Objective: This study aimed to determine the important clinical management bottlenecks that contribute to underuse of weight loss surgery (WLS) and assess risk factors for attrition at each of them. ...Methods: A multistate conceptual model of progression from primary care to WLS was developed and used to study all adults who were seen by a primary care provider (PCP) and eligible for WLS from 2016 to 2017 at a large institution. Outcomes were progression from each state to each subsequent state in the model: PCP visit, endocrine weight management referral, endocrine weight management visit, WLS referral, WLS visit, and WLS. Results: Beginning with an initial PCP visit, the respective two-year Kaplan-Meier estimate for each outcome was 35% (n = 2063), 15.6% (n = 930), 6.3% (n = 400), 4.7% (n = 298), and 1.0% (n = 69) among 5876 eligible patients. Individual providers and clinics differed significantly in their referral practices. Female patients, younger patients, those with higher BMI, and those seen by trainees were more likely to progress. A simulated intervention to increase referrals among PCPs would generate about 49 additional WLS procedures over 3 years. Conclusions: This study discovered novel insights into the specific dynamics underlying low WLS use rates. This methodology permits in silico testing of interventions designed to optimize obesity care prior to implementation.
The Primary Care Behavioral Health (PCBH) model of service delivery is being used increasingly as an effective way to integrate behavioral health services into primary care. Despite its growing ...popularity, scientifically robust research on the model is lacking. In this article, we provide a qualitative review of published PCBH model research on patient and implementation outcomes. We review common barriers and potential solutions for improving the quantity and quality of PCBH model research, the vital data that need to be collected over the next 10 years, and how to collect those data.
Background: This study sought to examine current weight management services provided in primary care practice and factors associated with a higher reported provision of services. Methods: Survey ...completed in 18 diverse primary care health system practices in Colorado. We used descriptive statistics to summarize responses and linear regression with generalized estimating equations to assess the association between clinician characteristics and the amount of weight management services provided. Results: The overall response rate was 65% (257/397). We created a listing of 19 weight management services (e.g. identifying obesity, educating, prescribing medications, etc.) to assess the amount and type of weight loss assistance provided. On average, clinicians reported performing 70% (IQR: 60%-80%) of the services and when grouped into minimal, basic, and extensive types of services, the clinicians on average performed 87%, 78%, and 69% of them respectively. Factors associated with performing more services included perception of overall better practice culture (more team-ness, less chaos, more change culture) and perception of weight management implementation climate (support for, recognition and expectation to support weight loss) (p<0.05). Demographics, satisfaction with the practices provision of weight loss services, importance of providing weight management, and clinician-specific joy at work and level of burnout were not associated with the number of services performed. Ninety-six percent of clinicians indicated interest in learning more about weight management, especially recommendations about diet and eating plans and organizing workflows to accommodate weight management. Conclusions: Practice-associated factors such as culture and implementation climate may be worth examining to understanding how to implement weight management in primary care. These data add to the growing knowledge base about overcoming challenges to address obesity in the US.
Background
Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team ...completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians.
Objective
To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams.
Design
We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014.
Participants
Primary care personnel at VA clinics responding to a national survey.
Main Measures
Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity).
Key Results
There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio OR = 0.55, 95% CI 0.47–0.65), having turnover on the team (OR = 1.67, 95% CI 1.43–1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01–1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition.
Conclusions
Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.
Primary Care and Public Health Institute of Medicine; Board on Population Health and Public Health Practice; Committee on Integrating Primary Care and Public Health
03/2012
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Ensuring that members of society are healthy and reaching their full potential requires the prevention of disease and injury; the promotion of health and well-being; the assurance of conditions in ...which people can be healthy; and the provision of timely, effective, and coordinated health care. Achieving substantial and lasting improvements in population health will require a concerted effort from all these entities, aligned with a common goal. The Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) requested that the Institute of Medicine (IOM) examine the integration of primary care and public health.
Primary Care and Public Health identifies the best examples of effective public health and primary care integration and the factors that promote and sustain these efforts, examines ways by which HRSA and CDC can use provisions of the Patient Protection and Affordable Care Act to promote the integration of primary care and public health, and discusses how HRSA-supported primary care systems and state and local public health departments can effectively integrate and coordinate to improve efforts directed at disease prevention.
This report is essential for all health care centers and providers, state and local policy makers, educators, government agencies, and the public for learning how to integrate and improve population health.
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