Articles: primary-care.
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Annals of family medicine · Jan 2023
Randomized Controlled TrialEffect of a Medical-Legal Partnership on Mental Health and Utilization: A Randomized Controlled Trial in Primary Care.
Context: Family physicians lack resources to effectively intervene on health-harming legal needs (HHLNs), despite growing calls to address social determinants of health. One promising model is the medical-legal partnership (MLP), which embeds legal screening and referral in clinics, but more evidence is needed prior to broader implementation. Objective: To examine whether an MLP reduces stress, depression, and medical overutilization. ⋯ Being in the intervention group was associated with lower PSS scores (18.8 vs. 19.9; PP = 75%) but higher hospitalizations (0.4 vs. 0.3; PP = 78%) and GAD-7 scores (10.3 vs. 6.7; PP=90%). Conclusion: Findings in this trial of an MLP referral were mixed. At 6 months, participants who received an MLP referral appeared to be less stressed but also reported higher anxiety and more hospitalizations.
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Annals of family medicine · Jan 2023
Randomized Controlled TrialEvaluation of a Virtual Pre-Consultation Tool for Older Adults in Primary Care: Results from a Randomized Trial.
Context: Virtual pre-consultation screening of patient needs may offer opportunities to improve the care and health outcomes of older patients in primary care, especially those with multiple care needs. Objective: We sought to implement and evaluate the effectiveness of a multidimensional virtual pre-consultation tool in the primary care setting to support rapid and standardized needs assessment for older persons. Study Design and Analysis: Pragmatic, multi-center, 1:1 individually randomized trial design. ⋯ Final results of the intention-to-treat analysis will be presented overall and stratified by urban and rural sites. Conclusions: Intended consequences of this intervention include an increased responsiveness of consultations for providers resulting in improved care of older patients. Overall, we hope results will support the implementation of evidence-based, multidimensional and virtual pre-consultation tools for older persons in the primary care setting.
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Annals of family medicine · Apr 2022
Randomized Controlled TrialRandomized controlled trial of an audit and feedback cycle to improve adherence to Choosing Wisely Canada recommendations.
Context: Choosing Wisely Canada (CWC) aims to engage healthcare providers to reduce unnecessary care. Reducing overuse of antimicrobials and antipsychotics in patients with dementia in primary care settings remains an ongoing challenge. Audit and Feedback (A&F) interventions can facilitate practice change but can be improved by understanding factors affecting the likelihood of uptake of the feedback. ⋯ There were no statistically significant provider characteristics when considering all providers with improved prescribing, but male, rural and fee for service providers were more likely to decrease prescribing greater than the mean. Conclusion: Both practice specific and generic A&F information sent directly to primary care providers by a trusted source reduced potentially unnecessary prescriptions. This supports ongoing engagement with primary care providers in practice-based research networks to improve care and promote sustained practice changes.
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Annals of family medicine · Apr 2022
Randomized Controlled Trial Pragmatic Clinical TrialIntegrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit.
Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. ⋯ Conclusions: The specific intervention tested in this study was inexpensive, but had only a small impact on the degree of BH integration, and none on patient outcomes. However, practices that had more integration at baseline had better patient outcomes, independent of the intervention. Although this particular intervention was ineffective, IBH remains an attractive strategy for improving patient outcomes.
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Randomized Controlled Trial
Tool to improve patient-provider interactions in adult primary care: Randomized controlled pilot study.
To assess whether an intervention to help patients prioritize goals for their visit would improve patient-provider communication and clinical outcomes. ⋯ A single previsit tool designed to prompt patients to set a prioritized agenda improved patient activation during the visit, but did not affect the quality of the interaction or postvisit patient-centred outcomes.