Literature Collection

OBJECTIVES: To examine the number of patients screening positive for depression, while self-completing an automated check-in screen prior to a general practice consultation. DESIGN: A descriptive cross-sectional study. SETTING: 10 general practices in the West Midlands, England. Recruitment commenced in March 2023 and concluded in June 2023. PARTICIPANTS: All patients aged 18 years and over, self-completing an automated check-in screen for any general practice prebooked appointment, were invited to participate during a 3-week recruitment period. PRIMARY AND SECONDARY OUTCOME MEASURES: The number of patients screening positive for depression using the Whooley case finding research questions was the primary outcome measure. Secondary outcome measures included: demographic and (general practice level) deprivation differences in completion responses. RESULTS: 73.5% (n=3666) of patients self-completing an automated check-in screen participated in the CAse-fInding foR depressiOn in primary care (CAIRO) study, (61.1% (n=2239) female, mean age 55.0 years (18-96 years, SD=18.5)).28.3% (n=1039) of participants provided a positive response to at least one of the two Whooley research questions (31.2% female and 23.8% male). Significantly more positive responses were obtained from females, those aged between 35 years and 49 years and those from more deprived practices. CONCLUSIONS: Over a quarter of CAIRO participants provided a positive response to at least one of the two Whooley questions, suggesting possible unmet need in the population studied. A follow-up study could investigate whether responses provided at the point of check-in are raised and addressed in the subsequent consultation.

BACKGROUND: Electronic health record (EHR) transitions can cause major disruptions in the provision of primary care services. Veteran Health Administration (VHA), one of the largest integrated healthcare systems, underwent a major EHR transition at two sites. To date, there is limited data on the experience of primary care service lines at EHR transition sites. OBJECTIVE: To describe and quantify changes in the provision of primary care services at two sites that have experienced EHR transition. DESIGN: We conducted a retrospective study of primary care encounters 12 months before and after EHR transition. In addition, we applied economic structural change analysis using the expanded length of time (10 years of prior primary care encounters at sites) to understand how the transition of EHR compares to other major changes in primary care encounter volume during this time period. DATA SOURCE AND MAIN MEASURE: Primary care encounters were measured using algorithms pre- and post-EHR transition from the national VHA Corporate Data Warehouse (CDW) and Cerner Millennium (CDW2) Databases. KEY RESULTS: In Spokane, the average number of monthly primary care encounters decreased from 7155 (SD = 682) in the 12 months prior to October 2020 (transition date) to 4181 (SD = 813) in the 12 months after implementation, a decrease of 41.6 %. The average number of monthly primary care encounters decreased from 8029 (SD = 511) in the 12 months prior to April 2022 (transition date) to 6495 (SD = 1152) in the 12 months after implementation, a decrease of 19.1 %. The structural change analysis identified EHR transition dates at both sites, including a major decrease in volume of primary care encounters. CONCLUSIONS: Given the substantial decrease in primary care services, VHA must identify strategies to mitigate both the amount and the duration of reduced primary care encounters during the EHR transition.

BACKGROUND: To determine how clinicians with a DATA waiver to prescribe buprenorphine for opioid use disorder (OUD) adapted during the COVID-19 pandemic to emergency authorities, including use of telehealth to prescribe buprenorphine, the challenges faced by clinicians, and strategies employed by them to manage patients with OUD. METHODS: From June 23, 2020 to August 19, 2020, we conducted an electronic survey of U.S. DATA-waivered clinicians. Descriptive statistics and multivariable logistic regression were used for analysis. RESULTS: Among 10,238 respondents, 68 % were physicians, 25 % nursing-related providers, and 6% physician assistants; 28 % reported never prescribing or not prescribing in the 12 months prior to the survey. Among the 72 % of clinicians who reported past 12-month buprenorphine prescribing (i.e. active practitioners during the pandemic) 30 % reported their practice setting closed to in-person visits during COVID-19; 33 % reported remote prescribing to new patients without an in-person examination. The strongest predictors of remote buprenorphine prescribing to new patients were prescribing buprenorphine to larger numbers of patients in an average month in the past year and closure of the practice setting during the pandemic; previous experience with remote prescribing to established patients prior to COVID-19 also was a significant predictor. Among clinicians prescribing to new patients without an in-person examination, 5.5 % reported difficulties with buprenorphine induction, most commonly withdrawal symptoms. CONCLUSIONS: Telehealth practices and prescribing to new patients without an in-person examination were adopted by DATA-waivered clinicians during the first six months of COVID-19. Permanent adoption of these authorities may enable expanded access to buprenorphine treatment.