Physician behavior was not influenced by FRAX results in the intervention group; however, positive patient behavior changes occurred in both groups. Primary prevention efforts conducted through heel ultrasound screening and pharmacist consultation led women to follow-up; however, awareness still needs to be raised of the value of FRAX in osteoporosis prevention.
A pharmacist telephonically contacted patients ≥65 years with Medicare insurance following hospital discharge to perform medication reconciliation, review discharge instructions, and schedule a follow-up appointment (n = 34). At this follow-up appointment, the pharmacist reviewed the patient's electronic medical record (EMR) and communicated recommendations to the physician. The current standard of care, which does not involve a pharmacist, at a similar local physician practice was used as a comparative group (n = 45) RESULTS: The difference in 30-day readmission rates did not reach statistical significance (P = .27); however, there was a trending decrease in the percentage of patients readmitted between the control and the intervention groups (26.7% vs 14.7%). Additionally, there was nearly a statistically significant decrease in readmission rates for those patients who interacted with the pharmacist face to face versus only telephonically (P = .05) CONCLUSIONS: These results impact the decision to continue and expand the pilot program and demonstrate that pharmacists in the ambulatory setting based within a patient-centered medical home have a potential role in decreasing 30-day hospital readmissions.
Objectives To assess physician perspectives on perceived barriers and facilitators to type 2 diabetes self‐management (DSM) in a primary care setting. Methods The study utilized survey methodology to measure perspectives of primary care physicians on DSM and the challenges they face in managing patients with poor glycaemic stability. Demographic and practice site‐related information of the physicians were also collected. Key findings Of the 21 physicians who responded (53.8% response rate), 71.2% were aged 50 years or older, 54.2% had ≥25 years of clinical experience, and 50% practiced in an urban setting. The physicians examined 5–60 patients with type 2 diabetes per week (mean = 20), and over 75% of them spent <20 min on face‐to‐face visits. Approximately, 95% of physicians considered self‐care activities such as regular moderate exercise, following a recommended diet, regular blood glucose testing, proper insulin administration and adherence to oral medication as extremely important. Practice‐related aspects such as patient–physician communication, patient health literacy and patient follow‐up were unanimously considered extremely important, and performance on these measures was rated positively. Interestingly, 66% of physicians felt responsible to some extent for their patient's failure to reach type 2 DSM goals. Physician perceived barriers that contributed to clinical inertia included cost of medications, lack of patient motivation and knowledge, non‐compliance with diet and medications, polypharmacy and lack of time and social support. Conclusions The study results underscore the importance of DSM in the overall management of type 2 diabetes. Addressing the challenges faced by physicians may result in better self‐management and improved clinical outcomes in type 2 diabetes population.
Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.
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