WMJ : official publication of the State Medical Society of Wisconsin最新文献

Background: Health care agent (HCA) documentation as part of advance care planning (ACP) helps clinicians understand patient care wishes. This project aimed to habituate these conversations and increase documentation rates.

Methods: Workflow redesign and novel educational interventions were implemented. Patients aged 50 and older received an HCA education "blue sheet" at check-in as a discussion prompt.

Results: Of 968 visits, patients in 44% received the intervention and 4% added HCA documentation. Chart audits found that 69% of patients had outdated (older than 5 years) ACP/HCA documentation. Clinician and staff found the process helpful, important to patients, and sustainable.

Discussion: This inexpensive intervention increased HCA documentation and highlighted the need to update old ACP documents.

Introduction: More availability of HIV pre-exposure prophylaxis (PrEP) is needed to end the HIV epidemic, but this means more clinicians will encounter false positive HIV test results. These cases highlight such occurrences and the steps a clinician may take to determine the significance of such results.

Case presentation: We present the case of a 68-year-old male who presented for routine follow-up for HIV PrEP and a 41-year-old transgender male who presented to establish care with a primary care clinician. On labs, both had repeatedly positive HIV antigen/antibody tests with undetectable viral loads.

Discussion: With increasing prescription of HIV PrEP comes a need for accurate interpretation of HIV serologies. HIV PrEP users may have altered stages of seroconversion. Additionally, heterophile antibody interference can lead to false positive or negative results.

Conclusions: The reader should gain an understanding of HIV testing, potential pitfalls, and next steps amidst unclear results.

Introduction: The growing prevalence of dementia calls for nonpharmacological interventions to reduce negative quality of life effects for those living with dementia and their caregivers. Brain and Body Fitness, a community-based collaborative group program, engages people living with dementia and their caregivers through a combination of physical, cognitive, and socialization strategies, to maximize health benefits for sustained functioning.

Methods: Using an adapted form of the Patient-Reported Outcomes Measurement Information System (PROMIS) Applied Cognition tool, ex post facto data were collected from both participants affected with Alzheimer's disease and related dementias and their caregivers during 12 biweekly sessions of the Brain and Body Fitness program conducted from 2017 through 2021.

Results: Brain and Body Fitness program participants were affected by 4 quality of life indicators: anxiety, sleep, fatigue, and depression. Data reveal significant reductions in anxiety symptoms and significant improvements in fatigue for affected participants. Anecdotally, the program demonstrates nonsignificant trends of overall mood improvement.

Conclusions: Given the positive outcomes, communities may consider adopting a similar program to provide additional support for participants.

Introduction: Froedtert & the Medical College of Wisconsin belongs to a minority of institutions in which opioids are more frequently prescribed to non-Hispanic Black patients than their non-Hispanic White counterparts. The objective of this study was to evaluate racial and ethnic differences in prescribing practices for Medicare patients to determine areas for intervention.

Methods: This was a retrospective review of adult patients with Medicare insurance who received an ambulatory opioid prescription for pain. Outcomes included number of prescriptions, and maximum morphine milligram equivalent (MME). Unadjusted and adjusted linear regression models were used to examine associations between race and ethnicity and each outcome with and without adjustments for covariates.

Results: A total of 17 105 patients were given an ambulatory opioid prescription over the study period. Although most prescriptions were provided to non-Hispanic White patients, non-Hispanic Black patients had a higher mean number of prescriptions (4.36; 95% CI, 4.08 - 4.63) and higher MMEs at 495.31 (95% CI , 445.72 - 544.91). After controlling for demographics and comorbidities, individual comorbidities emerged as independent variables associated with greater numbers of prescriptions, with sickle cell disease (β 9.86; 95% CI, 9.08-10.64; PP <  0.001), drug abuse (β 5.22; 95% CI, 4.96-5.48; PP < 0.001), and paralysis (β 2.20; 95% CI, 1.73-2.67; PP <0.001) having the strongest relationships, while after adjustment, the significance of race and ethnicity was lost.

Conclusions: Institutions should explore reasons for racially inequitable opioid receipt. Individual comorbidities were associated with differences in opioid prescribing, allowing for targeted interventions in these patient groups.

Introduction: Implicit bias in patient care and outcomes is well documented. However, the presence of bias in hospital security interactions is a relatively new area of research. Flags placed on the electronic medical record identify patients considered high risk for negative outcomes, including those with security interactions.

Objective: We sought to explore the types of flags and their frequency, differences among patients with flags, and their pattern over time.

Methods: We conducted a retrospective chart review of flags placed on electronic medical records over 13 years of adults 18 years or older who were patients at a Midwest, tertiary, academic medical center. Descriptive statistics were used to explore patient demographic data. Chi-square tests were executed to compare patients with different flag types.

Results: Three flag types were investigated: "communication alert," "vulnerable/unsafe, behavior" and "risk management." The communication alert flag was most common, although Black male patients were more likely to receive a vulnerable/unsafe behavior flag than a communication alert flag (P = 0.001). Patients who were prescribed anti-anxiety medications, antidepressants, antipsychotics, and psychotherapeutics also were more likely to receive a vulnerable/unsafe behavior flag than a communication alert flag (P = 0.001). The highest number of flags was placed during quarter 3 - the months of July, August, and September.

Conclusions: Records of patients with certain demographics and on certain medications were more likely to be labeled with vulnerable/unsafe behavior flags. There is no clear protocol to determine what behaviors elicit which flag. Standardized procedures could help provide transparency to this issue.

Background: Burnout among health care providers has reached epidemic levels, raising concerns about clinician wellness and the quality of care delivered. Based on years of collaboration with primary care providers through various models-including the Collaborative Care Model (CoCM)-the authors observed that such partnerships may enhance provider well-being. This study aimed to assess provider perceptions of CoCM and its impact of provider wellness.

Methods: In March 2023 a brief, anonymous, 9-question survey was distributed via email to 51 physicians, advanced practice nurse prescribers, and physician assistants working in 4 primary care clinics, each of which had implemented CoCM for at least 1 year. For this study, we examined 3 questions that specifically addressed provider wellness.

Results: Twenty-six (51%) primary care providers completed the survey. Among the responses to wellness-related questions, 84.6% indicated reduced stress level, 80.8% reported improved job satisfaction, and 57.7% noted increased comfort with prescribing psychotropic medications. All respondents recommended CoCM to their colleagues.

Conclusions: Primary care providers strongly endorsed CoCM as beneficial to provider wellness. Further research is needed to confirm these findings and to explore whether improvements in clinician well-being translate to enhanced patient care.

Introduction: Health care professionals can protect children by identifying and reporting injuries concerning for child physical abuse, such as sentinel injuries (bruising and intra-oral injuries in precruising infants). Citing knowledge and collaboration barriers, health care professionals sometimes fail to recognize sentinel injuries as concerning for abuse. Interprofessional education may be an ideal format to improve health care professional's responses to sentinel injuries. However, it is traditionally limited to health care professions, while responding to suspected child physical abuse requires collaboration between health care professionals and non-health care professionals. This study's purpose was to understand if an interprofessional education framework could support the need and development of interprofessional education for child physical abuse beyond health care professions.

Methods: Data were collected through semistructured interviews and analyzed using a qualitative descriptive methodology. Participants included 27 professionals who had engaged in child physical abuse responses in a US midwestern urban county. Participant professions included health care, child protective services, law enforcement, courts, victim advocates, and child advocacy center employees.

Results: Six themes were identified: 4 themes aligned with competencies of the interprofessional education framework, 1 described engaging with families, and 1 described features unique to sentinel injury investigations.

Conclusions: This study supports the need for child physical abuse interprofessional education beyond health care professions. Legal thresholds for responding to suspected abuse differ by profession, and there is no shared interprofessional language around child physical abuse. This contributes to a steep learning curve for new professionals. This study also supports that an existing interprofessional education framework can provide the foundational framework for development of such education.