Michael Mendoza

Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors?

OBJECTIVE Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure. METHODS The main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit). RESULTS Sixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR=6.16, 95% CI [1.53, 24.81], p=0.011) and reported greater stressor disclosure confidence (exp[B]=1.06, 95% CI [1.01, 1.12], p=0.028). No differences were found in patient activation or the length of the office visit. CONCLUSION Customized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit. PRACTICE IMPLICATIONS Brief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit.

STFM DEVELOPS PRECEPTOR GUIDELINES AND A POSITION STATEMENT ON STUDENT USE OF ELECTRONIC HEALTH RECORDS

The Society of Teachers of Family Medicine has created 2 documents to help preceptors and other educators when working with students using electronic health records (EHRs). The guidelines will help preceptors work effectively with students when using EHRs. The position statement will assist preceptors and other educators when engaging compliance officers or organizations in discussions about the need for medical students to work meaningfully with electronic medical records.

Using Telemedicine for Tuberculosis Care Management: a Three County Inter-Municipal Approach

Tuberculosis (TB) is a life threatening illness caused by the bacteriumMycobacterium tuberculosis. TB requires specialty knowledge and is treated with multiple combinations of antibiotics for a course that ranges from 6 to 12 months [1]. TB is becoming increasingly more complex for clinicians due to rise in antibiotic resistance which can occur when the drugs are misused or mismanaged. Many healthcare providers do not have the expertise in identifying and managing patients infected with TB [2, 3]. New York State Public Health Law requires all county health departments to be responsible for providing or securing TB care and treatment. With this law, it has been challenging for local health departments such as Genesee and Orleans County Health Departments to find expert TB specialists to effectively diagnose and manage infection within their counties. Genesee and Orleans are rural counties that are located between the cities of Rochester and Buffalo in Western New York. Residents of each county have limited local access to experts for diagnosing, treating and managing TB disease and latent tuberculosis infection (LTBI). Orleans ratio of population to primary care physicians is amongst the worst in the state at 10,500:1 according to the 2017 BCounty Health Rankings & Roadmaps^, and that for Genesee County is 2690 [4]. Individuals residing in these counties requiring care have to travel significant distances to access care. Both counties have special populations that have increased risk factors for TB such as persons that have relocated from areas with rates of TB and persons who work or reside in correctional facilities. In 2016, Genesee and Orleans County sought out Monroe County Health Department (MCHD) to enter into an intermunicipal agreement to provide TB specialty care for their residents. MCHD has a comprehensive TB Control Program that provides clinical services, disease reporting/surveillance, directly observed therapy (DOT) and provider/community education and consultation to prevent and treat TB. MCHD operates a New York State Article 28 licensed diagnostic and treatment facility that in addition to medical management, provides screening of high risk populations, case management and consultation, contact investigation and outreach program that provides DOT to all cases of TB and high risk cases of Latent Tuberculosis Infection (LTBI). The staff is expert at managing TB, and currently serves 20–25 new cases of disease and provides treatment to over 550 persons with LTBI, per year. The average TB case rate for Monroe County is 3 per 100,000, however the TB case rate for the City of Rochester, located in Monroe County is 10 per 100,000. MCHD contracts with a group of nationally-recognized, board-certified attending pulmonary/critical care physicians from the University of Rochester, to provide the medical care and oversight. The MCHD inter-municipal agreement with Genesee and Orleans County Health Departments provides clinical expertise and comprehensive TB services to patients residing in Genesee and Orleans counties with TB disease and LTBI. Patients residing in Genesee and Orleans counties will have a comprehensive medical home for TB services, which will include chest x-ray, sputum induction, medication, physician management, and phlebotomy on-site at the MCHD TB Clinic. Patients now have access to TB specialists with telemedicine for routine follow-up; the utilization of telemedicine can eliminate barriers for residents in rural counties and improve access to expert TB care. Telehealth provides face to face visits with the pulmonary TB specialist. These telehealth visits are identical to what a patient would experience if they This article is part of the Topical Collection on Patient Facing Systems

Promoting Cardiovascular Health in Men

Heart disease remains the leading cause of death in the United States (USA) and the leading cause of mortality in men, killing 307,384 men in 2010. Although the age-adjusted heart disease death rate decreased 30 % from 257.6 to 179.1 deaths per 100,000 population between 2000 and 2010, heart disease still accounts for approximately 1 in 4 deaths among males [1]. Heart disease is the leading cause of mortality for men across most racial/ethnic groups in the USA, including African Americans, American Indians or Alaska Natives, Hispanics, and whites. For Asian American or Pacific Islander men, heart disease is second only to cancer as the leading cause of mortality [2]. About 8.5 % of all white men, 7.9 % of black men, and 6.3 % of Mexican American men have coronary heart disease. Half of the men who die suddenly of coronary heart disease have no previous symptoms. It is thought that between 70 % and 89 % of sudden cardiac events occur in men [3]. High blood pressure, low-density lipoprotein (LDL) cholesterol, diabetes mellitus, and smoking are key risk factors for heart disease. About half of Americans (49 %) have at least one of these three risk factors [4].

Proceedings of the 2013 Society of Teachers of Family Medicine (STFM) Conference on Medical Student Education

The Society of Teachers of Family Medicine (STFM; http:// www.stfm.org) is a community of professionals devoted to teaching family medicine through undergraduate, graduate, and continuing medical education. This multidisciplinary group of physicians, educators, behavioral scientists, and researchers works to further STFM’s mission of improving the health of all people through education, research, patient care, and advocacy. The STFM held its 39th Conference on Medical Student Education in San Antonio, Texas, from January 24 to 27, 2013. Steven Berk, MD, and Betsy Goebel Jones, EdD, of the Texas Tech University Health Sciences Center opened the conference with a look at an innovative way to expand the primary care physician workforce: the accelerated track. Throughout the conference, the more than 430 participants shared ideas and learned new skills in numerous workshops, seminars, and discussions as well as educational research and curriculum evaluation papers, and poster presentations. Andrew Bazemore, MD, MPH, director of the Robert Graham Center for Policy Studies in Primary Care, closed the conference with a joint presentation to STFM and the Society of Student Run Free Clinics. Dr. Bazemore spoke of the need and the opportunities to advance and transform the U.S. primary care function. The STFM Education Committee selected 10 papers from the educational research and curriculum evaluation papers, felt to be of interest to readers of Teaching and Learning in Medicine. Two of the papers deal with preclerkship education, 2 with 3rdand 4th-year education, 3 with longitudinal experiences across all years of medical school, and 3 with assessment.