PRiMER (Leawood, Kan.)最新文献

{"title":"Impact of an Interprofessional HIV Quality Improvement Team on Patient Care and Resident Learning Opportunities.","authors":"Marilyn K Sauk,&nbsp;Kento Sonoda,&nbsp;Carly T Gabriel,&nbsp;Akruti Patel,&nbsp;Cynthia L Salter,&nbsp;Cara R McAnaney,&nbsp;Stephanie L Ballard","doi":"10.22454/PRiMER.2023.691851","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.691851","url":null,"abstract":"<p><strong>Introduction: </strong>Although human immunodeficiency virus (HIV) care is a recommended competency for family medicine training, many programs report a lack of HIV expertise among faculty. After the departure of faculty with HIV care experience, an interprofessional HIV quality improvement team (HIV-QIT) of physicians and pharmacists aimed to maintain on-site HIV care and retain learning opportunities for residents, using process improvement and panel reviews with a remote HIV specialist faculty member.</p><p><strong>Methods: </strong>This study reports on a multicycle quality improvement pilot project with pre- and postintervention chart reviews between December 2019 and May 2021. All patients received primary care and HIV-QIT chart reviews on-site. We compared patients with integrated HIV care on-site to those receiving external HIV specialty care. Primary outcomes included virologic suppression, CD4 count ≥200 cells/mm³, and adherence to guideline-recommended HIV care. In cycle 1 (January-June 2020), the HIV-QIT reviewed patient charts and sent guideline-based recommendations to physicians. In cycle 2 (July 2020-May 2021), the HIV-QIT implemented several HIV-specific processes, including decision support updates, note templates, order sets, and reference materials. Sustained process improvements included HIV panel chart audits every 3 to 6 months and subsequent provider education.</p><p><strong>Results: </strong>Of 29 patients, more than half (55%, n=16) received integrated HIV care at the primary care site. We found no significant difference in care quality measures between primary and specialty care. Barriers to care completion included missed or canceled follow-up visits, on-site phlebotomy service closures, and declined HIV services.</p><p><strong>Conclusions: </strong>The HIV-QIT maintained on-site HIV treatment and retained experiential learning opportunities through process improvement and specialist-supported care recommendations to primary care physicians.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544635/pdf/primer-7-32.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Multidisciplinary Medication Refill Protocol.","authors":"Samia Khan,&nbsp;Jessica J F Kram,&nbsp;Dennis J Baumgardner,&nbsp;Amanda G Sessions,&nbsp;Patrick Foss,&nbsp;Carl Bellinger,&nbsp;Fabiana Kotovicz","doi":"10.22454/PRiMER.2023.418724","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.418724","url":null,"abstract":"<p><strong>Introduction: </strong>Primary care clinicians spend significant time managing nonvisit activities, including processing of requests for prescription renewal. Delays in processing refills may lead to patient dissatisfaction and impact provider productivity. Having nonclinicians process refills can be more efficient and time-saving. We aimed to evaluate the use of a multidisciplinary medication refill protocol to decrease the time to complete refill requests.</p><p><strong>Methods: </strong>We implemented nursing<b>-</b>driven management of refill requests within two family medicine residency clinics in Milwaukee, Wisconsin (Phase 1: single clinic implementation [March 2017-June 2019]; Phase 2: added second clinic prepandemic [June 2019-March 2020] and postpandemic [April 2020-December 2020]). The multidisciplinary refill protocol was created by faculty, residents, pharmacy, and nursing. Data were collected using electronic health record time stamps to determine when refill requests were initiated and filled by faculty, residents, and nurses. We used Mood's median test to compare the median time for medication refill completion. We used Levene's test to test for equal variance surrounding the median of each caregiver group. We used Fisher's exact test or χ² test with Yates' correction for 2×2 contingency tables.</p><p><strong>Results: </strong>In both phases, we identified a significant reduction in median time to refill completion ( <i>P</i><.001) and variability of time to refill completion ( <i>P</i><.001). Notably, in Phase 1, reduction in median refill time was most apparent among residents (383 vs 79 min postimplementation); and in Phase 2, the percentage of refills completed within 48 hours significantly increased between the pre-COVID-19 and COVID-19 pandemic among faculty and nursing in Clinic 1 and residents and faculty in Clinic 2 (all <i>P</i>'s<.001).</p><p><strong>Conclusions: </strong>Implementation of a multidisciplinary refill protocol significantly improved time and predictability of refill completion in both phases.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544644/pdf/primer-7-31.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41107789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for the 2023 CERA Clerkship Director Survey.","authors":"Amanda Kost,&nbsp;Miranda A Moore,&nbsp;Tiffany Ho,&nbsp;Ray Biggs","doi":"10.22454/PRiMER.2023.238868","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.238868","url":null,"abstract":"<p><strong>Introduction: </strong>CERA, the Council of Academic Family Medicine Educational Research Alliance, is a unique collaboration between multiple family medicine organizations to conduct omnibus surveys of distinct groups within family medicine. CERA's vision is to support excellence in family medicine educational research and improve research skills in family medicine. This paper describes the methods of the 2023 Clerkship Directory Survey and presents the demographic results of survey respondents.</p><p><strong>Methods: </strong>CERA's call for proposals for the annual Clerkship Directory Survey opened from January 2023 to February 2023. Five topics were selected, and authors of the selected proposals had a mentor assigned to their project. The survey was sent to Clerkship Directors via SurveyMonkey (Momentive, Inc) on May 30, 2023 and responses were collected through June 30, 2023. χ² tests were used for descriptive analysis.</p><p><strong>Results: </strong>The survey was initially sent to 179 potential respondents but after receiving updated clerkship information, the final pool size was 169 (163 United States, 16 Canada). Ninety-six clerkship directors completed the survey, with a response rate of 56.80% (96/169). The demographic data of potential clerkship director respondents were compared with the demographic data of actual respondents. There were no significant difference in demographic data including location, gender, race/ethnicity and underrepresented in medicine status.</p><p><strong>Discussion: </strong>This paper describes the methods of the 2023 CERA Clerkship Directory Survey and shows that survey respondents are representative of clerkship directors. Authors of the five accepted survey topics are responsible for publishing their study findings.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544638/pdf/primer-7-30.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Exploring the Applications of ChatGPT in Family Medicine Medical Education\".","authors":"Jason A Horton, Irshad Ally","doi":"10.22454/PRiMER.2023.940827","DOIUrl":"10.22454/PRiMER.2023.940827","url":null,"abstract":"","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544640/pdf/primer-7-28.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic Characteristics and Career Plans of First-Generation Medical Students at a Single Medical School in the United States.","authors":"Allison R Casola,&nbsp;Brianna Kunes,&nbsp;Ricky Burns,&nbsp;Erin L Kelly,&nbsp;Maria Syl de la Cruz","doi":"10.22454/PRiMER.2023.471624","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.471624","url":null,"abstract":"<p><strong>Introduction: </strong>Recruitment of first-generation medical students is essential to improving diversity and inclusion in US medical colleges. First-generation students offer unique experiential insights that foster empathy and cultural competency in the learning environment and improve health outcomes for patients. However, little is known about their demographic characteristics or career goals. It is important to identify these factors to provide insight on ways to better support first-generation students.</p><p><strong>Methods: </strong>This exploratory pilot study aimed to describe background, demographic characteristics, and goals of students. We administered a secondary analysis of a quality improvement and health disparities survey to third-year medical students at a large, private medical school in Philadelphia, Pennsylvania. Measures included demographic information, interest in loan forgiveness programs, and other career goal items. We conducted χ² goodness-of-fit tests to examine differences by first-generation status.</p><p><strong>Results: </strong>Thirteen percent of respondents identified as first-generation medical students (n=26). First-generation medical students were more likely to be male, aged 21-26 years, White, and non-Hispanic/Latino. First-generation students were significantly more likely to report wanting to care for underserved populations during their career and enter loan forgiveness programs, with Department of Education's Public Service Loan Forgiveness program most often cited.</p><p><strong>Conclusion: </strong>This study provides an exploratory profile of characteristics of first-generation medical students and their career intentions. Our results suggests that enrollment of first-generation students may increase the number of physicians who are willing to serve underserved populations. However, first-generation students may also need more financial support through loan forgiveness programs which has important implications for medical education.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544633/pdf/primer-7-29.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41107734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hazards of Using ChatGPT: A Call to Action for Medical Education Researchers.","authors":"Winston Liaw, Summer Chavez, Cecilia Pham, Salik Tehami, Romi Govender","doi":"10.22454/PRiMER.2023.295710","DOIUrl":"10.22454/PRiMER.2023.295710","url":null,"abstract":"","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544637/pdf/primer-7-27.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future Doctors From Underrepresented in Medicine Communities at the University of Utah.","authors":"Paloma F Cariello,&nbsp;Edgar Figueroa,&nbsp;Christopher M Harris,&nbsp;Donna R Eldridge,&nbsp;Melanie Hooten,&nbsp;Guillermo E Cuevas,&nbsp;Jessica L Jones,&nbsp;Maia Hightower,&nbsp;Kendall M Campbell,&nbsp;Mike Martineau,&nbsp;José E Rodríguez,&nbsp;Luis A Oquendo","doi":"10.22454/PRiMER.2023.296084","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.296084","url":null,"abstract":"<p><strong>Background and objectives: </strong>Future Doctors (FD), a high school pathway program, was developed to address the lack of compositional diversity in the health professions at our health sciences campus.</p><p><strong>Methods: </strong>We obtained, analyzed, and compared data on FD student demographic and educational achievement at undergraduate and graduate programs at the University of Utah and graduate programs at other institutions to non-FD students. We followed students from high school to graduate school.</p><p><strong>Results: </strong>We analyzed data from 1,897 FD participants (2014-2019). FD participants were 71% women, with 50.3% identifying as students of color. Ninety-eight students matriculated in graduate school, with 75 (76%) remaining at University of Utah and 45 (46%) attending health sciences graduate programs.</p><p><strong>Conclusions: </strong>FD student cohorts are more diverse than those in the University of Utah undergraduate and graduate programs, contributing to the diversity of those programs. More research is needed to ensure that graduate school gains are evidenced in all underrepresented groups.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544629/pdf/primer-7-25.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Applications of ChatGPT in Family Medicine Education: Five Innovative Ways for Faculty Integration.","authors":"Karim Hanna","doi":"10.22454/PRiMER.2023.985351","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.985351","url":null,"abstract":"","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544634/pdf/primer-7-26.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41167620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities and Barriers to Screening and Counseling for Safe Firearm Storage.","authors":"Grace Owens,&nbsp;Anh Nguyen,&nbsp;Paul Hershberger,&nbsp;Katharine Conway,&nbsp;Timothy Crawford","doi":"10.22454/PRiMER.2023.953811","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.953811","url":null,"abstract":"<p><strong>Objectives: </strong>Safety practices such as storing a firearm locked and unloaded are widely promoted although not universally applied. Educating patients about firearm safety practices is effective in increasing safe firearms storage behaviors; however, screening for safe firearm storage in practice remains low. The aim of this study was to evaluate whether our clinic population was at risk for firearm-related injuries and whether opportunities existed to study risk-mitigation interventions in future work.</p><p><strong>Methods: </strong>The study was conducted at a suburban, midwestern academic family medicine clinic. Patients filled out paper surveys about firearm ownership and willingness to discuss firearms safety with clinicians. Health care personnel filled out paper or electronic surveys about their comfort level in discussing firearm safety with patients. Data then were collated and analyzed.</p><p><strong>Results: </strong>We surveyed 160 patients (60% female, 80% White), and 40.6% of respondents reported living in a home with a firearm. Respondents who stored their firearm unsafely were more willing to discuss firearm safety than to change their storage behavior. Eighteen health care personnel responded to our health care personnel survey. Perceived barriers to asking about firearms included lack of time, knowledge, or educational materials. Having a screening policy was selected as the best opportunity for improvement.</p><p><strong>Conclusions: </strong>Firearm owners appear willing to discuss firearm safety with their clinician, potentially representing an opportunity to promote risk-reduction through approaches such as motivational interviewing. In a busy outpatient setting, automating the firearm screening process could lessen the burden on clinicians.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544631/pdf/primer-7-22.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Impact of a Dedicated LGBTQ+ Clinical Exposure During Residency.","authors":"Joel Amidon,&nbsp;Shannon Stark Taylor,&nbsp;Sarah Hinton","doi":"10.22454/PRiMER.2023.329607","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.329607","url":null,"abstract":"<p><strong>Background and objectives: </strong>An increased focus on lesbian, gay, bisexual, transgender, queer (LGBTQ+) care in graduate medical education is needed to address health disparities in this patient population. This study assessed practice confidence and practice intentions of residents who rotated through an LGBTQ+ clinic during their residency.</p><p><strong>Methods: </strong>Residents completed three to eight half-day sessions in a dedicated LGBTQ+ clinic focusing on primary care, pre-exposure prophylaxis (PrEP), and gender-affirming care from 2019 to 2022. Prior to this clinical experience, they were provided background reading materials, care guidelines, and clinical cases. Residents were electronically surveyed at two time points after completing this clinical experience to retrospectively assess their pre-and postcurricular confidence.</p><p><strong>Results: </strong>Seventeen out of 18 (94%) residents who completed the curricular experience responded to the initial survey, which showed statistically significant differences between reported pre- and postcurricular confidence in providing primary care, PrEP, and gender affirmation care. Eight-eight percent of residents reported that they planned to or have already incorporated this care into their practice. In a follow-up survey 1 year later, 15 out of 18 (83%) responded, reporting consistent skills confidence. Seventy-one percent of participants reported currently providing LGBTQ+ care. We noted no statistical difference between the initial postconfidence survey and the follow-up survey.</p><p><strong>Conclusion: </strong>This study demonstrated positive associations between a focused curricular experience in LGBTQ+ care and both confidence providing LGBTQ+ care and planned and actual postgraduation practice patterns.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544642/pdf/primer-7-24.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}