Wagner, Kylie Kidd, Austin, June, Toon, Lynn, Barber, Tanya, and Green, Lee A.
Annals of Family Medicine. 2019 Supplement, Vol. 17, pS50-S56. 7p.
PATIENT-centered medical homes, COGNITIVE analysis, TASK analysis, DIFFUSION of innovations, MEDICAL care costs, HOME diagnostic tests, and SUPPORT groups
Purpose: Primary care transformation is widely seen as essential to improving patient outcomes and health care costs. The medical home model can achieve these ends, but dissemination and scale-up of practice transformation is challenging. We sought to understand how to move past successful pilot efforts by early adopters to widespread adoption by applying cognitive task analysis using the diffusion of innovations framework.Methods: We undertook a qualitative cross-sectional comparison of 3 early adopter practices and 15 early majority practices in Alberta, Canada. Practices completed a total of 42 cognitive task analysis interviews. We conducted a framework-guided qualitative analysis, with allowance for emergent themes, using the macrocognition framework on which cognitive task analysis is based. Independent codings of interview transcripts for key macrocognitive functions were reviewed in group analysis meetings to describe macrocognitive functions and team mental models, and identify emergent themes. Two external focus groups provided support for these findings.Results: Three prominent findings emerged. The first was a spectrum of mental models from "doctor with helpers," through degrees of delegation, to fully team based care. The second was differences in how teams distributed macrocognitive functions among members, with early adopters distributing these functions more widely across the team than early majority practices. Finally, we saw emergence of several themes also common in the diffusion of innovations literature, such as the importance of trying new practices in small, reversible steps.Conclusions: Our findings provide guidance to practice teams, health systems, and policymakers seeking to move beyond early adopters, to improve team functioning and advance the medical home transformation at scale. [ABSTRACT FROM AUTHOR]
OPIOIDS, DRUG prescription laws, DRUG therapy, MORPHINE, EMERGENCY medicine, PUBLIC health, and MEDICARE
Background: Prescription opioids have been linked to over half of the 28,000 opioid overdose deaths in 2014. High rates of prescription opioid non-medical use have continued despite nearly all states implementing large-scale prescription drug monitoring programs (PDMP), which points to the need to examine the impact of state PDMP's on curbing inappropriate opioid prescribing. In the short-term, PDMPs have been associated with short-term prescribing declines. Yet little is known about how such policies differentially impact patient subgroups or are interpreted by prescribing providers. Our objective was to compare volumes of prescribed opioids before and after Indiana implemented opioid prescribing emergency rules and stratify the changes in opioid prescribing by patient and provider subgroups.Methods: An interrupted time series analysis was conducted using data obtained from the Indiana PDMP. Prescription level data was merged with census data to characterize patient socioeconomic status. Analyses were stratified by patients' gender, age, opioid dosage, and payer. The primary outcome indicator was the total morphine equivalent dose (MED) of dispensed opioids per day in the state of Indiana. Also considered were number of unique patients, unique providers, and prescriptions; MED per transaction and per day; and number of days supplied.Results: After controlling for time trends, we found that total MED for opioids decreased after implementing the new emergency rules, differing by patient gender, age, and payer. The effect was larger for males than females and almost 10 times larger for 0-20 year olds as compared to the 60+ age range. Medicare and Medicaid patients experienced more decline in prescribing than patients with private insurance. Patients with prescriptions paid for by workers' comp experienced the most significant decline. The emergency rules were associated with decline in both the number of prescribers and the number of day supply.Conclusions: Although the Indiana opioid prescribing emergency rules impacted statewide prescribing behavior across all individual patient and provider characteristics, the emergency rules' effect was not consistent across patient characteristics. Further studies are needed to assess how individual patient characteristics influence the interpretation and application of state policies on opioid prescribing. [ABSTRACT FROM AUTHOR]
Xue-you XU, Zhen-yu YANG, Jia-quan SONG, Jian LIU, Xin XIANG, Liang-zhao CHU, Yi-min CHEN, Ming-hao DONG, and Hua YANG
Chinese Journal of Contemporary Neurology and Neurosurgery, Vol 19, Iss 9, Pp 666-672 (2019)
hematoma, subdural, chronic, drainage, aged, 80 and over, practice patterns, physicians', Neurology. Diseases of the nervous system, and RC346-429
Objective To explore the multi-disciplinary diagnosis and treatment mode of elderly patients with chronic subdural hematoma (CSDH), and the effect and safety of trepanation and drainage under this mode. Methods A total of 37 elderly patients with CSDH (≥ 80 years old) were treated by trepanation and drainage under multi-disciplinary team (MDT) model from December 2014 to December 2018. Summarized the perioperative management process of CSDH in the elderly patients under MDT model, and observed its complications and prognosis. Bender grade was used to evaluate the clinical symptoms and neurological deficits, CT was used to evaluate the curative effect, and Karnofsky Performance Status (KPS) was used to evaluate quality of life. Results Operation-related complications of 37 patients included non-tension pneumocephalus (19 cases, 51.35% ), subdural effusion in (5 cases, 13.51% ),intracranial hypotension (2 cases, 5.41% ) and epilepsy (1 case, 2.70% ). The age-related complications included new pulmonary infection (1 case, 2.70% ), abnormal blood pressure (3 cases, 8.11% ), elevated blood sugar (2 cases, 5.41%) and acute coronary diseases (3 cases, 8.11%). There was no perioperative death. The clinical symptoms and neurological function was improved significantly after operation (Z = 6.198, P = 0.000). Postoperative CT showed that the total effective rate was 86.49% (32/37). During the follow-up period, the KPS was over 60 score, and CT showed that the total effective rate was 96.43% (27/ 28). Conclusions MDT model can optimize the diagnosis and treatment process of CSDH, and formulate detailed individualized treatment plan. Trepanation and drainage under the MDT model for the treatment of elderly patients with CSDH is helpful to improve prognosis and reduce mortality. DOI:10.3969/j.issn.1672-6731.2019.09.011
FIBRINOLYTIC agents -- Therapeutic use, ANTICOAGULANTS (Medicine), ASPIRIN, DRUG utilization, LONGITUDINAL method, RESEARCH methodology, ORAL medication, SELF-evaluation, SURVEYS, THROMBOEMBOLISM, VEINS, and WARFARIN
Objectives: The objective of this study is to describe the most common self-reported antithrombotic therapy utilization patterns in a national cohort of patients with recent venous thromboembolism (VTE). Methods: Extant data from a national online survey administered to 907 patients 18 years of age or older with VTE in the last two years were analyzed. Patients' self-reported antithrombotic usage patterns used during three phases of treatment for the most recent VTE episode were summarized using descriptive statistics. Results: The following overall antithrombotic usage patterns were identified: warfarin (38.7%), direct oral anticoagulants (DOACs) (26.1%), switching between warfarin and DOACs (13.3%), aspirin only (8.7%), switching between different DOACs (4.5%), injectable anticoagulants only (3.9%), and no treatment (4.7%). Extended antithrombotic therapy beyond 90 days was reported by 65.7% of patients. Aspirin coadministration with anticoagulant therapy occurred for 33.7%. Conclusions: In this national sample of recent VTE sufferers warfarin therapy remains the most used anticoagulant followed closely by DOAC therapy. Switching between warfarin and DOACs and between different DOACs was common which could indicate adverse events or affordability issues. Aspirin coadministration with anticoagulant therapy was present in 1 of 3 patients and is a potential medication safety intervention for anticoagulation providers. [ABSTRACT FROM AUTHOR]
e Bont, Eefje G. P. M., Dinant, Geert-Jan, lshout, Gijs, van Well, Gijs, Francis, Nick A., Winkens, Bjorn, Cals, Jochen W. L., RS: CAPHRI - R5 - Optimising Patient Care, Promovendi PHPC, Huisartsgeneeskunde, Kindergeneeskunde, AZM: E-M-O Medische Staf Kindergen, AZM: E-M-O Arts Assistenten Kindergen, RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, RS: CAPHRI - R6 - Promoting Health & Personalised Care, and FHML Methodologie & Statistiek