Primary Care Commons^™

The Revised Cdc Chronic Pain Guidelines And Payer Opioid Analgesic Policies In Michigan, Victoria Tutag Lehr, Cynthia L. Arfken

Michigan Journal of Public Health

Abstract

The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Gender Segregation In Caring Labor: The Impact Of Social Norms On Career Choices, Evelyn Xinhui Cheng

CBER Conference

Women engage in work stereotypically seen as "women's work," or work based on the perceived "natural" female tendency towards caring and relational thinking (Tung 2000). In pre-reform China, Shu (2005) found that women were more concentrated in the lowerpaying collective sector compared to men in the state-owned sector, contributing to the gender wage gap. China's horizontal occupational segregation by gender has significant implications for gender pay gaps, workforce attachment, and the perceived value of caring labor in society. Feminist scholars argue that gendered norms around caring originate that conflate womanhood with nurturing (England 2005; Litt & Zimmerman 2003). The main …

Understanding Provider Competency In Gender Affirming Care, Vanessa Castle, Lindsay Gietzen

Pacific Journal of Health

Lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual plus (LGBTQ+) individuals, especially transgender patients, face many healthcare disparities. It is extremely important for them to have access to high-quality healthcare, particularly Gender Affirming Care (GAC), to support their well-being and mental health. However, many healthcare providers, including clinical social workers, NPs, PAs, and MDs lack proper training to offer GAC. The current training opportunities available are often basic and lack comprehensive, detailed information. To reduce healthcare barriers for the transgender and gender-diverse community, we must have comprehensive training on GAC available for providers so they can treat their patients with …

Biodata Drives Treatment Success, Steve Carstensen Dds

Metro Denver Dental Society Articulator Magazine

This article explores the growing role of biosignals and digital health technologies in dentistry, emphasizing how devices like wearable rings and sensors are enhancing the diagnosis and management of conditions such as obstructive sleep apnea, periodontal disease and chronic pain. By integrating biosignal data into patient care, dentists can provide more precise, personalized treatments, improving outcomes and supporting collaboration with primary care providers in managing chronic diseases.

Association Between Teaching Clinic Structure And The Readiness Of Ophthalmology Residents To Enter Independent Practice, T. Michael Kashner, Marjorie A. Bowman, Catherine P. Kaminetzky, Andrea D. Birnbaum, John M. Byrne, Paul B. Greenberg, Steven S. Henley, Karen M. Sanders

Population and Public Health Sciences Faculty Publications

Our objective is to determine if the structure of Graduate Medical Education teaching clinics is associated with how well ophthalmology residents are prepared to meet the workload demands of independent clinical practice. Resident preparedness to enter independent practice was measured by the Readiness Index. Part of the Department of Veterans Affairs’ new Workload-based Resident Academic Performance measures (WRAP), resident readiness is computed from electronic health records for residents by clinic and service-date. The index compares resident productivity net of supervision and adjusted for care quality to the average productivity of non-supervising ophthalmologists. Readiness comprises a Workload component (ratio of resident …

How Low Can We Go: Evaluation Of A Pharmacist-Led Weight Loss Management Program, Kelly Rubi, Elaina Rosario, Sara Panella, Jacqualine Igwe, Maria Pulido, Faaria Quadri

Nursing & Health Sciences Research Journal

Background: Obesity is a major health challenge that is associated with several health risks, including diabetes and hypertension. The purpose of this project was to evaluate the impact of clinical pharmacists on the therapy optimization of GLP-1 receptor agonists (GLP-1RAs) in a weight management program. Methods: This project evaluated a quality improvement initiative through a retrospective chart review that included patients who were treated with semaglutide or liraglutide between October 2022 and July 2023, with body mass indices (BMI) of 27 kg/m2 or greater with at least one weight-related comorbidity or a BMI greater than or equal to 30 kg/m2. …

Comprehensive Community Medicine, Alexander Walther

Capstone Projects and Master's Theses

Comprehensive Community Medicine (CCM) is a theoretical framework designed to address the complex needs of individuals with dual diagnoses of mental illness and substance use disorders (SUDs). Dual diagnosis is highly prevalent, particularly among populations experiencing homelessness, and is associated with poorer health outcomes and increased healthcare service utilization. Structural inequities, including a fractured healthcare system, exacerbate the challenges faced by this vulnerable group. Research indicates that effective care for dually diagnosed individuals requires a layered approach addressing clinical, systemic, legal, and housing barriers.

The development of CCM has been informed by interviews with local stakeholders, including County EMS board …

Laboratory Literacy: Surveying Lab Result Interpretations Of A Local Patient Population, Jordan Franco, Mark K. Fung

Patient Experience Journal

A patient's independent interpretation of their medical laboratory data has become an unspoken prerequisite in the current age of medicine. In the outpatient setting, it is anecdotally commonplace for patients to receive their lab results before their physicians, resulting in patients often relying on self-interpretations of their results. This study analyzed the degree to which patients are comfortable interpreting lab results and sought to shed light on the question: How are patients interpreting their laboratory reports? A survey was constructed to include the items from a validated health literacy screening tool, followed by items inquiring about the respondent's experience and …

Socio-Economic Disparities In Prenatal Prognosis And Intervention Accessibility, Simona Raluca Iacoban, Madalina Piron Dumitrascu, Camil Laurentiu Bohiltea, Ioan Dumitru Suciu, Silviu Cristian Voinea, Nicolae Suciu

Journal of Mind and Medical Sciences

Objectives. This study aimed to assess the impact of socio-economic factors on prenatal care accessibility and outcomes and to evaluate the effectiveness of specialized integrative prenatal care in mitigating these disparities. Materials and Methods. A prospective cohort study was conducted between 2020 and 2023 in Bucharest, Romania, involving 100 pregnant women. Participants were equally divided into two groups that received standard and specialized prenatal care. Data were collected through structured interviews, medical record reviews, and standardized questionnaires at multiple time points during pregnancy and postpartum. Results. Women receiving integrative care had longer gestation periods (37.8 vs. 37.6 weeks), higher average …

The Telehealth Shared Decision-Making Coaching And Navigation In Primary Care (Telescope) Intervention: A Study Protocol For Delivering Shared Decision-Making For Lung Cancer Screening By Patient Navigators, Naomi Q P Tan, Lisa M Lowenstein, Elisa E Douglas, Jeanne Silva, Joshua M Bershad, Jinghua An, Sanjay S Shete, Michael B Steinberg, Jeanne M Ferrante, Elizabeth C Clark, Ana Natale-Pereira, Novneet N Sahu, Shirin E Hastings, Richard M Hoffman, Robert J Volk, Anita Y Kinney

Faculty, Staff and Student Publications

BACKGROUND: Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching and navigation intervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm.

METHODS: Patients (n = 420) of primary care clinicians (n …

Child Maltreatment And Behavioral Health Outcomes In Child Welfare: Exploring The Roles Of Severity And Polyvictimization, Lauren Malthaner, Jill Mcleigh, Gregory Knell, Katelyn Jetelina, Folefac Atem, Sarah Messiah

Behavioral Health/Developmental Delay

Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

Barriers To Health Care Among Adults With Disabilities In Connecticut, Mary Beth Bruder Phd, Tara M. Lutz Phd, Kelly E. Ferreira Phd

Developmental Disabilities Network Journal

It is estimated that 25% of adults in the US are living with one or more disabilities. Persons with disabilities (PWD) have unmet health care needs, experience health disparities compared to those without disabilities. Barriers to quality health care include structural barriers such as access to transportation, physical access to facilities, and lack of accessible medical equipment. Other barriers include the knowledge, skills, beliefs, and attitudes of health care providers to meet the needs of PWD. To examine the barriers to health care experienced by adults with disabilities in Connecticut, the University of Connecticut Center for Excellence in Developmental Disabilities …

The Impact Of Health Status On Health Care Utilization Of Children In Foster Care, Jill Mcleigh, Gunjan Singh, Rong Huang

Health Status, Outcomes, and Literacy and Healthcare Utilization

This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization.

For questions about this study or others, please email [email protected]

childrens.com/fostercare

A Pilot Physician Mentoring Program In A Large Hospital System, Crista C. Keller Md

HCA Healthcare Journal of Medicine

This article summarizes the development and implementation of a mentoring program designed to support and educate physicians new to practice in a large, outpatient hospital system. The program addresses organizational, operational, and financial elements of medical practice. Topics include efficiency and time management, coding education, leadership, and burnout. These topics are often not directly addressed in medical education, yet are crucial to physician well-being. The article describes the program structure, initial feedback, and recommendations for program replication and expansion.

This Is A Call To Action For All Primary Care Providers: Do Better For Your Transgender Patients, Kate Castor

Theses and Graduate Projects

Background: Patients of all ages benefit from primary care. However, not everyone has equal access to primary care. Transgender patients often face a multitude of barriers to receiving basic healthcare.

Purpose: Improve health outcomes for transgender patients, enlighten providers on significant disparities, and offer solutions to these disparities faced by transgender community in the healthcare setting and when receiving cancer screening.

Methods: Literature review comprising results from Augsburg University Lindell Library databases, American Journal of Medicine, and Google Scholar.

Conclusions: Everyone can do better for their transgender patients, but primary care providers should take extra care cultivating relationships with these …

Barriers To Healthcare Faced By Individuals With Autism Spectrum Disorder And Their Families, Jennifer Lu

Theses and Graduate Projects

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that is characterized by impairments in social interaction and communication as well as repetitive behaviors or interests that can affect daily functioning. ASD individuals are also more likely to experience poor physical and mental health along with reduced life expectancy compared to non-autistic people. Thus, it is crucial that those with ASD are able to obtain adequate healthcare. However, there is limited research on the barriers to medical care access faced by those with ASD and their families.

Purpose: Due to the lack of autism awareness in the general population and …

Cruising Speed: Our Journal's 10-Year Voyage, Dennis J. Baumgardner, Joe Grundle

Journal of Patient-Centered Research and Reviews

In this invited editorial, two long-tenured editors for the Journal of Patient-Centered Research and Reviews recount the publication’s many impactful contributions to the medical literature over its first 10 years.

A Mixed Methods Acceptability And Feasibility Study Of A Patient-Initiated Approach To Increasing Weight Communication In Primary Care, Jocelyn E. Remmert, Leon Mccrea, Nicole T. Crane, Adam Gilden, Meghan L. Butryn

The Journal of Integrated Primary Care

Background: Weight discussions between patients and physicians can have a positive impact on patients’ health, yet they occur infrequently in primary care. No study to date has promoted patient-initiated weight discussions. This study aimed to test the feasibility, acceptability, and explore trends of the effect of a waiting room-based pamphlet intervention to promote patient-initiated weight discussions.

Methods: Adults (n=60) with overweight or obesity attending a primary care appointment were recruited from the waiting room and randomized to receive the intervention pamphlet or to a non-intervention control condition. All participants attended their appointment and completed post-appointment assessments.

Results: Three …