Literature Collection

7481

Physician conceptions of responsibility to individual patients and distributive justice in health care

Type: Journal Article

Authors: Mary Catherine Beach, Lisa S. Meredith, Jodi Halpern, Kenneth B. Wells, Daniel E. Ford

Year: 2005

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7482

Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements

Type: Journal Article

Authors: Corey S. Davis, Derek Carr

Year: 2016

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7483

Physician education in addiction medicine

Type: Journal Article

Authors: Evan Wood, Jeffrey H. Samet, Nora D. Volkow

Year: 2013

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7484

Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain

Type: Journal Article

Authors: T. Munzing

Year: 2017

Publication Place: United States

Abstract: Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians' illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient's well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible.

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7485

Physician identification and management of psychosocial problems in primary care

Type: Journal Article

Authors: M. M. Steele, A. S. Lochrie, M. C. Roberts

Year: 2010

Publication Place: United States

Abstract: Often the burden of identifying children with behavioral or developmental problems is left up to the primary care physician (PCP). However, previous literature shows that PCPs consistently underidentify children with developmental/behavioral problems in pediatric primary care. For the current study, questionnaires containing three vignettes followed by questions addressing common psychosocial problems, general questions about their practice and training, and the Physician Belief Scale were distributed to physicians. Results indicated that physicians were better at identifying severe problems, had more difficulty identifying psychosocial problems with mild symptomatology, and tended to refer to a medical specialist or mental health professional more often for severe problems, depression or a developmental problem. Physicians tended to view treating psychosocial problems favorably.

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7486

Physician perception regarding side-effect profile at the onset of antidepressant treatment: a survey of Israeli psychiatrists and primary care physicians

Type: Journal Article

Authors: U. Nitzan, T. Bekerman, G. Becker, P. Lichtenberg, S. Lev-Ran, G. Walter, H. Maoz, Y. Bloch

Year: 2016

Publication Place: England

Abstract: BACKGROUND: One of the major factors affecting treatment compliance and outcome in patients is the wide range of side effects (SEs) associated with antidepressants. In the present study, we aimed to assess the extent to which Israeli primary care (PC) physicians and psychiatrists discuss the SEs of selective serotonin reuptake inhibitors (SSRIs) with patients prior to the onset of treatment. METHODS: A cross-sectional questionnaire survey was conducted among PC physicians (N = 123) and psychiatrists (N = 105). Questionnaires were distributed using a mixed-modality design, combining a web survey and in-person delivery of questionnaires. RESULTS: A significant percentage of our respondents reported that they rarely discuss psychological (60 %) or severe (29 %) SEs of SSRIs. Nearly half (41 %) admitted to avoiding discussion of impact on suicidal ideation. Specialists were noted to discuss and evaluate SEs significantly more than residents, and Psychiatrists more than PC physicians. Specifically, psychiatrists more often discussed the possibility of sexual dysfunction (t (225) = 2.23; p < 0.05) and suicidal ideation (t (225) = 2.11; p < 0.05). CONCLUSIONS: It seems that PC physicians and psychiatrists surveyed in this study do not share sufficient information regarding the SEs of SSRIs with their patients at the onset of treatment. In improving this practice, the integration of proper SE management into educational interventions has potential in enhancing compliance and improving expertise and level of care.

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7487

Physician perceptions of primary prevention: qualitative base for the conceptual shaping of a practice intervention tool

Type: Journal Article

Authors: A. L. Mirand, G. P. Beehler, C. L. Kuo, M. C. Mahoney

Year: 2002

Publication Place: England

Abstract: BACKGROUND: A practice intervention must have its basis in an understanding of the physician and practice to secure its benefit and relevancy. We used a formative process to characterize primary care physician attitudes, needs, and practice obstacles regarding primary prevention. The characterization will provide the conceptual framework for the development of a practice tool to facilitate routine delivery of primary preventive care. METHODS: A focus group of primary care physician Opinion Leaders was audio-taped, transcribed, and qualitatively analyzed to identify emergent themes that described physicians' perceptions of prevention in daily practice. RESULTS: The conceptual worth of primary prevention, including behavioral counseling, was high, but its practice was significantly countered by the predominant clinical emphasis on and rewards for secondary care. In addition, lack of health behavior training, perceived low self-efficacy, and patient resistance to change were key deterrents to primary prevention delivery. Also, the preventive focus in primary care is not on cancer, but on predominant chronic nonmalignant conditions. CONCLUSIONS: The success of the future practice tool will be largely dependent on its ability to "fit" primary prevention into the clinical culture of diagnoses and treatment sustained by physicians, patients, and payers. The tool's message output must be formatted to facilitate physician delivery of patient-tailored behavioral counseling in an accurate, confident, and efficacious manner. Also, the tool's health behavior messages should be behavior-specific, not disease-specific, to draw on shared risk behaviors of numerous diseases and increase the likelihood of perceived salience and utility of the tool in primary care.

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7488

Physician Perspectives on Telemedicine at an Integrated Health System During the COVID-19 Pandemic

Type: Journal Article

Authors: A. M. Luciani, M. Parry, I. F. Udoeyo, M. Suk, J. J. Mercuri, E. M. DelSole

Year: 2023

Abstract:

Introduction: The use of telemedicine (TM) for patient care greatly increased during the COVID pandemic. This study presents data from a single health system regarding physician's perspectives on TM, which could ultimately determine how it is used in the future. Methods: A questionnaire was distributed to physicians throughout the health system. Physicians were divided based on the standard level of patient interaction in each specialty, as well as practice locations and years in practice. Physician perspectives were categorized by their opinions on different aspects of telehealth visits. Results: Of 1,794 physicians, 379 (20.7%) responded to the survey. Psychiatrists used TM significantly more than other groups and project the most future use. Surgeons were least likely to incorporate TM in the future. Ability to perform a physical examination via TM differed significantly by specialty and practice environment, but not by years in practice. Frequency of being able to complete a treatment plan via TM differed significantly by specialty, but not by years in practice or practice environment. Overall, 76.3% of physicians reported feeling "satisfied" with performing TM visits. Satisfaction with TM varied significantly by specialty and practice environment, but not by years in practice. There were no significant differences regarding physician expectations on reimbursement or billing for TM visits based on specialty, age, or practice environment. Conclusions: Discrepancies exist among physicians with respect to their satisfaction and expected future use of TM. Consensus may be difficult to reach regarding reimbursement for these visits, and further work is needed to clarify the optimal practice setting for TM.

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7489

Physician practice participation in accountable care organizations: the emergence of the unicorn

Type: Journal Article

Authors: S. M. Shortell, S. R. McClellan, P. P. Ramsay, L. P. Casalino, A. M. Ryan, K. R. Copeland

Year: 2014

Publication Place: United States

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7490

Physician Practices and Readiness for Medical Home Reforms: Policy, Pitfalls, and Possibilities

Type: Journal Article

Authors: John M. Hollingsworth, Sanjay Saint, Joseph W. Sakshaug, Rodney A. Hayward, Lingling Zhang, David C. Miller

Year: 2011

Publication Place: United Kingdom

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7491

Physician prescribing of opioid agonist treatments in provincial correctional facilities in Ontario, Canada: A survey

Type: Journal Article

Authors: F. G. Kouyoumdjian, A. Patel, M. J. To, L. Kiefer, L. Regenstreif

Year: 2018

Publication Place: United States

Abstract: BACKGROUND: Substance use and substance use disorders are common in people who experience detention or incarceration in Canada, and opioid agonist treatment (OAT) may reduce the harms associated with substance use disorders. We aimed to define current physician practice in provincial correctional facilities in Ontario with respect to prescribing OAT and to identify potential barriers and facilitators to prescribing OAT. METHODS: We invited all physicians practicing in the 26 provincial correctional facilities for adults in Ontario to participate in an online survey. RESULTS: Twenty-seven physicians participated, with representation from most correctional facilities in Ontario. Of participating physicians, 52% reported prescribing methadone and 48% reported prescribing buprenorphine/naloxone to patients in provincial correctional facilities. Nineteen percent of participants reported initiating methadone treatment and 11% reported initiating buprenorphine/naloxone for patients in custody. Participants identified multiple barriers to initiating OAT in provincial correctional facilities including concerns about medication diversion and safety, concerns about initiating treatment in patients who are not currently using opioids, lack of linkage with community-based providers and the Ministry of Community Safety and Correctional Services policy. Identified facilitators to initiating OAT were support from institutional health care staff and administrative staff, adequate resources for program delivery and access to linkage with community-based OAT providers. CONCLUSIONS: This study identifies opportunities to improve OAT programs and to improve access to OAT for persons in provincial correctional facilities in Ontario.

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7492

Physician Response to COVID-19-Driven Telehealth Flexibility for Opioid Use Disorder

Type: Journal Article

Authors: Tamara Beetham, David A. Fiellin, Susan H. Busch

Year: 2022

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7493

Physician Satisfaction With Integrated Behavioral Health in Pediatric Primary Care

Type: Journal Article

Authors: J. F. Hine, A. Q. Grennan, K. M. Menousek, G. Robertson, R. J. Valleley, J. H. Evans

Year: 2017

Publication Place: United States

Abstract: As the benefits of integrated behavioral health care services are becoming more widely recognized, this study investigated physician satisfaction with ongoing integrated psychology services in pediatric primary care clinics. Data were collected across 5 urban and 6 rural clinics and demonstrated the specific factors that physicians view as assets to having efficient access to a pediatric behavioral health practitioner. Results indicated significant satisfaction related to quality and continuity of care and improved access to services. Such models of care may increase access to care and reduce other service barriers encountered by individuals and their families with behavioral health concerns (ie, those who otherwise would seek services through referrals to traditional tertiary care facilities).

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7494

Physician trust in the patient: development and validation of a new measure

Type: Journal Article

Authors: D. H. Thom, S. T. Wong, D. Guzman, A. Wu, J. Penko, C. Miaskowski, M. Kushel

Year: 2011

Publication Place: United States

Abstract: PURPOSE: Mutual trust is an important aspect of the patient-physician relationship with positive consequences for both parties. Previous measures have been limited to patient trust in the physician. We set out to develop and validate a measure of physician trust in the patient. METHODS: We identified candidate items for the scale by content analysis of a previous qualitative study of patient-physician trust and developed and validated a scale among 61 primary care clinicians (50 physicians and 11 nonphysicians) with respect to 168 patients as part of a community-based study of prescription opioid use for chronic, nonmalignant pain in HIV-positive adults. Polychoric factor structure analysis using the Pratt D matrix was used to reduce the number of items and describe the factor structure. Construct validity was tested by comparing mean clinician trust scores for patients by clinician and patient behaviors expected to be associated with clinician trust using a generalized linear mixed model. RESULTS: The final 12-item scale had high internal reliability (Cronbach alpha =.93) and a distinct 2-factor pattern with the Pratt matrix D. Construct validity was demonstrated with respect to clinician-reported self-behaviors including toxicology screening (P <.001), and refusal to prescribe opioids (P <.001) and with patient behaviors including reporting opioids lost or stolen (P=.008), taking opioids to get high (P <.001), and selling opioids (P<.001). CONCLUSIONS: If validated in other populations, this measure of physician trust in the patient will be useful in investigating the antecedents and consequences of mutual trust, and the relationship between mutual trust and processes of care, which can help improve the delivery of clinical care.

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7495

Physician Utilization of a Universal Psychosocial Screening Protocol in Pediatric Primary Care

Type: Journal Article

Authors: A. B. Shellman, A. C. Meinert, D. F. Curtis

Year: 2019

Publication Place: United States

Abstract: This study evaluated physicians' utilization of a universal psychosocial screening protocol within a pediatric primary care setting. Pediatricians (n = 20) adopted a multitiered screening algorithm using the Pediatric Symptom Checklist-17 (PSC-17) within well-child checkups (WCC) for children, ages 7 and 11 years. Descriptive analyses were performed to evaluate the initial 3 years of physician screening protocol implementation to: (1) determine frequency and proportion of use and (2) examine patient outcomes associated with accessing behavioral health care. Physicians frequently initiated the protocol, administering the PSC-17 within 3678 WCC encounters, with frequency progressively increasing over the 3-year period. Results highlighted elements of screener utilization, cost-effectiveness, screening algorithm fidelity, and prevalence of psychosocial concerns identified. Secondary implementation challenges were observed after initial screening, specific to implementation of prescribed follow-up procedures. Primary care behavioral health collaborations appear helpful for improving universal screening utilization and cost-effectiveness, and for ensuring children with psychosocial problems are identified early and directed to follow-up care as needed.

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7496

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department

Type: Journal Article

Authors: G. Logan, A. Mirajkar, J. Houck, F. Rivera-Alvarez, E. Drone, P. Patel, A. Craen, L. Dub, N. Elahi, D. Lebowitz, A. Walker, L. Ganti

Year: 2021

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7497

Physicians report adopting safer opioid prescribing behaviors after academic detailing intervention

Type: Journal Article

Authors: Mary Jo Larson, Cheryl Browne, Ruslan V. Nikitin, Nikki R. Wooten, Sarah Ball, Rachel Sayko Adams, Kelly Barth

Year: 2018

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7498

Physicians' Beliefs about the nature of addiction: a survey of primary care physicians and psychiatrists

Type: Journal Article

Authors: R. E. Lawrence, K. A. Rasinski, J. D. Yoon, F. A. Curlin

Year: 2013

Publication Place: England

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7499

Physicians' Decision-making When Implementing Buprenorphine With New Patients: Conjoint Analyses of Data From a Cohort of Current Prescribers

Type: Journal Article

Authors: H. K. Knudsen, M. R. Lofwall, S. L. Walsh, J. R. Havens, J. L. Studts

Year: 2018

Publication Place: United States

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7500

Physicians' influence on primary care patients' reluctance to use mental health treatment

Type: Journal Article

Authors: T. Hornik-Lurie, Y. Lerner, N. Zilber, M. C. Feinson, J. G. Cwikel

Year: 2014

Publication Place: United States

Abstract: OBJECTIVES: The study examined attitudes of primary care patients toward mental health treatment and whether ambivalent or negative attitudes change after patients receive recommendations from their primary care physicians to seek treatment from a mental health professional. METHODS: Data were collected in face-to-face interviews with 902 Jewish patients aged 25-75 in eight primary care clinics in Israel. Measures included validated mental health instruments and a vignette eliciting patients' readiness to consider treatment and potential influence of a physician's recommendation. RESULTS: Initially, almost half of patients were reluctant to consider specialized mental health treatment. The probability of having a more positive attitude after the physician's recommendation was significantly higher among patients with more severe clinical diagnoses. CONCLUSIONS: A major finding was the positive impact of primary care physicians' recommendations on reluctant patients. Encouraging physicians to discuss mental health issues would likely promote more positive attitudes and increase patients' willingness to access treatment.

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