Primary Care Commons^™

Meaningful Engagement Of Patients And Families In A Complex Trial Of Advance Care Planning In Primary Care, Angela K. Combe, Deborah L. Dokken, Mary M. Minniti, Annette M. Totten

Patient Experience Journal

Engagement of Patient and Family Advisors (PFAs) is increasingly recommended as best practice in research. During the design and conduct of a large trial of advance care planning (ACP) in primary care, we expanded on the funder’s (Patient-Centered Outcomes Research Institute®) requirement for an engagement plan and sought to develop an innovative approach to fostering and sustaining meaningful engagement of PFAs throughout all phases of the trial. Structures were developed that integrated PFAs into planning and provided the foundation for their ongoing participation. A continuous quality improvement approach became the framework for ongoing engagement. This involved setting goals; collecting data …

Patient-Provider Communication About Cognition And The Role Of Memory Concerns: A Descriptive Study, Nikki L. Hill, Emily Bratlee-Whitaker, Heejung Jang, Sakshi Bhargava, Andrea Yevchak Sillner, Justin Do, Jacqueline Mogle

Student Papers, Posters & Projects

BACKGROUND: Early identification of cognitive impairment is an important part of health promotion in aging. However, many older adults do not seek help for cognitive problems until their ability to function independently is substantially impacted. The purpose of this descriptive study was to explore older adults' experiences with patient-provider communication specific to cognition as well as compare barriers and facilitators between those with and without memory concerns.

METHODS: We conducted an online survey with individuals aged 65 + years (n = 409; mean age = 71.4(4.73); 54% female; 79% non-Hispanic White), purposively sampled to include those with and without memory …

Weighty Words: Addressing Weight Bias In Primary Care, Jharna Jahnavi

Family Medicine Clerkship Student Projects

Weight bias in healthcare impacts a great proportion of patients. ­In some ways, weight bias often goes unaddressed compared to other forms of discrimination and spans across diverse groups of people resulting a double burden of bias in patients with intersecting marginalized identities. It is essential that providers and healthcare workers are better trained in building inclusivity for patients of all weights and body types to improve healthcare access and acceptance. Patients who experience weight bias in the office are less likely to return for routine preventative care and less likely to feel safe and comfortable with their providers. This …

Healthcare Altruism And Dysconscious Healthism In The Delivery Of Integrated Healthcare Services To Individuals Who Are Deaf, Hard Of Hearing, And Deafblind, Jaime A.B. Wilson, Michael John Gournaris

JADARA

Healthcare altruism and dysconscious healthism are terms proposed to recognize the barriers to healthcare access faced by not only individuals with hearing loss but also all minority populations. The implications of an integrated healthcare model to provide services to individuals who are d/Deaf, hard of hearing, or DeafBlind (D/HH/DB) are explored. Unique insights are then offered regarding existing barriers to healthcare access and the next steps.

Impact Of Mychart Communication On Provider Burden, Samantha R. Schuetz

Family Medicine Clerkship Student Projects

Patient portals have shown promise in engaging individuals in the management of their health by allowing exchange of secure electronic messages with their providers. Increased messaging increases physician workload and contributes to burnout among primary care physicians. This project examines both patient and provider perspectives of MyChart messaging and suggests ways in which this tool can be better utilized.

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Fabiana Kotovicz, MD

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin. Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Journal of Patient-Centered Research and Reviews

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin.

Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

Every Word, Every Gesture, Dennis J. Baumgardner

Dennis J. Baumgardner, MD

Two nonverbal patients teach a novice clinician the power and often hidden impact of the physician-patient relationship.

Every Word, Every Gesture, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Two nonverbal patients teach a novice clinician the power and often hidden impact of the physician-patient relationship.

Improving Collaboration Between Pharmacists And Physicians, Paras Patel

BU Well

Physicians and pharmacists have differing but complementary roles that can optimize patient care when structured effectively. Unfortunately, these two professionals are not collaborating well enough, as patient outcomes, especially in relation to medication adherence, continue to decline. Coordinated care of patients can improve by expanding bidirectional communication and sharing additional patient information with each other. It will be necessary to continue to promote collaborative care in the educational and training stages of these professionals’ careers to build trust and understanding of professional scope. Ultimately, the healthcare infrastructure will have to continue to progress to make collaboration more available and valuable …

Dietary Supplements: A Consumer Profile Of Knowledge And Use, Sarah J. Kucera, Yen Nguyen

All Electronic Theses and Dissertations

Alternative medicine, in the form of dietary supplements, is appealing to Americans. Supplements have been marketed as being natural promoters of general well-being, healing, and disease prevention. Even with minimal regulation and research, the majority of supplement use is self-prescribed, fueling an industry last estimated at $32.5 billion in 2012. The study explored the degree of consumer knowledge with regards to regulation, appropriate indications and dosages, and potential adverse effects of various dietary supplements. The study also sought to evaluate the relationship between supplement knowledge and demographic information as well as the extent of discussion about supplement use with a …

Integrated Care: Improving Coordination Of Care Between Primary Care And Psychiatric Services, Eunice Fu

Family Medicine Clerkship Student Projects

The majority of the highest utilizers of medical care are affected by mental health issues, yet multiple studies have shown that PCPs have mixed success in recognition and management of mental illness on their own. An integrated model of primary and mental healthcare is ideal to increase acceptability and availability of mental health services. However, there is a growing body of research demonstrating high rates of dissatisfaction with primary-specialty communication. Northwestern Counseling and Support Services has implemented a new care coordination model to address barriers to collaboration in Franklin and Grand Isle Counties. This project summarizes results of the 1-year …

Improving Awareness Of Low Health Literacy And Strategies To Overcome It, Sherilyn Destefano

Family Medicine Clerkship Student Projects

This project outlines an intervention delivered at a family medicine residency program in Bangor, ME to increase residents' knowledge of the impact of low health literacy and supply them with communication techniques to help improve patient understanding. Over 36% of U.S. adults have basic or below basic health literacy skills and low health literacy has been shown to lead to poorer health outcomes, increased health disparities, and increased cost. Our presentation focused on communication techniques like Teach-Back, an evidence-based strategy that assesses patient understanding by asking patients to repeat back healthcare instructions in their own words, that has been shown …

Promoting Strategies To Overcome Low Health Literacy And Improve Patient Understanding In Outpatient Setting, Samantha M. Siskind

Family Medicine Clerkship Student Projects

Over 36% of US adults have low health literacy. This contributes to poorer health outcomes and increased costs for individuals and health care systems. Many strategies can be used to overcome the barrier of low health literacy and improve patient understanding in clinical encounters. As health care providers have been shown to underestimate patient's needs for information and overestimate their own ability to communicate effectively with patients, these strategies should be used universally. We prepared a presentation on health literacy, its epidemiology, risk factors and implications, and strategies to overcome low health literacy and improve patient understanding. We focused most …

Exploring Doctor-Patient Communication In The Context Of Complementary And Alternative Medicine, Eva Rachelle Zimmerman

Honors Theses

The introduction of Complementary and Alternative Medicine (CAM) in the United States has recently led to increased interest in this topic. CAM encompasses a range of health care approaches that attempt to maintain or prevent illness, such as herbal supplements and acupuncture. The integrative health care movement, which is the integration of CAM with conventional medicine, has been rapidly growing among both health care providers and health care consumers, because most consumers use both types of medicine. Despite this growth, there are barriers to the acceptance and integration of CAM, including the inability of doctors to communicate with patients about …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

An Exploration Of Patients' Trust In Physicians In Training, Denise Bonds, Kristie Foley, Elizabeth Dugan, Mark Hall, Pam Extrom

Elizabeth Dugan

Several characteristics associated with patient trust are identified. To determine the level of trust patients from disadvantaged circumstances have in their primary care resident physician, and to determine patient and physician characteristics that predict trust, we administered a survey to randomly selected primary care patients of an academic medical center staffed by internal medicine residents after a visit to their primary care provider. Participants were adults. The group was racially diverse (50% non-white), English-speaking, and from lower socioeconomic groups. The 10-page survey consisted of 7 sections (Physician Trust Scale, Patient Demographics, Patient Health and Well-Being, Patient-Physician Relationship Characteristics, Global Doctor …

Physician Satisfaction: The Role Of E-Mail Communication In The Practice Of Medicine, Joaquin Alvarado

Honors Theses

Communication between a physician and a patient is an integral part to the healthcare delivery system. E-mail has the power to fully utilize a physician’s medical expertise for the good of the patient. However, many physicians do not offer this service to their patients in the United States. This study analyzes factors that impact e‐mail utilization among physicians and whether e-mail use contributes to career satisfaction of physicians using the 2008 Health Tracking and Physician Survey. Controlling for the effect of physician and practice characteristics, such as financial incentive for providing services, gender, specialty, practice type, and reliance on Medicaid …

Adolescent Sexual And Reproductive Health: Interviewing Skills, Clara Keegan Md, Nellie Wirsing Md

Family Medicine Scholarly Works

Objectives

Increase comfort with discussion of sexual health topics relevant to adolescents: sexual history, contraception, sexually transmitted infections, options counseling, coming out.

Begin to apply motivational interviewing techniques to the adolescent population.