J Am Board Fam Med
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Randomized Controlled Trial
A Pilot of a Randomized Control Trial of Melatonin and Vitamin C for Mild-to-Moderate COVID-19.
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Randomized Controlled Trial Pragmatic Clinical Trial
Patient and Clinician Perspectives on Two Telemedicine Approaches for Treating Patients with Mental Health Disorders in Underserved Areas.
Primary care practices in underserved and/or rural areas have limited access to mental health specialty resources for their patients. Telemedicine can help address this issue, but little is known about how patients and clinicians experience telemental health care. ⋯ Both approaches addressed patient needs and provided access to specialty mental health care. Each approach better aligned with different patients' needs, suggesting that having both approaches available to practices is optimal for supporting patient-centered care.
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Randomized Controlled Trial
Successful Trial of Practice Facilitation for Plan, Do, Study, Act Quality Improvement.
Practice facilitation (PF) is a promising but relatively new intervention supporting data-driven practice change. There is a need to better detail research-based facilitation methods, which must balance intervention fidelity and time restrictions with the flexibility required for the intervention. As part of a multi-level 4-armed cluster randomized clinical trial (RCT), 32 rural primary care practices received PF for 1 year. We evaluated the feasibility of having facilitators guide practices to perform 4 key driver domain activities, implemented as Plan-Do-Study-Act (PDSA) cycles, to better understand facilitation "exposure." We describe the intervention and activity length such that our experiences may be useful to other PF research efforts. ⋯ In this trial, it was feasible for PFs to engage practices in at least 4 Key Driver quality improvement activities within 1 year, which will inform PF methods and protocol development in future trials.
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Randomized Controlled Trial
Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care.
To describe characteristics of patients, providers, and clinics associated with opioid or non-opioid pain medication prescribing patterns for patients who received lower spine imaging in primary care clinics. ⋯ After adjusting for factors that could affect prescribing, the strongest differences observed in pain-medication prescribing were across racial categories and for patients with previous pain prescriptions. Further research is needed to understand these differences and to optimize prescribing.
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Randomized Controlled Trial Multicenter Study
The Relationship Between Social Determinants of Health and Functional Capacity in Adult Primary Care Patients With Multiple Chronic Conditions.
Social determinants of health (SDoH) including insecure access to food, housing, and financial resources are critical threats to overall health. We sought to examine this relationship among adult primary care patients with multiple chronic conditions. ⋯ Among primary care patients with chronic conditions, SDoH are associated with poorer functional capacity, independent of other social and demographic factors. Primary care offers a promising, if underused, opportunity to intervene in SDoH. There is a need for future studies to explore the role of screening and intervention by primary care providers to mitigate or prevent SDoH.