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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 721 Research Studies DisplayedBarton AJ, Amura CR, Willems EL
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
The aim of this study was to describe the patient and provider encounter in the unexpected telehealth application that took place with the onset of the COVID-19 pandemic. Patients and providers from 3 nurse-led models of care (federally qualified health centers, nurse midwifery practices, and the Nurse-Family partnership program) in Colorado were surveyed. Data from the Patient Attitude toward Telehealth survey and Provider Perceptions about Telehealth were collected. Patients who resided in urban areas utilized telehealth with greater frequency than in rural or frontier areas. Across each of the 5 domains assessed, rural/frontier patients had significantly lower attitude scores than urban patients. The mode of Telehealth employed differed across location, with video calls utilized more frequently by urban providers, and phone calls utilized by rural/frontier providers.
AHRQ-funded; HS028085.
Citation: Barton AJ, Amura CR, Willems EL .
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
J Patient Exp 2023 Jan 25; 10:23743735231151546. doi: 10.1177/23743735231151546..
Keywords: COVID-19, Telehealth, Primary Care, Patient Experience, Rural Health, Urban Health, Vulnerable Populations, Provider: Nurse
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF .
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Barlow SE, Yudkin J, Nelson V
Dynamo Kids!/¡Niños Dinámicos! A web site for pediatric primary care providers to offer parents of children 6-12 years old with overweight and obesity: web site development and protocol for pilot study.
The purpose of this study will be to determine whether a self-guided web site offered by pediatric primary care providers could assist parents with applying healthy behaviors. If successful, a large, controlled study may be conducted to further assess. The Dynamo Kids/¡Niños Dinámicos program was created with feedback from parents and health care professionals, developing a bilingual site for parents to about healthy behavior changes for their children and how to implement them. Electronic health record modifications alert providers to qualified children at well-child encounters. Parents complete online surveys before entering the site. In month 3 of the study, the practitioners will examine children in weight-focused appointments. Outcomes include change in Family Nutrition and Physical Activity parent survey score (primary) and change in child relative BMI (secondary). Additional data include time spent on site, provider surveys, and provider and parent interviews.
AHRQ-funded; HS022418.
Citation: Barlow SE, Yudkin J, Nelson V .
Dynamo Kids!/¡Niños Dinámicos! A web site for pediatric primary care providers to offer parents of children 6-12 years old with overweight and obesity: web site development and protocol for pilot study.
J Pediatr Health Care 2023 Jan-Feb; 37(1):17-24. doi: 10.1016/j.pedhc.2022.09.003..
Keywords: Children/Adolescents, Primary Care, Obesity, Obesity: Weight Management, Education: Patient and Caregiver, Family Health and History
Quigley DD, Elliott MN, Slaughter ME
Follow-up shadow coaching improves primary care provider-patient interactions and maintains improvements when conducted regularly: a spline model analysis.
The purpose of this study was to explore whether a second shadow coaching session (re-coaching) improves the patient experience and maintains it over time. The researchers observed a statistically significant increase of 3.7 points among re-coached providers after re-coaching on overall provider rating (OPR) and 3.5 points on provider communication (PC) (differences of 1, 3, and 5 points or more are considered small, medium, and large, respectively). Improvements from the re-coaching endured for 12 months for OPR and 8 months for PC.
AHRQ-funded; HS025920.
Citation: Quigley DD, Elliott MN, Slaughter ME .
Follow-up shadow coaching improves primary care provider-patient interactions and maintains improvements when conducted regularly: a spline model analysis.
J Gen Intern Med 2023 Jan; 38(1):221-27. doi: 10.1007/s11606-022-07881-y..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Primary Care, Clinician-Patient Communication, Patient Experience, Provider Performance
Safon CB, Estela MG, Rosenberg J
Implementation of a novel pediatric behavioral health integration initiative.
The purpose of this concurrent, qualitative-dominant mixed methods empirical study was to explore healthcare professionals' perceptions of the impact of behavioral health integration (BHI) on pediatric primary care delivery in community health centers (CHCs). The researchers utilized semi-structured interviews with healthcare professionals at the end of the implementation phase of a 3-year process and surveys administered at three time points. Qualitative themes were mapped onto the Relational Coordination (RC) conceptual framework to triangulate and complement final qualitative results with quantitative results. The researchers round five emergent themes aligning with RC domains. The results of the survey showed that healthcare professionals reported both greater behavioral healthcare integration into clinic practice and greater clinic readiness to address behavioral health needs. The researchers concluded that effective pediatric BHI and care delivery at CHCs may depend on solid professional relationships and communication.
AHRQ-funded; HS022242.
Citation: Safon CB, Estela MG, Rosenberg J .
Implementation of a novel pediatric behavioral health integration initiative.
J Behav Health Serv Res 2023 Jan;50(1):1-17. doi: 10.1007/s11414-022-09803-6..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Delivery, Primary Care, Patient-Centered Healthcare, Community-Based Practice
Sirkin JT, Flanagan E, Tong ST
AHRQ Author: Tong ST, McNellis RJ, Bierman AS
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
The purpose of this paper was to review the Agency for Healthcare Research and Quality’s (AHRQ) learning community organized to engage and support primary care in responding to COVID-19 and provide an opportunity for participants to communicate learning and peer support, improve understanding of the stressors and challenges faced by practices, determine needs, and identify possible solutions to challenges of the pandemic. The researchers identified challenges, responses, and innovations that occurred through the engagement and information sharing of the learning community and categorized them across 5 domains, including: patient-centeredness, clinician and practice, systems and infrastructure, community and public health; and health equity which cut across each of the other domains. The authors concluded that the learning community provided valuable insights for future research and policy, primary care delivery improvement, and ensuring greater preparedness for future challenges.
AHRQ-authored.
Citation: Sirkin JT, Flanagan E, Tong ST .
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
Ann Fam Med 2023 Jan-Feb; 21(1):76-82. doi: 10.1370/afm.2904..
Keywords: COVID-19, Primary Care, Learning Health Systems, Health Systems, Evidence-Based Practice, Public Health
Quigley DD, Quereshi N, Hays RD
Reasons primary care practices chose patient experience surveys during patient-centered medical home transformation.
This study’s objective was to identify reasons primary care practices chose to implement a patient experience survey during their patient-centered medical home transformation. The authors conducted interviews with a stratified-random sample of 105 of these practices. Fifty-one practices used a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and 53 administered another patient survey. The three most common reasons to use a survey were given as: (1) to compare performance against other practices, which requires systematically collected data across large numbers of practices (ie, the Consumer Assessment of Healthcare Providers and Systems survey), (2) participation in an external patient-centered medical home program, and (3) survey administration cost. A second patient survey was used to identify quality improvement needs.
AHRQ-funded; HS016980; HS025920.
Citation: Quigley DD, Quereshi N, Hays RD .
Reasons primary care practices chose patient experience surveys during patient-centered medical home transformation.
J Ambul Care Manage 2023 Jan-Mar;46(1):34-44. doi: 10.1097/jac.0000000000000442.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient-Centered Healthcare, Primary Care, Quality Improvement, Practice Improvement
Beidler LB, Razon N, Lang H
"More than just giving them a piece of paper": interviews with primary care on social needs referrals to community-based organizations.
The purpose of this qualitative study was to describe primary care practice’s referrals to community-based organizations. The researchers utilized semi-structured interviews with 50 healthcare administrators in charge of social care efforts within their organization. Fifty diverse United States healthcare organizations and agencies were included. The study found that social needs referrals were an essential element of administrator’s social care activities. Administrators described the optimal referral program as one which places limited burden on care teams, provides patients with customized referrals, and facilitates closed-loop referrals. The researchers identified three key challenges organizations encounter when trying to implement the optimal referrals program: 1) developing and maintaining resources lists; 2) aligning referrals with patient needs; and 3) measuring the efficacy of referrals. Administrators The study concluded that primary care practice referrals to community-based organizations were used to improve patients' social conditions, but administrators report challenges providing customized and current information to their patients.
AHRQ-funded; HS024075.
Citation: Beidler LB, Razon N, Lang H .
"More than just giving them a piece of paper": interviews with primary care on social needs referrals to community-based organizations.
J Gen Intern Med 2022 Dec;37(16):4160-67. doi: 10.1007/s11606-022-07531-3..
Keywords: Primary Care, Social Determinants of Health, Community-Based Practice, Healthcare Delivery
Hinesley JLG, Brooks EM, O'Loughlin K
Feasibility of patient navigation for care planning in primary care.
The purpose of this study was to help better control chronic conditions by connecting patients with a navigator for support creating a personal care goal. Twenty-four clinicians in 12 practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) participated in a care planning intervention under a structured process that guided 87 patients with uncontrolled chronic conditions, trained navigators, and adapted the navigation process to meet the needs of each practice. Findings indicated that patient navigation to address care plans should be feasible, with a minimal time commitment and non-intensive training. However, given the burden and competing demands in primary care, this help cannot be offered without additional resources.
AHRQ-funded; HS026223.
Citation: Hinesley JLG, Brooks EM, O'Loughlin K .
Feasibility of patient navigation for care planning in primary care.
J Prim Care Community Health 2022 Jan-Dec;13:21501319221134754. doi: 10.1177/21501319221134754..
Keywords: Primary Care, Chronic Conditions, Patient and Family Engagement
Cohen DJ, Balasubramanian BA, Lindner S
How does prior experience pay off in large-scale quality improvement initiatives?
This study’s goal was to examine the association of prior investment on the effectiveness of organizations delivering large-scale external support to improve primary care. A mixed-methods study was conducted with 7 EvidenceNOW grantees and their recruited primary practices (n = 1720). Data was analyzed on the grantees’ implementation of helping primary care practice improve (1) clinical quality, measured as practices' performance on Aspirin, Blood Pressure, Cholesterol, and Smoking (ABCS); and (2) practice capacity, measured using the Adaptive Reserve (AR) score and Change Process Capacity Questionnaire (CPCQ). Grantees with higher levels of prior experience with and investment in large-scale QI before EvidenceNOW recruited more geographically dispersed and diverse practices. They also had lower baseline ABCS performance (differences ranging from 2.8% for blood pressure to 41.5% for smoking), delivered more facilitation (mean=+20.3 hours), and made greater improvements in practices' QI capacity (CPCQ: +2.04) and smoking performance (+6.43%) than grantees with less experience. Having established networks of facilitators at the start of EvidenceNOW and leadership experienced in supporting this workforce explained their better recruitment, delivery of facilitation, and improvement in outcomes.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Balasubramanian BA, Lindner S .
How does prior experience pay off in large-scale quality improvement initiatives?
J Am Board Fam Med 2022 Dec; 35(6):1115-27. doi: 10.3122/jabfm.2022.AP.220088..
Keywords: Quality Improvement, Primary Care, Quality of Care
Encinosa W, Nguyen P
AHRQ Author: Encinosa W
Is the recent surge in physician-hospital consolidation finally producing cost-savings?
This article revisits earlier integration studies using IBM MarketScan data 2010–2016 to re-examine the relationship between primary care physicians integrated with hospitals and spending under the Affordable Care Act (ACA) during that period. The authors observe an association between physician-hospital integration and overall cost-savings, a reversal of the relationship noted in earlier studies. They recommend that future research examine the precise mechanism of physician-hospital clinical integration in greater detail.
AHRQ-authored.
Citation: Encinosa W, Nguyen P .
Is the recent surge in physician-hospital consolidation finally producing cost-savings?
J Gen Intern Med 2022 Dec;37(16):4289-91. doi: 10.1007/s11606-022-07634-x..
Keywords: Healthcare Costs, Provider: Physician, Hospitals, Primary Care
Juergens N, Huang J, Gopalan A
The association between video or telephone telemedicine visit type and orders in primary care.
The purpose of this study was to examine the impact of telemedicine visit type on clinical ordering behavior. The researchers compared proportions of patient-scheduled video versus telephone visits for each of eight diagnosis groups and compared physician orders for medications, antibiotics, lab, and imaging studies by visit type within each diagnosis group. They observed statistically significant differences in clinician orders by visit type during telemedicine encounters for common primary care conditions. Their findings suggested that, for certain conditions, visual information conveyed during video visits may promote clinical work-up and treatment.
AHRQ-funded; HS025189.
Citation: Juergens N, Huang J, Gopalan A .
The association between video or telephone telemedicine visit type and orders in primary care.
BMC Med Inform Decis Mak 2022 Nov 19;22(1):302. doi: 10.1186/s12911-022-02040-z..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care
Schuttner L, Lee JR, Hockett Sherlock S
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
The purpose of this study was to explore primary care physician (PCP) perspectives on the influence of patients' values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and higher psychosocial complexity. Between May and July 2020 the researchers utilized semi-structured telephone interviews with 23 PCPs in patient-centered medical home teams in a nationally integrated health system in the United States. The study found three major themes: (1) The personal values of patients were rarely directly discussed in routine clinical encounters but informed more typically discussed constructs of patient preferences, goals, and priorities; (2) Patient preferences, goals, and priorities were sources of conflicting perspectives about care plans between healthcare teams, patients, and families; (3) Physicians used direct strategies to communicate and negotiate about patient preferences, goals, and priorities when developing care plans. The researchers concluded that during clinical decision-making for complex patients with multimorbidity, primary care physicians perceive patient values, preferences, health priorities and goals as influential.
AHRQ-funded; HS026369.
Citation: Schuttner L, Lee JR, Hockett Sherlock S .
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
Risk Manag Healthc Policy 2022 Nov 16; 15:2135-46. doi: 10.2147/rmhp.S380021..
Keywords: Primary Care, Provider: Physician, Shared Decision Making, Chronic Conditions
Teixeira da Silva D, Petsis D, Santos T
Chlamydia trachomatis/neisseria gonorrhea retesting among adolescents and young adults in a primary care network.
This study describes retesting following Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. Findings showed that guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients.
AHRQ-funded; HS026116.
Citation: Teixeira da Silva D, Petsis D, Santos T .
Chlamydia trachomatis/neisseria gonorrhea retesting among adolescents and young adults in a primary care network.
J Adolesc Health 2022 Nov;71(5):545-51. doi: 10.1016/j.jadohealth.2022.06.014..
Keywords: Children/Adolescents, Young Adults, Sexual Health, Infectious Diseases, Primary Care
White A, Fulda KG, Blythe R
Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety.
The purpose of this narrative review was to further define the nature of collaboration between pharmacists and primary care providers in improving medication safety in community settings, and to describe related barriers and strategies. The researchers searched PubMed studies published between January 2000 and December 2020 using search terms including: "collaboration," "community pharmacy," "patient safety," "medication safety," and "primary care physician." The identified articles were placed into 3 categories: 1) defining collaboration, 2) types of collaboration, and 3) barriers and solutions to collaboration. The authors concluded that medication review and other strategies are a common form of collaboration between pharmacists and primary care providers, and that barriers to that collaboration can include erroneous beliefs regarding roles, variation in access to clinical information, and differences in community pharmacy practice.
AHRQ-funded; HS027277.
Citation: White A, Fulda KG, Blythe R .
Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety.
Expert Opin Drug Saf 2022 Nov;21(11):1357-64. doi: 10.1080/14740338.2022.2147923..
Keywords: Provider: Pharmacist, Primary Care, Medication, Patient Safety, Community-Based Practice
Holtrop JS, Davis MM
Primary care research is hard to do during COVID-19: challenges and solutions.
This study examined challenges in conducting primary care research during the COVID-19 pandemic. The authors used their experience on over 15 individual projects during the pandemic. They identified 3 key challenges to conducting primary care research: (1) practice delivery trickle-down effects, (2) limited/changing resources and procedures for research, and (3) a generally tense milieu in US society during the pandemic. They presented strategies, informed by a set of questions, to help researchers decide how to address these challenges observed during our studies. They encouraged normalization and self-compassion; and encouraged researchers and funders to embrace pragmatic and adaptive research designs as the circumstances with COVID-19 evolve over time.
AHRQ-funded; HS027080.
Citation: Holtrop JS, Davis MM .
Primary care research is hard to do during COVID-19: challenges and solutions.
Ann Fam Med 2022 Nov-Dec; 20(6):568-72. doi: 10.1370/afm.2889..
Keywords: COVID-19, Primary Care, Health Services Research (HSR), Research Methodologies
Hoopes AJ, Brandzel SD, Luce C
What do adolescents and their parents need from mental health integration in primary care? A qualitative exploration of design insights.
The purpose of this study was to 1) explore the challenges of primary care-based mental health and substance use screening and care for adolescents and 2) identify program design solutions. The researchers conducted interviews and focus groups with adolescents receiving care at Kaiser Permanente Washington in 2020, and separate interviews with the parents of the participants. The study found five overarching design principle themes emerged from the 41 interviews and 10 focus groups: 1) Engagement, 2) Privacy, 3) Communication, 4) Choice, and 5) Ease.
Citation: Hoopes AJ, Brandzel SD, Luce C .
What do adolescents and their parents need from mental health integration in primary care? A qualitative exploration of design insights.
J Pediatr Health Care 2022 Nov-Dec; 36(6):570-81. doi: 10.1016/j.pedhc.2022.06.006..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Behavioral Health, Primary Care
Viswanathan M, Wallace IF, Cook Middleton J
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors sought to review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force. They found indirect evidence that suggested some screening instruments were reasonably accurate for detecting depression. Further, psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
AHRQ-funded; 290201500011I.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 18;328(15):1543-56. doi: 10.1001/jama.2022.16310..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Depression, Behavioral Health, Screening, Primary Care, Guidelines, Evidence-Based Practice, Prevention
Kuzel AJ, Cuellar A, Nichols L
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
The purpose of this study was for The Heart of Virginia Health care (HVH) collaborative (one of the Agency for Healthcare Research and Quality's (AHRQ) Evidence Now project’s 7 collaboratives) to test different ways to improve performance and outcomes on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling) within small primary care practices. The researchers recruited 264 eligible practices and randomized them to 3 cohorts in a stepped wedge design, with 173, utilizing 16 different EHRs, participated through the entire initiative. Trained coaches delivered the practice support curriculum to improve performance on the ABCS measures. The program included an initial kickoff meeting, 3 months of focused support, 9 months of continued support, and access to online materials and faculty. The intervention phase was shortened due to difficulty in recruiting a sufficient number of practices. The study found that the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other anti-thrombotics, small negative effects on blood pressure control, except for those practices which did not attend the kickoff, and small negative effects on smoking cessation counseling. The researchers concluded that the truncation of the intervention contributed to the lack of substantial improvements in the ABCS.
AHRQ-funded; HS023913.
Citation: Kuzel AJ, Cuellar A, Nichols L .
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
J Am Board Fam Med 2022 Oct 18;35(5):979-89. doi: 10.3122/jabfm.2022.05.210021..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Primary Care, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Healthcare Delivery
Viswanathan M, Wallace IF, Cook Middleton J
Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this paper was to review the evidence on screening for anxiety in children and adolescents to inform the US Preventive Services Task Force. Indirect evidence of findings suggested that some screening instruments were reasonably accurate. Cognitive behavioral therapy and pharmacotherapy were associated with benefits; no statistically significant association with harms was reported.
AHRQ-funded; 290201500011I, 75Q80120D00007.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 11;328(14):1445-55. doi: 10.1001/jama.2022.16303..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Anxiety, Behavioral Health, Primary Care, Screening, Guidelines, Evidence-Based Practice, Prevention
Campbell NL, Pitts C, Corvari C
Deprescribing anticholinergics in primary care older adults: experience from two models and impact on a continuous measure of exposure.
The purpose of this study was to assess two pilot pharmacist-based advanced practice deprescribing intervention models and their impact on patients’ exposure to high-risk anticholinergics. The researchers conducted pilot studies of a collaborative clinic-based pharmacist deprescribing intervention and a telephone-based pharmacist deprescribing intervention. Deprescribing was defined as a discontinuation or dose reduction. Patients participating in the clinic-based pharmacy model were aged 55 years and older and were referred for deprescribing at a specialty clinic. Patients participating in the telephone-based pharmacy model were aged 65 years and older and called by a clinical pharmacist for deprescribing without referral. The study found that among the 24 medications deemed eligible for deprescribing for the18 patients in the clinic-based model, 23 were deprescribed. The clinic-based deprescribing model resulted in a 93% reduction in median annualized total standardized dose (TSD), 56% lowered their annualized exposure below a cognitive risk threshold, and 17% of medications were represcribed within 6 months. Among the 24 medications deemed eligible for deprescribing for the 24 patients in the telephone-based pharmacy model, 50% were deprescribed. There was no change in the median annualized TSD, the annualized TSD was lowered below a cognitive risk threshold in 46%, and no medications were represcribed within 6 months. The researchers concluded that pharmacist-based deprescribing successfully reduced exposure to high-risk anticholinergics in the study population.
AHRQ-funded; HS24384.
Citation: Campbell NL, Pitts C, Corvari C .
Deprescribing anticholinergics in primary care older adults: experience from two models and impact on a continuous measure of exposure.
Journal of the American College of Pharmacy 2022 Oct;5(10):1039-47. doi: 10.1002/jac5.1682..
Keywords: Elderly, Primary Care, Medication, Provider: Pharmacist, Medication: Safety, Patient Safety
Dixit RA, Ratwani RM, Bishop JA
The impact of expanded telehealth availability on primary care utilization.
This study examined the impact of telehealth availability due to the COVID-19 pandemic and whether it may result in an unnecessary increase in utilization. The authors analyzed 4,114,651 primary care encounters from three healthcare systems between 2019 and 2021 and found little change in telehealth utilization as it became widely available.
AHRQ-funded; HS028255.
Citation: Dixit RA, Ratwani RM, Bishop JA .
The impact of expanded telehealth availability on primary care utilization.
NPJ Digit Med 2022 Sep 9;5(1):141. doi: 10.1038/s41746-022-00685-8..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Healthcare Utilization
Grauer A, Duran AT, Liyanage-Don NA
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
The purpose of this retrospective cohort study was to explore whether there is a relationship between telemedicine use in primary care and risk factor assessment and control for patients with diabetes mellitus. The study included patients with diabetes mellitus ages 18-75 with a telemedicine visit in a primary care network between February 2020 and December 2020. Researchers evaluated whether low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and hemoglobin A1c (HbA1c) and were assessed for each patient. The study identified 1,824 patients with diabetes during the study period and found that telemedicine use was associated with a lower proportion of patients with all three risk factors assessed. The researchers concluded that telemedicine use was related with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic.
AHRQ-funded; HS026121; HS024262.
Citation: Grauer A, Duran AT, Liyanage-Don NA .
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
J Endocrinol Invest 2022 Sep;45(9):1749-56. doi: 10.1007/s40618-022-01814-6..
Keywords: Diabetes, Chronic Conditions, Telehealth, Health Information Technology (HIT), Primary Care, Risk
Fraze TK, Lewis VA, Wood A
Configuration and delivery of primary care in rural and urban settings.
This study examined configuration and delivery of rural primary care of Medicare beneficiaries compared to more urban settings. The study included over 27 million participants with qualifying visits who were assigned to practices. The authors characterized practices’ structures, capabilities, and payment reform participation and measured beneficiary utilization by rurality. Rural practices were smaller, more primary care dominant and system owned with more beneficiaries per practice. Rural area beneficiaries were more likely to be from high-poverty areas and disabled. There was less engagement in quality-focused payment programs than in metropolitan practices. There was less preventive care, such as fewer beneficiaries with diabetes receiving an eye exam, fewer mammograms, and higher overall and condition-specific readmissions. While most isolated beneficiaries traveled to more urban practices for outpatient care, those receiving care in rural practices had similar outpatient and inpatient utilization to urban counterparts except for readmissions and quality metrics that rely on services outside of primary care.
AHRQ-funded; HS024075.
Citation: Fraze TK, Lewis VA, Wood A .
Configuration and delivery of primary care in rural and urban settings.
J Gen Intern Med 2022 Sep;37(12):3045-53. doi: 10.1007/s11606-022-07472-x..
Keywords: Primary Care, Healthcare Delivery, Rural Health, Urban Health, Medicare
Sweeney SM, Baron A, Hall JD
Effective facilitator strategies for supporting primary care practice change: a mixed methods study.
Investigators conducted a pragmatic qualitative study with patients who had participated in a health-related social needs (HRSN) intervention. They found that patients were likely to have initial skepticism or reservations about the intervention; they identified 4 positive intervention components regarding patient experience; and they found that patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Baron A, Hall JD .
Effective facilitator strategies for supporting primary care practice change: a mixed methods study.
Ann Fam Med 2022 Sep-Oct;20(5):414-22. doi: 10.1370/afm.2847..
Keywords: Primary Care, Practice Improvement, Quality Improvement, Quality of Care