expected workload on medical assistants and other members of the medical care team by determining the clinic schedules of providers. The expected workload is measured by the number of concurrent sessions and expected number of patient visits per hour. The project has developed an optimization model to suggest changes to the clinic schedule. Specifically in Pod 2/3, by strategically shifting 19.5% of provider sessions, we can achieve an 83% improvement in variability, as measured by the difference between maximum and minimum expected workload. Similar results are modeled for all pods in the IMA. The team has identified a pilot pod to test the model and is
by Vaishal J. Patel.
M.B.A.
S.M.
5
Dodd, Will. "Primary Care Cases." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8930.
6
Blackwelder, Reid B. "Primary Care Approach to Cough." Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/6994.
7
Stratelis, Georgios. "Chronic Obstructive PulmonaryDisease : Early detection and prevention in primary care." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-20736.
Abstract:
Background and aims. Early detection of Chronic Obstructive Pulmonary Disease (COPD) and secondary prevention by means of smoking cessation are the only available methods of stopping the progression of the disease. The overall aim was to examine the possibilities of early detection and prevention of COPD in General Practice. The specific aims were to evaluate a method of detecting COPD at its early stages, to investigate the rate of emphysema in smokers with normal lung function and smokers defined as preclinical COPD, to investigate the effects of performed spirometries and brief smoking cessation advice on smoking habits and to test if concentrations of certain biomarkers in blood, saliva and exhaled breath condensate (EBC) could identify subjects with COPD or non-COPD subjects supposed to be at risk of developing COPD. Methods. The first study evaluated an invitational method, which offered voluntary screening spirometry to a targeted population of smokers 40-55 years old. In the second follow-up study, all smokers with COPD and half of the smokers with normal lung function (NLF) were annually invited for spirometry and brief smoking cessation advice for a duration of 3 years, with half of the smokers with NLF being tested only last year. In the third study, 54 smokers with NLF were examined with High Resolution Computed Tomography (HRCT), with blood samples also being collected from each subject. In study four, 19 subjects categorised as having COPD, 30 non-COPD subjects and 15 healthy non-smoking volunteers were studied by means of spirometry, DLCO, and analysis of biomarkers in EBC, saliva and serum. Results. A total of 512 smokers responded. The prevalence of COPD was 27.5% and was classified as mild in 85% of the sufferers, moderate in 13% and severe in 2%. At year 1, 10% of the smokers with COPD had been continuously abstinent from smoking, compared to 2% of smokers with NLF. The prolonged abstinence rate increased yearly, and at year 3 the smoking cessation rates in smokers with COPD was 25% compared to 7% in smokers with NLF. By visual analysis, HRCT showed signs of emphysema in 43% of the subjects. Emphysema was also associated with low BMI. Higher serum concentrations of lysozyme and lower DLCO were recorded in those with COPD compared to non-COPD subjects. With the exception of chlorine, none of the remaining biomarkers were detected in EBC. Conclusions. By invitational targeted screening, COPD can be easily detected in its mild stages by using spirometry. By becoming diagnosed with COPD, smokers seem to be more motivated to stop smoking, and COPD patients should repeatedly be offered spirometry and smoking cessation advice which may prevent the progression of the disease to a severe disabling form. HRCT may detect smoke related parenchymal lung damage (i.e. emphysema) in symptom-free smokers with normal spirometry. Serum lysozyme and DLCO appeared to be the strongest discriminator between COPD and non-COPD subjects. The use of EBC as a tool to measure exhaled inflammatory biomarkers involved in COPD is as yet uncertain.
8
Van, Sickle K., A. Beecham, and Jodi Polaha. "Training a Workforce for Primary Care." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6583.
9
Polaha, Jodi, and Ivy Click. "Conducting Research in Primary Care Settings." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6752.
Abstract:
Book Summary: Practice-Based Research shows mental-health practitioners how to establish viable and productive research programs in routine clinical settings. Chapters written by experts in practice-based research use real-world examples to help clinicians work through some of the most common barriers to research output in these settings, including lack of access to institutional review boards, lack of organizational support, and limited access to financial resources. Specialized chapters also provide information on research methods and step-by-step suggestions tailored to a variety of practice settings. This is an essential volume for clinicians interested in establishing successful, long-lasting practice-based research programs.
10
Polaha, Jodi. "Integrating Behavioral Health Into Primary Care." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6648.
11
Polaha, Jodi. "Practice Transformation in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/6665.
Abstract:
This session will describe the evolution of the Pediatric Primary Behavioral Health Model in one clinic including the integration of behavioral health and social services into a residency training clinic. The implementation strategy used to develop this model will be described.
12
Holt, Jim. "Addressing Childhood Obesity in Primary Care Practice." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/6508.
13
Polaha, Jodi. "Postpartum Depression in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6677.
14
Manson, Leslie, Tawnya Meadows, Jodi Polaha, Sarah Trane, Robert M. Tolliver, Allison Dixson, Julie M. Austen, Hayley Quinn, and Sonny Pickowitz. "Toolkit for PCBH in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6660.
15
Polaha, Jodi. "Psychologists as Scientists in Integrated Primary Care." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6763.
Abstract:
This course will help psychologists-in-training begin to develop the knowledge, attitudes, and skills to provide leadership, clinical and consultation services, as well as program development and evaluation assistance in primary care settings. The “plug and play” structure of the course is designed to enable all graduate programs, even those who do not have faculty with direct primary care experience, offer training to students in this burgeoning area of integrated primary care.
Each module includes PowerPoint lectures with faculty notes, student exercises, illustrative videos that are easily accessed when the PowerPoint is in full screen mode and wifi is available, resources, and references. Instructor manuals elucidate key concepts and provide additional readings and resources. The modules can be supplemented to meet individual program needs and individual modules can be used as colloquia lectures or as adjunct lectures in existing classes.
The curriculum was developed by a core group of nine primary care psychologists with vast experience working and training in integrated primary care. Some of the topic modules, such as working with older adults and managing chronic pain, were written by experts in particular subject areas, in collaboration with the core team to ensure that they retained a foundation in primary care.
16
Florini, Marita A. "Primary care providers' perception of care coordination needs and strategies in adult primary care practice." Thesis, State University of New York at Binghamton, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3630859.
Abstract:
Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.
Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.
Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.
Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.
17
Boardman, Helen Fiona. "Headache in primary care : epidemiology, management, and use of health care services." Thesis, Keele University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275244.
18
Polaha, Jodi. "Champion Teams to Do QI in Primary Care." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6654.
19
Dyer, Halie, Byron Brooks, Karen Schetzina, and Jodi Polaha. "Behavioral Health Referrals in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6624.
Abstract:
Integrated care is rapidly becoming the new paradigm of healthcare and with the transition into integrated practice, many providers from various disciplines must determine how best to work as a team to improve patient outcomes. One particular setting where the logistics of integrated practice must be scrutinized is pediatric primary care, specifically in rural areas, as many psychological problems are presented in pediatric primary care, and rural children are at greater risk for engaging in unhealthy behaviors, such as sedentary lifestyle, poorer nutrition, and greater substance use. All of these concerns can be ameliorated with successful referral to behavioral health consultants (BHC) who can assist in treating these various psychosocial issues. In order for the BHC to assist with patients with psychosocial concerns, other medical providers must be able to recognize and refer these patients to the BHC. The purpose of this study was to determine the prevalence of psychosocial concerns in pediatric primary care and how often the attending medical provider noticed these concerns and referred the patient for behavioral health services. The study also examined what types of psychosocial concerns were raised, and if the referral was not addressed during the same visit, the latency between the initial referral and the behavioral health service. Retrospective electronic health record data (N=300) was collected from the well visits of all 4 and 5 year old patients in 2014 from a rural Appalachian pediatric primary care clinic. Results indicated that when a psychosocial issue was raised, the majority of medical providers appropriately referred the patient to the BHC. Psychosocial concerns were raised in 21.3% (n=64) of visits. When psychosocial concerns were raised, 62.5% (n=40) were referred for behavioral health services with 87.5% (n=35) to the in house BHC. When patients were referred to the in-house BHC, 83.3% (n =30) received services immediately, while patients who were not seen immediately, 16.7% (n=5), waited for an average 21 days to be seen by the BHC. The most common psychosocial concerns raised were related to toilet training, temper tantrums, sleep hygiene, and hyperactivity. These findings highlight the high prevalence of psychosocial issues presented in rural pediatric primary care and the continued education of providers about recognizing these concerns so the appropriate referral can be made. These findings also highlight the need for more integrated practice as primary care is the often the primary source of healthcare in rural areas and by addressing all concerns about patient well-being in this setting via integrated care, patient physical and mental health outcomes can be greatly improved.
20
Mukiapini, Shapi. "Baseline measures of Primary Health Care Team functioning and overall Primary Health Care performance at Du Noon Community Health Centre." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24504.
Abstract:
Background: The importance of effective team work for improving quality of care has been demonstrated consistently in research. We conducted a baseline measure of team effectiveness and a baseline measure of primary health care performance. Aim: To improve Primary health care team effectiveness and ultimately the quality and user experience of primary care at Du Noon Community Health Centre. (CHC) Setting: Du Noon CHC in the southern/western substructure of the Cape Town Metro district services. Methods: A cross sectional study using a combination of Nominal Group Technique (NGT) method and a questionnaire survey to assess PHC team effectiveness and to obtain baseline measure for Primary Health Care (PHC) organization and performance. Results: Data from 20 providers from the primary health care team, showed that the PHC team members perceived their team as a well functioning team (70% agreement on the 7 items of the PHC team assessment tool, incorporated in the ZA PCAT. The NGT method reveals that communication and leadership are the main challenges to effective team functioning, The NGT also provides ideas on how to deal with these challenges. Data from 110 users and 12 providers using the ZA PCAT: 18.2% of users rated first contact-access as acceptable to good; 47,3% rated ongoing care as acceptable to good. The remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 65% of the users. 33% of the providers (doctors and clinical nurse practitioners) rated first contact-access as acceptable to good; 25% rated ongoing care as acceptable to good, the remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 50% of providers. First contact-access received the lowest acceptable to good score (18.2%) and comprehensiveness (service available) received the highest score (88.2%) from the users. For the providers the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team (100%). The total primary scores are good (above 60%) for both users and providers but moderately higher for the providers. Conclusions: How teams perceive their effectiveness can motivate them to generate ideas for improvement. There were discrepancies between ZA PCAT (PHC team functioning) results and the NGT method results. The ZA PCAT (8 pre-existing domains) baseline results show a contrast between providers' and users' perceptions of the PHC system at Du Noon consistent with the finding of the Western Cape ZA PCAT study. We encourage Du Noon CHC to use these results to improve the user experience of primary health care services there.
21
Wu, Olivia. "Pharmacoeconomic evaluations and primary care prescribing." Thesis, University of Glasgow, 2004. http://theses.gla.ac.uk/2985/.
Abstract:
This study aimed to investigate the effect of incorporating adverse drug reactions in economic analyses of drug therapies. Subsequently, the impact of this information on prescribing in primary care is explored. In order to achieve the aims of the study, three main studies were conducted. In the first study, an economic analysis was conducted to estimate the comparative costs of a large UK population (N = 98 887) given nonsteroidal anti-inflammatory drug (NSAID) therapy alone and in combination of gastrointestinal (GI) protective agents including concomitant prescriptions of H2 blockers, omeprazole and misoprostol. The second study was a pharmacoeconomic analysis, using data from the literature and local expert opinion, of three commonly prescribed classes of drugs in primary care – NSAIDs, selective serotonin reuptake inhibitors (SSRIs) and angiotensin converting enzyme (ACE) inhibitors for the treatment of rheumatoid arthritis, depression and hypertension respectively. Finally, the results from the pharmacoeconomic analysis were disseminated to GPs in a local Health Board to explore the impact on influencing primary care prescribing. Economic analyses based on various data sources have shown that the total cost of drug therapies are often much higher than the purchasing cost alone. There is much value in taking into account the clinical and economic impact of drug-induced ADRs when conducting pharmacoeconomic evaluations. However, this is often restricted by the availability of some of the data that are required to complete the economic model. The necessary data do exist, but linked clinical data for this type of analysis are not readily available for research purposes. General practitioners were generally supportive of economic evaluations and the exploratory study on disseminating pharmacoeconomic information. However, the dissemination exercise had failed to demonstrate a positive relationship. In addition to the barriers highlighted in the literature, it was found that GPs do not feel that there is a role for the implementation of economic information in primary care.
22
Chesley, Kayla Lynn. "Combating Youth Depression in Primary Care." Diss., North Dakota State University, 2016. https://hdl.handle.net/10365/28254.
Abstract:
Youth depression is a serious mental health disorder that may have detrimental consequences. Half of all lifetime cases of mental illness begin before the age of 14 (Hagan, Shaw, & Duncan, 2008). Depression in youth is linked to increased morbidity and mortality, along with high-risk behaviors. Mental health and mood disorders are the leading cause of illness and burden among youth (Patel, 2013). Nationally, suicide is the third leading cause of death for individuals aged 15 to 24. In North Dakota, suicide is the first leading cause of death for individuals aged 15 to 24 (American Foundation for Suicide Prevention, 2016). Unfortunately, depression remains largely underdiagnosed and undertreated; only about 50 percent of youth with depression are diagnosed before they reach adulthood (Zuckerbrot, Cheung, Jensen, Stein, & Laraque, 2007). The purpose of this project was to improve the mental health of youth through increasing universal screening in the primary care setting, and improve the confidence and ability of the primary care provider to diagnose and treat youth depression. Primary care provider education was launched through collaboration with Essentia Health, providing education regarding youth depression focused on universal screening, identification of youth depression, and treatment modalities. To evaluate primary care provider education, a pretest/posttest was completed, along with key stakeholder interviews. Surveys demonstrated an increased intent to screen and increased confidence in identifying and managing youth depression. The interview with key stakeholders was used to determine the effectiveness and feasibility of universal screening and management of youth depression in the primary care setting.
23
Coyle, Natalie. "Primary Health Care Reform: Who joins a Family Medicine Group?" Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=106399.
Abstract:
Reorganization of primary health care is being actively pursued and new models of primary health care delivery are being developed in the U.S. and in several Canadian provinces. In Quebec, Family Medicine Groups (FMGs) were created in 2002 in order to provide enhanced access and better coordination of care through a team based approach to primary care. Previous research on new models of primary health care has often failed to evaluate their effects within a causal inference framework, and little attention has been paid to the type of physicians and patients that voluntarily join them. Understanding who is attracted to new models is not only important to adjust for selection bias, but it may affect future reforms by helping to elucidate what would happen if FMGs were implemented on a population level. This thesis attempts to understand the voluntary selection of patients and physicians into Family Medicine Groups in Quebec, Canada. A longitudinal administrative dataset of vulnerable patients (elderly or chronically ill) from the Régie de l'assurance maladie du Québec (RAMQ) has been divided between FMG and non-FMG users, and includes information on demographic characteristics, chronic illnesses and ambulatory and tertiary health service use before the advent of FMGs. Physicians of these patients are characterized by their FMG status, demographics, and practice and patient characteristics before FMGs are in place. Multivariate regression is used to identify key predictors of joining a FMG among both patients and physicians. Lastly, comparable physician and patient populations are created using propensity scores in order to set up the evaluation of health outcomes, utilization of services and costs in the years after joining a FMG. The distribution of propensity scores and their ability to balance key covariates after different matching and weighting techniques was investigated. Results of the analysis reveal that geographic location, socio-economic status, visits in an ambulatory setting, emergency room visits, hospitalizations and having a usual provider of care are all factors which affect the probability of a patient joining a FMG. Specifically, residents of remote regions, low socio-economic status and those who use emergency rooms and hospitals more often are more likely to be enrolled, whereas patients that use ambulatory services and have a usual provider of care are less likely to be enrolled. Similarly, it is shown that factors that affect a physician's likelihood of joining a FMG include time since graduation, geographic region and revenue from traditional fee-for-service vs. other sources. Younger physicians and those who practice in a local community centre (CLSC) and short term/acute inpatient hospital care (CHSCD) are more likely to participate. Propensity scores were able to balance the pre-treatment differences, and this finding is robust across different mechanisms of adjusting for the propensity score. Overall, it was shown that participation in a FMG is not a random process and any further research on the effect of FMGs, or any other type of primary health care reform, should consider this. Accounting for the type of patients that join different models, by using propensity score analysis for example, will be critical to forming evidence based policy recommendations. Particular consideration for geographic location, patients' morbidity, socio-economic status, health service use, as well as physicians' age and experience working in other settings is needed.La réorganisation des soins de santé primaires est un objectif qui suscite un intérêt considérable au moment où de nouveaux modèles de prestation de soins de santé primaires sont mis en place aux États-Unis et dans plusieurs provinces canadiennes. Au Québec, les Groupes de médecine de famille (GMF) sont créés en 2002 afin de fournir un accès aux soins élargi et une meilleure coordination grâce à une approche des soins de santé primaires favorisant le travail en équipe. Les études antérieures sur les nouveaux modèles de soins de santé primaires n'incluaient généralement pas d'évaluation de leurs effets sous l'angle de l'inférence causale et peu d'attention a été accordée au type de médecins et de patients qui y participaient volontairement. Cerner le profil des personnes qui sont attirées par ces modèles est important, pas seulement pour ajuster les biais de sélection, mais cela peut aussi affecter les réformes à venir en permettant d'établir ce qui se passerait si les GMF étaient mis en place au niveau de la population entière. Cette thèse cherche à comprendre le principe de la sélection volontaire des patients et des médecins dans les Groupes de médecine de famille au Québec. Un ensemble de données administratives longitudinales sur des patients vulnérables (personnes âgées ou malades chroniques), émanant de la Régie de l'assurance maladie du Québec (RAMQ) a été divisé entre les inscrits dans les GMF et les non-inscrits. Les données comportent des informations sur les caractéristiques démographiques, les maladies chroniques ainsi que sur l'utilisation de services de santé ambulatoires et tertiaires avant la mise en place des GMF. Les médecins de ces patients sont caractérisés par leur statut de GMF, leurs données démographiques ainsi que par les spécificités de leur cabinet et de leurs patients avant la mise en place des GMF. Une régression multidimensionnelle est utilisée afin de définir les prédicteurs clés à l'inscription aux GMF à la fois pour les patients et pour les médecins. Enfin, des populations comparables de médecins et de patients sont créées en utilisant des scores de propension afin de mettre au point l'évaluation des résultats pour la santé, de l'utilisation des services et des coûts dans les années suivant l'inscription à un GMF. La distribution des scores de propension et leur capacité à équilibrer les covariables à la suite de différentes techniques de regroupement et pondération, a été examinée. Les résultats de l'analyse révèlent que la situation géographique, le statut socio-économique, les visites dans un service ambulatoire, les visites dans les salles d'urgence, les hospitalisations et le fait d'avoir un prestataire de soins habituel sont tous des facteurs qui affectent la probabilité d'inscription à un GMF. Il est aussi démontré que les facteurs qui affectent la probabilité qu'un médecin soit membre d'un GMF incluent le nombre d'années écoulées depuis l'obtention du diplôme, la situation géographique et le revenu des traditionnelles rémunérations à l'acte par rapport à celui d'autres sources. Les scores de propension ont permis d'équilibrer les différences avant traitement, ce résultat est robuste par rapport à différents mécanismes d'ajustement du score de propension. Dans l'ensemble, il est démontré que la participation à un GMF ne relève pas du hasard, ce que toute recherche additionnelle sur l'effet des GMF ou toute autre réforme des soins de santé primaires, devrait prendre en considération. La comptabilisation du type de patients qui s'inscrit dans les différents modèles, par exemple en utilisant les scores de propension, sera critique dans l'élaboration de recommandations basées sur des faits établis. La prise en compte particulière de la situation géographique, de la morbidité des patients, du statut socioéconomique, de l'utilisation des services de santé ainsi que de l'âge des médecins et de leur expérience de travail dans divers environnements apparaît nécessaire.
24
Polaha, Jodi, William T. III Dalton, and Suzanne Allen. "The Prevalence of Psychosocial Concerns in Pediatric Primary Care Serving Rural Children in Pediatric Primary Care Serving Rural Children." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6745.
Abstract:
Objectives: To examine the prevalence of parent-reported emotional and behavior problems in pediatric primary care clinics serving rural Appalachia using methods commensurate with studies of broader samples. Methods: Parents presenting to pediatric primary care clinics completed a rating scale (Pediatric Symptom Checklist) of psychosocial problems for their child. Results: Approximately 21% of all rating scales were in the clinically significant range. Across all parents, 63% identified the child’s physician as their most common source of help. In contrast, mental health professionals had been sought out by only 24% of the sample. Conclusions: These data replicate previous findings showing high rates of parent-rated psychosocial problems in pediatric primary care. Given the prevalence of these problems in primary care and parents’ frequent help seeking in this setting, more research is needed on innovative approaches to integrated care in rural settings.
25
Holmqvist, Marika. "Addressing Alcohol : Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services." Doctoral thesis, Linköpings universitet, Socialmedicin och folkhälsovetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-16815.
Abstract:
Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol. This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey. Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient. OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories. Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy. MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.
26
Polaha, Jodi, and J. Hodgeson. "INTRA-Disciplinary Care: Can Mental Health Professionals Work Together in Primary Care?" Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6767.
Abstract:
Excerpt: Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project.
27
Marerro, Magaly V. (Magaly Victoria). "Primary Care Screening for Psychological Factors." Thesis, North Texas State University, 1986. https://digital.library.unt.edu/ark:/67531/metadc331793/.
Abstract:
The Behavioral Medicine Questionnare (BMQ) is a 44- item instrument administered via a computer CRT display or pencil and paper. The BMQ was designed to help primary care physicians treating spinal disorders to screen for emotional factors which warrant further psychological evaluation. The test is composed of three scales: Anxiety, Depression, and Somatization. Concurrent validity for each scale was determined through comparisons with subject (n = 133) scores on clinician judgement ratings, pain drawings, and the MMPI. The psychometric properties of the test were supported through statistical analysis. Significant correlations were found between the BMQ, MMPI, and clinician ratings, with the latter showing relationships of lesser strength. The only significant correlation to subject generated pain drawings was to the BMQ depression scale. Analysis indicated the need for seperate norms for males and females. Further research is needed to facilitate measurement and interpretation of the BMQ.
28
Dodd, Will. "Addressing Adolescent Suicidality in Primary Care." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etsu-works/8918.
Abstract:
Develop awareness of the current literature on risk and protective factors related to adolescent suicidal thoughts and behaviors. Describe one evidence supported clinical tool that can guide adolescent suicide risk assessment in primary care
29
Baker, Robin Lynn. "Primary Care and Mental Health Integration in Coordinated Care Organizations." PDXScholar, 2017. https://pdxscholar.library.pdx.edu/open_access_etds/3616.
Abstract:
The prevalence of untreated and undertreated mental health concerns and the comorbidity of chronic conditions and mental illness has led to greater calls for the integration of primary care and mental health. In 2012, the Oregon Health Authority authorized 16 Coordinated Care Organizations (CCO) to partner with their local communities to better coordinate physical, behavioral, and dental health care for Medicaid recipients. One part of this larger effort to increase coordination is the integration of primary care and mental health services in both primary care and community mental health settings.
The underlying assumption of CCOs is that organizations have the capacity to fundamentally change how health care is organized, delivered, and financed in ways that lead to improved access, quality of care, and health outcomes. Using the Rainbow Model of Integrated Care (RMIC), this study examined the factors that impact organizational efforts to facilitate the integration of primary care and mental health through interviews with executive and senior staff from three CCOs. The RMIC focuses attention on the different levels at which integration processes may occur as well as acknowledges the role that both functional and normative enablers of integration can play in facilitating integration processes within as well as across levels. The following research question was explored: What key factors in Oregon's health care system impede or facilitate the ability of Coordinated Care Organizations to encourage the integration of primary care and mental health?
Using a case study approach, this study drew upon qualitative methods to examine and identify the factors throughout the system, organizational, professional, and clinic levels that support CCO efforts to facilitate the integration of primary care and mental health. Fourteen primary interviews were conducted with executive and senior staff. In addition, eleven secondary interviews from a NIDA funded project as well as twenty-four key CCO documents from three CCOs were also included in this study.
The RMIC was successful in differentiating extent of CCO integration of primary care and mental health. Findings demonstrate that normative and functional enablers of integration were most prevalent at the system and organization level for integrating mental health into primary care for these three CCOs. However, there was variation in CCO involvement in the development of functional and normative enablers of integration at the professional and clinic levels. Normative and functional enablers of integration were limited at all of the RMIC levels for integrating primary care into community mental health settings across all three CCOs.
The Patient-Centered Primary Care Home model provided CCOs with an opportunity to develop functional and normative enablers of integration for integrating mental health in primary care settings. The lack of a fully developed model for integrating primary care services in community mental health settings serves as a barrier for reverse integration. An additional barrier is the instability of community mental health as compared to primary care; contributing factors include historically low wages and increased administrative burden. System wide conversations about where people are best served (i.e., primary care or community mental health) has yet to occur; yet these conversations may be critical for facilitating cross-collaboration and referral processes. Finally, work is needed to create and validate measures of integration for both primary care and community mental health settings. Overall findings confirm that integrating primary care and mental health is complex but that organizations can play an important role by ensuring the development of normative and functional enablers of integration at all levels of the system.
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Polaha, Jodi, and Karen Schetzina. "A Collaborative Practice Model for Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6670.
31
Petersson, Ulla. "Screening for Cardiovascular Risk and Diabetes in Primary Health Care : The Söderåkra Risk Factor Screening Study." Doctoral thesis, Linköpings universitet, Allmänmedicin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17692.
Abstract:
Background: Cardiovascular disease (CVD) has been the predominant cause of morbidity and mortality for many decades in Sweden. Preventive work in primary health care through individual approach and community-based programmes has shown some success. Still, we need better risk assessment tools and health strategies to lessen the burden of CVD in our population. Methods: This thesis is based on four studies that explore the cardiovascular risk factor pattern and its development to CVD morbidity and mortality in the middle-aged (40-59 years) population in Söderåkra, southern Sweden, 1989-2006. At a single physician consultation in 1989-1990 the participants provided information about lifestyle in a self-administered questionnaire, underwent a physical examination and received medical advice after a laboratory investigation. The laboratory tests consisted mainly of blood glucose, serum lipids and thyroid function tests. Blood samples were also frozen for later analyses. A telephone interview on self-reported lifestyle changes was conducted ten years later. In 2006, primary health care medical records were studied for incident diabetes and also for impaired glucose tolerance (IGT). Finally, national registers were studied for incident fatal or nonfatal cardiovascular disease until 2006. Cardiovascular risk assessments using three separate risk algorithms were applied on the population. Results: The participation rate was high with 90% attendance. The conclusion of this cross-sectional baseline analysis was that it is meaningful to check for a secondary cause of hyperlipidemia, hypothyroidism, in women with a cholesterol value above 7.0 mmol/L. After 10 years follow-up women reported significantly more lifestyle changes than men, odds ratio (OR) 1.56 (95% CI: 1.11- 2.18; p= 0.010). Men with a history of smoking or CVD at baseline and women with treated hypertension at baseline made successful lifestyle changes, OR 4.77 (95% CI: 2.18-10.5; p<0.001 and OR 1.84 (95% CI: 1.12-3.02; p= 0.016), respectively, than those without these characteristics. Until 2006, 38 participants had developed diabetes and four subjects IGT out of 664 participants, excluding 10 with diabetes at baseline. A low level of IGFBP-1 at baseline was associated with the development of type 2 diabetes/IGT, hazard ratio (HR) 3.54 (95% CI: 1.18-10.6, p=0.024). This was independent of abdominal obesity or inflammation (CRP). After excluding 16 participants with prevalent CVD at baseline, 71 first fatal or nonfatal CVD events in 689 men and women were registered. Several known risk factors and risk markers were applied on this population. Those that turned out to be significantly associated with development of incident CVD in univariate Cox´s regression proportional hazard analyses where used in three different risk assessment models: the consultation model, SCORE and the extensive model. A non-laboratory-based risk assessment model, including variables easily obtained during one consultation visit to a general practitioner (GP), predicted cardiovascular events as accurately, HR 2.72; (CI 95% 2.18-3.39, p<0.001), as the established SCORE algorithm, HR 2.73; (CI 95% 2.10-3.55, p<0.001), which requires laboratory testing. Furthermore, adding laboratory measurements covering lipids, inflammation and endothelial dysfunction, did not confer any additional value to the prediction of CVD risk, HR 2.72; (CI 95% 2.19-3.37, p<0.001). The c-statistics for the consultation model (0.794; CI 95% 0.762-0.823) was not significantly different from SCORE (0.767; CI 95% 0.733-0.798, p=0.12) or the extended model (0.806; CI 95% 0.774-0.835, p=0.55). Conclusions: Our study showed that it is worth searching for hypothyroidism, in women with a cholesterol value above 7 mmol/L. The study identified female gender, previous CVD, hypertension and smoking as predictors of positive lifestyle change during follow-up. A low level of IGFBP-1 predicted future diabetes/IGT in this population as did increased waist and CRP. Finally, data on nonlaboratory risk factors obtained during one GP visit predicted future cardiovascular risk as accurately as SCORE or a laboratory-based risk algorithm.
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Suther, Sandra Gayle. "Genomic medicine in primary care: Texas physicians' adoption of an innovation." Texas A&M University, 2003. http://hdl.handle.net/1969.1/222.
Abstract:
New applications of genomic medicine stemming from the Human Genome Project are predicted to become routine components of primary care. Primary care physicians (PCPs) will increasingly become responsible for screening patients for inherited diseases, recommending genetic testing, and making referrals to genetic services. Clinical applications of genomic medicine will occur at a variable pace. Characteristics of an innovation such as genomic medicine are strong indicators of its potential for adoption. The purpose of this study is to assess whether (and to what extent) physicians' perceptions of genomic medicine as an innovation influence their likelihood of adopting this innovation into primary care. The study's sample consists of 400 primary care physicians in Texas and employs a survey design. Based on Rogers' Diffusion of Innovations Theory, the perceived characteristics of genomic medicine - Relative Advantage, Compatibility, Complexity, Trialability, and Observability - are the study's independent/predictor variables. Likelihood of PCPs Adopting Genomic Medicine is the dependent variable. The nature of the social system (private or group practice) is examined as a possible moderator variable. The study suggests that Texas PCPs who are likely to adopt genomic medicine strongly perceive its clinical uses (such as genetic testing for carrier status or susceptibility to common diseases, testing an embryo for genetic disorders before it is implanted, and supplementing a family history) to be highly advantageous. For half of the PCPs, genetic services such as genetic counseling and genetic testing are not compatible with current practice. Perceived complexity of the innovation is the strongest predictor of likelihood of PCPs adopting genomic medicine. Many PCPs find it difficult to stay updated on genomic medicine and locate genetic services. Although Texas PCPs feel genomic medicine can be gradually incorporated into primary care practice, most are not presently observing their colleagues adopting genomic medicine or assisting their patients to make decisions regarding genetic services.
Future efforts to advance the use of genomic medicine in primary care will require more emphasis on genetics in medical school curriculum and continuing education programs. Links with specialists trained in genetic counseling and health education will be essential to translate relevant information to patients and families.
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Crocker, Robert L., Amy J. Grizzle, Jason T. Hurwitz, Rick A. Rehfeld, Ivo Abraham, Randy Horwitz, Andrew Weil, and Victoria Maizes. "Integrative medicine primary care: assessing the practice model through patients’ experiences." BIOMED CENTRAL LTD, 2017. http://hdl.handle.net/10150/626183.
Abstract:
Background: The University of Arizona Integrative Health Center (UAIHC) was an innovative integrative medicine (IM) adult primary care clinic in Phoenix, Arizona. UAIHC used a hybrid payment model to deliver comprehensive healthcare that includes conventional and complementary medical treatments. Methods: Fidelity measures were collected to evaluate how well the IM care delivery process matched ideals for IM. Patient experiences are presented here. Patients visiting UAIHC on 1 of 10 randomly selected days between September 2013 and February 2015 were surveyed. Patients were asked about their experience with: holistic care; promotion of health, self-care, and well-being; relationship and communication with practitioners; and overall satisfaction. Results: Eighty-three patients completed surveys. Based on patient-reported experiences, UAIHC delivered IM care as defined by the practice model. Conclusions: Patients received holistic care, established positive caring relationships with providers who promoted their self-care and well-being, and reported high overall satisfaction with UAIHC.
34
Wong, Wendy, and 黃韻婷. "Effectiveness of traditional Chinese medicine in primary care in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42841586.
35
Perry, Rachel Elizabeth. "Complementary and alternative medicine in primary care : practice, attitudes and effectiveness." Thesis, University of Bristol, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.752755.
36
Wong, Wendy. "Effectiveness of traditional Chinese medicine in primary care in Hong Kong." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42841586.
37
Calloway, J., and Jodi Polaha. "Training Pediatric Residents in ADHD Management in Primary Care." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6637.
38
Slater, Julie Anne. "Occupational stress in primary health care : an investigation of the sources of stress in primary health care, the effects of these stressors on primary health care team members and the moderating effects of individual differences." Thesis, Cardiff University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.362503.
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McDowell, Joan Rachel Somerville. "Management of Type 2 diabetes mellitus in primary care." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5139/.
Abstract:
Background: The incidence and prevalence of diabetes mellitus (diabetes) is increasing globally. The majority of people have type 2 diabetes, initially managed by lifestyle changes and the gradual introduction of oral, followed by subcutaneous, medications. Due to the increasing numbers of people with type 2 diabetes, different models of care management have been utilised within the United Kingdom. One Health Board within Scotland received funding to undertake a service redesign whereby the responsibility of care for people with type 2 diabetes was transferred from secondary care to primary care, with referral to specialist services based on clinical need. Aim: The aim of this thesis is to present the body of published work on an evaluation research study on the change in service delivery for people with type 2 diabetes. The published works have arisen from two funded research studies resulting in one peer reviewed report and five peer-reviewed papers published in international journals.
40
Metzger, K., J. Ham, A. Schafer, and Jodi Polaha. "Resident Training in Primary Care Management of Knee Osteoarthritis." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6559.
41
Nelson, E., Jodi Polaha, and W. J. Kuzbyt. "Three Primary Care Approaches to ADHD Treatment Over Telemedicine." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6615.
42
Polaha, Jodi, Jesse M. Hinde, Gregory P. Beehler, and Nadiya Sunderji. "Evaluating Time in Primary Care: What Are We Busy About?" Digital Commons @ East Tennessee State University, 2019. https://doi.org/10.1037/fsh0000453.
43
Grimes, Bonnie. "Veterans with Chronic Back Pain Managed in Primary Care: Patient Aligned Care Team." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4726.
Abstract:
Chronic pain affects approximately 100 million adults in the United States annually, and costs exceeding $635 billion. Pain is the most common complaint in primary care, and chronic pain accounts for up to 16% of emergency room visits. Additionally, chronic pain accounts for 25% of missed workdays annually. Veterans are particularly vulnerable to chronic pain and have an increased incidence of chronic non-cancer pain. Chronic pain for veterans cost the Veterans Administration (VA) about $385 billion each year. This project evaluated the Patient Aligned Care Team (PACT) model to manage chronic lower back pain (CLBP) at a VA primary care center. The framework that guided the project was the theory of planned change and the chronic care model. A retrospective electronic chart review of demographic and pain management data was collected from a convenience sample of veterans (20 women, 20 men) with a history of CLBP managed by the primary care center for at least 1 year prior to and one year after the PACT model was implemented. Overall, the paired-samples t-test to was not statistically significant for improvements in veteran reported pain scores over time. However, there was a significant interaction between time and gender that indicates changes over time significantly differed because of gender. In addition, descriptively the mean pain levels were initially higher for men as compared to women, and these levels increased sharply for females over time while the men decreased. This project contributes positively to social change for veterans as the findings indicate an important gender difference in patient reported pain scores over time. There needs to be additional investigation to understand the etiology of the gender difference in the pain outcomes for CLBP.
44
Michaels-Strasser, Susan D. "The impact of care competency training for primary care nurses in South Africa." Doctoral thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/7440.
Abstract:
Includes bibliographical references (leaves 184-200).To effectively support the primary health care transformation of the South African health system, human resource development is needed. Nurses, at the forefront of primary care service delivery, urgently need support and advancement to fulfill their role. This study aimed to investigate the impact of core competency training on primary care nurse competence. To begin this investigation, a framework or core competencies was generated through two reference group meetings. This work was followed by a Delphi study to further define core competence in primary care nursing and how best to measure such competence. Nine core competencies were defined which led to the development and piloting of a core competency evaluation tool including a self-lest and observation tool. This early work was followed by the implementation and evaluation of a novel core-competency training program. This program was implemented within district health systems with working clinic nurses. It involved tour distinct sites in three different provinces. A total of 162 nurses took part in the study, including an intervention and reference group. The goal was to assess the impact of training in a real world setting. Using the self-lest and observation tools, this study showed that competence does improve with this type of training. Additionally, competence is most reliably assessed through observation since test familiarity and possible contamination decrease the usefulness of repeated self-test measures. Further assessment or this novel training program and ref1nement of the measurement tool are recommended. This study can serve to inform health policies, particularly regarding human resource development within emerging district health systems. It provides a practical and effective training approach for increasing nurse performance of primary care core competencies.
45
Mathews, J. R., J. H. Evans, Jodi Polaha, and R. J. Valleley. "A New Model for Behavioral Health Services in Primary Care." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/6616.
46
Polaha, Jodi. "The Management of Common Sleep Problems in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/6694.
47
Smith, Fiona Jane Elizabeth. "The ongoing care of patients with cancer : what is the appropriate balance of cancer care between specialists and primary care?" Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/5970/.
Abstract:
Background: Mortality rates have fallen resulting in people living longer with cancer. However, cancer survivors can face significant treatment related physical and psychosocial issues including comorbidities. Treatment related side effects can persist in the long-term or may occur many years later. There is now a focus on the best way to provide appropriate care to people who have survived cancer and its treatment. Aim: The aim of this study is to explore the appropriate balance of cancer care for patients following diagnosis and treatment between specialist and primary care. Methods: Semi-structured interviews with a purposive sample of 40 oncologists, CNSs and GPs across Scotland. Data are analysed in a systematic fashion using constant comparison. Findings: Many patients face significant health care issues after a diagnosis of cancer. Professionals often play a pivotal role during follow-up by identifying and managing patients’ physical and psychosocial needs and by sign posting to address the challenges that arise. Psychosocial needs, long-term and late effects are sometimes not addressed. Oncologists are leaders of the cancer care process. CNSs often play a central role in survivorship both in specialist and primary care. GPs’ roles are seen to span the full spectrum of survivorship care, although this is largely opportunistic in nature. Communication between specialist and primary care is a key issue. Professionals perceived that there is insufficient contact across the interface in terms of understanding others’ viewpoints about the nature of their work. Efforts are needed to improve the timeliness and detail of letters to primary care. Successful primary care follow-up may require development of nurses’ roles in general practice and the community. It is perceived that GPs could attend specialist care for survivorship education or become cancer specialists in general practice. Cancer Care Reviews are considered useful tools in terms of allowing GPs to engage with their patients. Improvements to technology and further research are considered central to optimal cancer care. Conclusion: Considerable barriers exist with the current system of follow-up. After the treatment phase, GP survivorship care is largely opportunistic and driven by patients’ needs. Based on the findings from this study, strategies of care could potentially be planned to facilitate the role of primary care. However, research supporting these practices is needed.
48
Evans, J. H., R. J. Valleley, and Jodi Polaha. "Integrating Pediatric Behavioral Health Into Rural Primary Care: Research Findings." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/6617.
49
Petgrave, Dannel K., Kayla McCarter, Courtney Lilly, Natasha Gouge, and Jodi Polaha. "Managing Multiple Concerns in Pediatric Primary Care: Impact on Time." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6632.
Abstract:
Behavioral problems in children are common concerns in pediatric primary care. Time is an important factor for primary care providers (PCP) and it has been shown that pediatricians spend approximately five minutes longer providing care when behavioral concerns are presented, reducing the number of patients for which they can provide care. To date, no research has looked at the relationship between the quantity of behavioral concerns and PCP time demands, which is the aim of the present study. Using a sample of 516 children at a pediatric setting in rural southwest Virginia, data was recoded to classify children in one of two groups: those with behavioral concerns and those without. Using descriptive statistics, it was found that 96 children (18.6%) presented with at least one behavioral concern (with a range of 1 to 6 total behavioral concerns). Children with behavioral concerns were compared to children with medical-only concerns (with a range of 1-7 total medical concerns). When one concern was presented and it was behavioral, it took longer to address than when patients presented with up to four medical-only concerns. Regardless of the total number of concerns presented, PCPs spent 6.57 minutes longer with children presenting with at least one behavioral concern when compared to children in the medical-only group. More specifically, PCPs spent 5.07 additional minutes when one behavioral concern was presented and 9.03 additional minutes when two behavioral concerns were presented. Despite the quantity of behavioral concerns presented and the impact such concerns have on PCP’s time, results show that 100% of concerns raised were addressed at all times by PCPs within this clinic. Although from a consumer’s prospective, this is a desirable approach, such a model is not an especially time or cost efficient way for pediatricians to spend their time. As PCPs continue to address behavioral concerns, it is critical to develop and implement strategies (e.g., prioritizing concerns, identifying less time consuming concerns, scheduling follow up appointments) to address behavioral concerns more efficiently. Furthermore, incorporation of a full time on-site behavioral health provider might be an especially efficient way to maximize patient care while also relieving providers from the additional time burdens associated with the high prevalence of behavioral concerns within pediatric practices.
50
John, George Kunjunjukutty. "Medicine usage patterns in Potchefstroom primary health care clinics / George Kunjunjukutty John." Thesis, North-West University, 2004. http://hdl.handle.net/10394/696.