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BackgroundAdvance care planning is the process of discussing health care treatment preferences based on patients’ personal values, and it often involves the completion of advance directives. In the first months of 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began circulating widely in the American state of Colorado, leading to widespread diagnosis of coronavirus disease (COVID-19), hospitalizations, and deaths. In this context, the importance of technology-based, non–face-to-face methods to conduct advance care planning via patient portals has increased. ObjectiveThe aim of this study was to determine the rates of use of a web-based advance care planning tool through a health system–based electronic patient portal both before and in the early months of the COVID-19 pandemic. MethodsIn 2017, we implemented web-based tools through the patient portal of UCHealth’s electronic health record (EHR) for patients to learn about advance care planning and complete an electronically signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. Patients accessing the portal can complete and submit a legally valid MDPOA, which becomes part of their medical record. We collected data on the patients’ date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phase of the COVID-19 pandemic (December 29, 2019, to May 30, 2020). ResultsOver a 5-month period that includes the early phase of the COVID-19 pandemic in Colorado, total monthly use of the advance care planning portal tool increased from 418 users in January to 1037 users in April and then decreased slightly to 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the stay-at-home order was issued in Colorado on March 26, 2020 (P

Background: Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices. Methods: American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February–April, 2019, and February–April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices' responses. Descriptive statistics and binary logistic and multinomial regressions were used. Results: Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion. Discussion: Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations. Conclusions: Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis. [ABSTRACT FROM AUTHOR]

This pooled cross-sectional study explores prescribing rates for glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors among US patients with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Context: Metabolic syndrome, includes elevated fasting glucose, high triglycerides, hypertension, low HDL & abdominal obesity, affects 35% of adults in the United States. People with metabolic syndrome are at high risk for diabetes and cardiovascular disease and have higher all-cause mortality. Usual treatment for metabolic syndrome is weight loss through diet and exercise. Evidence supports the use of mindfulness as a strategy for effective weight management. Objective: Are group visits for mindful eating and healthy nutrition education feasible and acceptable across different primary care settings for patients, staff and clinicians? Study design: Pilot/feasibility study. Setting: Needham Wellesley Family Medicine PC, a physician-owned family medicine practice in Wellesley, MA and UC Health Integrative Medicine Center in Denver, CO. Population Studied: 3 primary care clinicians (1 in MA, 2 in CO), 3 mindfulness teachers (1 RN in MA, 2 clinical psychologists in CO); 15 patients 18+ years with obesity/overweight and metabolic syndrome or diabetes, cardiovascular disease, hypertension. actively enrolled in MA; able to consent, understand procedures; Patient exclusions: lack cognitive capacity, unable/unwilling to consent or complete study. Intervention: Group visits with mindful eating, healthy nutrition for adults with metabolic syndrome and related conditions. Curriculum: evidence-based principles of mindful eating, healthy nutrition, and activity to improve management of metabolic syndrome and related conditions. The curriculum seeks to foster sustainable lifestyle change related to eating behaviors, nutrition choices, activity, self-efficacy, goal setting. Physician, mindfulness teacher, patients meet for 13 weekly group visits during 3 months. Outcome measures: survey questions, semi-structured interviews for physicians and mindfulness teachers. feasibility & acceptability to clinicians learning and leading the curriculum. Results: Clinicians report: (5=best) helped patients acquire new skills 4.8/5; clinicians enjoyed leading the program 4.2/5; time to explore difficult issues more deeply, curriculum was very interesting. Challenges: learning complex curriculum, charting medical records for a group of patients; staffing/scheduling/locating group visits. Conclusions: Mindful eating healthy nutrition group visits are feasible. Clinicians report acceptability for leading group visits to enhance healthier eating & lifestyle change., Presenters Leonard Finn, MD, Jacqueline Kiel, Tarin Clay, BA, Elisabeth Callen, PhD, Lauren Kiel, Elizabeth Staton, [...]

Context: Metabolic syndrome, includes elevated fasting glucose, high triglycerides, hypertension, low HDL & abdominal obesity, affects 35% of adults in the United States. People with metabolic syndrome are at high risk for diabetes and cardiovascular disease and have higher all-cause mortality. Usual treatment for metabolic syndrome is weight loss through diet and exercise. Evidence supports the use of mindfulness as a strategy for effective weight management. Objective: Are group visits for mindful eating and healthy nutrition education feasible and acceptable across different primary care settings for patients, staff and clinicians? Study design: Pilot/feasibility study. Setting: Needham Wellesley Family Medicine PC, a physician-owned family medicine practice in Wellesley, MA. Population Studied: 15 patients 18+ years with obesity/overweight and metabolic syndrome or diabetes, cardiovascular disease, hypertension. actively enrolled at site, able to consent, understand procedures, Exclusions: lack cognitive capacity, unable/unwilling to consent or complete study. Intervention: Group visits with mindfulness, mindful eating, healthy nutrition for adults with metabolic syndrome and related conditions. Curriculum: evidence-based principles of mindfulness, mindful eating, healthy nutrition, and activity to improve patient management of metabolic syndrome and related conditions. The curriculum seeks to foster sustainable lifestyle change related to eating behaviors, nutrition choices, activity, self- efficacy, stress-management, and goal setting. Physician, mindfulness teacher and patients meet for 13 weekly group visits during 3 months. Outcome measures: patient surveys at T0, weeks 5 and 10. measure mindfulness, mindful eating, nutrition practices. Survey questions and semi-structured interviews after the sessions ended. We collected feasibility data for scheduling, staffing, recruiting patients, and for patients acquiring skills and knowledge; and acceptability to patients; Results: Patients report: increased fruits, vegetables, salads, fish; decreased simple carbohydrates; and (5=better) eating healthier 4.5/5, achieve goals for lifestyle change 4.2/5; mindful eating was helpful 4.7/5; positive reinforcement from shared experiences, request more direct teaching, and more time to share with others. Conclusions: Mindful eating healthy nutrition group visits are feasible. Patients report acceptability for group visits, healthier eating & lifestyle change., Presenters Leonard Finn, MD, Jacqueline Kiel, Kirsten Scharer, Tarin Clay, BA, Elisabeth Callen, PhD, Lauren Kiel, Elizabeth Staton, [...]

Context: The PeRson EmPowered Asthma RElief (PREPARE) study was a pragmatic open-label randomized trial that tested a patient empowered approach to using inhaled corticosteroids together with short-acting bronchodilators as rescue therapy to reduce exacerbations in two highly impacted groups with asthma. This study used a mixed modal survey approach (i.e., mail, phone, online) to ensure equitable and convenient access to monthly surveys and optimize response rates. Respondents selected their preference for completing surveys. This sub-study examines respondent characteristics by selection of survey modality. Objectives: 1). Describe respondent characteristics by main modality used to complete surveys. 2). Explore differences in respondent characteristics across survey modalities. Study Design and Analysis: Sub-study of the PREPARE study, describing characteristics of the cohort by survey modality choice are presented. Dataset: Baseline assessment and monthly surveys. Population Studied: Adults, 18-75 years, who self-identified as African American/Black (AA/B) or Hispanic/Latinx (H/L) and had a clinical diagnosis of moderate to severe asthma. Total of 603 AA/B and 598 H/L participants enrolled at 19 family medicine and subspecialty sites in the U.S. and Puerto Rico. Intervention/Instrument: Baseline assessment included respondent characteristics. Monthly surveys assessed asthma symptoms, exacerbations, missed work/school or usual activities, and medication use. Respondents were asked to complete 13-15 monthly surveys. Outcome Measures: Baseline respondent characteristics, survey modality selection, and survey completion rates. Results: Overall, a >90% survey response rate was achieved. The majority of participants (68%) filled out most of their surveys online, 27% by telephone, 3% by paper. Survey modality choice differed by responders' race/ethnicity, language, age, education, and income. Conclusions: Providing options to complete survey had a positive impact on response rates. Findings from this study show that there are differences in survey modality utilization and respondents characteristics. Online and telephone survey options were widely utilized; mail option was selected infrequently and could be dropped in the future., Presenters Brian Manning, MPH, Maureen Fagan, DNP, FNP-BC, FAAN, Jean Kruse, Joel Shields, MA, Elizabeth Staton, MSTC, Wilson Pace, MD, FAAFP, Juan Carlos Cardet, MD, MPH, Alicia Brooks-Greisen, Anne Fuhlbrigge, [...]

The cornerstone of this improvement project was a series of clinician focus groups. Here's what they told us about well-being. [ABSTRACT FROM AUTHOR]

Patients want weight management in primary care, but regular office visits tend to focus on comorbidities, leaving little time to talk about weight. In a weight-prioritized visit, both patient and clinician understand the visit will be dedicated to talking about weight and co-creating a comprehensive, personalized treatment plan. Patients want weight management in primary care, but regular office visits tend to focus on comorbidities, leaving little time to talk about weight. [ABSTRACT FROM AUTHOR]

Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. Applied Strategies for Improving Patient Safety (ASIPS) was a demonstration project designed to collect and analyze medical error reports and use these reports to develop and implement interventions aimed at decreasing errors. ASIPS participants were clinicians and staff in 2 practice-based research networks: the Colorado Research Network (CaReNet) and the High Plains Research Network (HPRN). This paper describes ASIPS in HPRN. Fourteen HPRN practices with a total of 150 clinicians and staff have participated in ASIPS. Participants have submitted 128 reports. Diagnostic tests were involved in 26% of events; medication errors appeared in 20% of events. Communication errors were reported in 72%. Two learning groups developed "Principles for Process Improvement" for medication errors and diagnostic testing errors. Several safety "alerts" were issued to improve care, and 2 interventions were implemented to decrease errors. A safe and secure reporting system that relies on voluntary reporting from clinicians and staff can be successfully implemented in rural primary care settings. Information from reports can be used to identify processes that can be improved.

Background and Objectives While advance care planning (ACP) is critical for ensuring optimal end-of-life outcomes among individuals with mild cognitive impairment (MCI), many individuals who may benefit from ACP have not initiated this process. This article aims to describe the iterative design of an MCI group visit-based intervention and evaluate the feasibility and acceptability of the intervention. Research Design and Methods We used human-centered design, rapid-cycle prototyping, and multiple methods to adapt an ENgaging in Advance Care planning Talks (ENACT) Group Visits intervention. We convened an advisory panel of persons with MCI and care partners (n = 6 dyads) to refine the intervention and conducted a single-arm pilot of 4 MCI ENACT intervention prototypes (n = 13 dyads). We used surveys and interviews to assess outcomes from multiple perspectives. Results The advisory panel affirmed that ACP is a priority for individuals with MCI, described the need for ACP in a group setting, and suggested refinements to ACP resources for the MCI ENACT intervention. Feasibility of recruitment was limited. MCI ENACT intervention participants strongly agreed that group discussions provided useful information and recommended the intervention. Themes supporting acceptability included (a) feedback on acceptability of the intervention, (b) previous experiences with ACP, and (c) reasons for participation, including desire for discussions about MCI and how it relates to ACP. Discussion and Implications Despite stakeholders' positive ratings of acceptability of the MCI ENACT intervention, future work is needed to enhance the feasibility of recruitment to support implementation into clinical settings. [ABSTRACT FROM AUTHOR]

Background: Primary care clinicians need to recognize and diagnose Adult ADHD (AADHD). We tested the feasibility and outcomes of a two-step screening process for AADHD in primary care. Methods: Seven practices screened patients using computerized surveys. Patients screening positive completed the AADHD Quality of Life (AAQoL). We explored the impact of screening on workflow and the acceptability to patients, and identified key barriers/opportunities to continuing screening. Results: Of the 711 participating adults, 188 (26.4%) screened positive, of which 32 (17.0%) had scores at least one standard deviation below means on two or more domains on the AAQoL (average 23.6 ± 7.3). These 32 individuals represented 4.5% of all participants. Clinicians were willing to screen, diagnose, and treat AADHD, but need additional resources. The screening process and technology was acceptable to patients and staff. Conclusions: A two-step screening method shows promise for routine screening for AADHD. [ABSTRACT FROM AUTHOR]

Abstract Background Many medical errors occur during the laboratory testing process, including lost test results. Patient inquiry concerning results often represents the final safety net for locating lost results. This qualitative study sought to identify, from a patient perspective, specific preferences and factors that influence the process of communicating normal (negative) laboratory test results to patients. Methods We conducted 30-minute guided interviews with 20 adult patients. Patients were recruited from two practice-based research networks in Colorado that were participating in a medical errors study. A semi-structured interview elicited the participant's experience with and preference for laboratory test result notification. Quantitative descriptive statistics were generated for demographic and preference data. Qualitative results were analyzed by a team of experienced qualitative researchers using multiple styles of qualitative analyses, including a template approach and an editing approach. Results Ninety percent of participants wanted to be notified of all tests results. Important issues related to notification included privacy, responsive and interactive feedback, convenience, timeliness, and provision of details. Telephone notification was preferred, followed by regular mail. Electronic notification was perceived as uncomfortable because it was not secure. While 65% preferred being notified by a provider, participants acknowledge that this may be impractical; thus, they wanted to be notified by someone knowledgeable enough to answer questions. Participants do not normally discuss their preferences for test result notification with their providers. Conclusion Privacy, responsive and interactive feedback, convenience, and timeliness with detailed information may be critical for patient satisfaction and for improving patient safety, and are features that may be incorporated into emerging communication channels.