Family practice
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Nearly half of American adults fail to meet national guidelines for physical activity (PA). As a major contributor to the development of preventable chronic diseases, insufficient PA is an important target for health behaviour interventions. Exercise is Medicine (EIM) aims to increase PA levels among primary care patients through routine PA evaluation, prescription, brief counselling, and referral to community resources. PA is treated as a vital sign with the goal of increasing PA levels in prescribed manageable doses. EIM is currently being implemented in UC San Diego Health System's primary care clinics. ⋯ Overall, patients reported positive perceptions of EIM. While patient perceptions of EIM suggested that PA discussions with PCPs are happening during the majority of visits, PCP documentation fell behind. Documentation via smartphrase may need to be modified for physicians to use.
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Past research has established that transgender people experience significant disparities in mental health outcomes and healthcare dissatisfaction compared with cisgender people, but more research is needed on how supportive healthcare interactions relate to the mental health of transgender people. ⋯ When transgender people receive supportive care from their primary care providers they experience better mental health, despite ongoing negative healthcare experiences. Future research is needed to confirm ways of supporting positive trajectories of mental health for transgender people but these findings demonstrate the importance of positive aspects of care.
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Observational Study
Feasibility of the cardiac output response to stress test in suspected heart failure patients.
Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited. ⋯ The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.
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Mental health (MH) disorders are increasingly prevalent in primary care (PC) and this has generated, in recent years, the development of strategies based on the collaborative model and the stepped care model. The Primary Support Program (PSP) was implemented in the community of Catalonia (Spain) during 2006 to improve, from the first level of care, treatment of the population with mild-moderate complexity MH problems along with identification and referral of severe cases to specialized care. The aim of the present study was to identify the strengths and limitations of the PSP from the perspective of health professionals involved in the programme. ⋯ The operation of the PSP could benefit from a review of the programme framework and optimization of MH liaison. Improvements are also proposed for MH training in PC, intraprofessional coordination, use of community resources, and creation of efficient continuous assessment systems.
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Observational Study
Opportunity loss: care team job satisfaction and urgent care, emergency department, and hospital costs for patients with cardiovascular disease.
This study evaluates the association between primary care team job satisfaction and urgent care, emergency department, and hospital costs for their patients with cardiovascular disease (CVD). ⋯ Health care employee job satisfaction in primary care is an important factor to consider in efforts to lower medical costs for patients with CVD.