The Role of Primary Care Providers for Uveitis

Uveitis, a treatable sight-threatening condition, may often be misdiagnosed and treated as pink eye, a common ophthalmic condition encountered in the primary care setting. Although more than 50% of cases of uveitis are idiopathic, a variety of underlying medical conditions, such as genetic, traumatic, systemic immune-mediated conditions, or infectious mechanisms can trigger uveitis. An accurate and prompt diagnosis is critical for initiating vision-saving treatment. Because a high percentage of uveitis was reported in the primary care setting, the role of primary care providers should focus on identifying the condition, initiating first-line therapy, and promptly referring to an ophthalmologist.     

Development of a Smoking Cessation Algorithm for Primary Care Providers

The primary care setting is an ideal location to promote smoking cessation through counseling and pharmacological aids. Effective smoking cessation options should be offered by primary care providers (PCPs) at each office visit. Smokers report receptiveness to smoking cessation advice given by PCPs. The US Preventive Services Task Force recommends asking about tobacco use in all adults. Counseling using the 5-A model can be performed during a visit. This article discusses development of an evidence-based algorithm using the 5-A model to help PCPs implement a smoking cessation protocol.     

Depression Screening in Adolescents: Implications for Primary Care Nurse Practitioners

The majority of all mental health disorders, including depression, emerge before the age of 24. However, many symptoms go undetected and thus untreated. Primary care nurse practitioners are well positioned to recognize high-risk situations, routinely screen for depression, and provide first-line evidence-based treatment as appropriate in their adolescent patients.     

Child Sexual Abuse in Boys: Implications for Primary Care

Child sexual abuse occurs in both girls and boys. The public is more aware of the occurrence of sexual abuse in boys, but boys who experience sexual abuse are not always detected because of disclosure concerns. The sequelae of child sexual abuse in boys can lead to risky health behaviors and psychological problems later in life. Primary care nurse practitioners can screen and identify child sexual abuse in their patients. This article discusses recent evidence on child sexual abuse in boys, provides clinical practice guidance for its identification, and recommends referral sources and follow-up visits.     

Trauma Screening Is More Common When Primary Care Patients Trust Providers

Trauma exposure and posttraumatic stress disorder can have a considerable impact on psychiatric health, physical health, and health behaviors. This study assessed how often screening occurs among primary care patients and which patients are more likely to be screened. Primary care patients (N = 316) completed a survey with a trauma screen and measures of trust toward their providers. Trust improved the likelihood of screening in unadjusted (odds ratio, 1.06; 95% confidence interval, 1.01-1.12) and in adjusted models (odds ratio, 1.10; 95% confidence interval, 1.03-1.16). Screenings occurred more commonly among patients with mental health issues and who had higher trust in their provider. Implications are discussed.     

Hepatitis C Management Simplification From Test to Cure: A Framework for Primary Care Providers

This article proposes a strategy for primary care providers to begin treating patients with hepatitis C virus (HCV). We are motivated by the need to expand HCV treatment and by developments that have simplified treatment for most patients. This article presents 5 steps to achieving quality HCV treatment in the primary care setting: (1) accurate diagnosis via reflex testing; (2) risk stratification and identifying comorbidities via pretreatment evaluation; (3) simple, once-daily, pan-genotypic HCV treatment regimens; (4) minimized on-treatment monitoring: and (5) posttreatment monitoring and high-quality care for comorbidities such as cirrhosis and injection drug use. We provide indications for referral to specialists: notably children, patients with genotype 3 and cirrhosis, advanced liver or kidney disease, previous treatment failures, drug interactions with recommended regimens, and hepatitis B co-infection. Finally, potential barriers for providers are discussed, as well as further research findings and policy interventions that can promote HCV treatment in the primary care setting. We believe that a substantial portion of patients with HCV can be treated safely and effectively by nonspecialists and that the engagement of primary care providers is critical to efforts to end the HCV epidemic.     

Fetal Alcohol Spectrum Disorders: Implications for Primary Care Nurse Practitioners

Fetal alcohol spectrum disorders (FASDs) encompass a myriad of biological, psychological, and physiological variants. In primary care, FASDs are not routinely screened for, while prevalence rates remain high at 5% to 9%. Alcohol screening and brief intervention is an evidence-based practice that identifies those who may be consuming alcohol at risky levels and provides a brief motivation-enhancing intervention. FASDs are completely preventable when women do not consume alcohol during the prenatal period, and nurse practitioners who provide patient-centered primary care to women are ideally positioned to help in the prevention FASDs     

Underutilization of Primary Care Providers in Treating Opiate Addiction

There are inadequate numbers of care providers or treatment programs to treat opioid abuse. Although many primary care nurse practitioners care for patients who are dependent on or abuse opioids, they are not allowed to prescribe the schedule 3 medications to treat them. This option is available to primary care physicians with additional training. This article discusses the effectiveness of opioid substitution therapy in a primary care setting, the patient populations, patient satisfaction, and barriers preventing primary care providers from providing treatment to opioid patients. Nurse practitioners can help overcome some of these barriers and improve access to this underserved population.     

Early Palliative Care Initiation: Role of the Primary Care Clinician

Palliative care provided to patients with chronic life-limiting illnesses shows improvement in symptom management, quality of life, and caregiver support while reducing cost of care. Early initiation of palliative care faces a multitude of barriers in the primary care setting, including provider confidence, coordination and implementation, education, and family and patient misconceptions. A team-based approach along with additional education, clear referral triggers, and resources for advanced-care planning discussions allows providers to overcome many of these barriers. With the population’s advancing age, it is essential that primary care providers are properly prepared for early initiation of palliative care.     

Assessing the Prevalence and Predictors of Bullying Among Emergency Medical Service Providers

Background: Bullying as a stressor in the workplace has been evaluated in numerous settings. It has never been evaluated in the emergency medical service (EMS) environment where bullying can occur from many different sources. The Negative Acts Questionnaire-Revised (NAQ-R) is a 22-question validated tool for evaluating bullying. Our hypothesis was that we could identify a shortened version of the NAQ-R that identifies bullying as accurately as the full screening tool. Methods: This was a cross sectional study of EMS providers in our local EMS transport agency. The local EMS agency transports approximately 50,000 patients per year and is a paramedic level response system. Results on the NAQ-R were on a 5-point Likert scale for each of 22 different categories of bullying that were summed by adding each questions 1–5 response for the 22 questions. Respondents were also categorized as victims or non-victims of bullying based on being positive for any of the 22 types of bullying at least once a week. We performed a binomial decision tree analysis and a cross-validation. Results: Data were collected from 153 providers. Mean age was 33?±?10 years and 50% were male. Total years in EMS were 8?±?8 years. NAQ-R summed results in our group ranged between 22 and 88, with an average of 40?±?15. A NAQ-R score of 33 or less was 91% accurate in identifying non-victims and a score of 45 or more was 94% accurate in identifying victims. The majority at 51% (77/152) of respondents were victims of one or more types of bullying. A combination of five questions was 94% accurate in identifying a victim of bullying among EMS providers. Cross validation resulted in a misclassification risk estimate of 0.12?±?.03. Conclusion: NAQ-R bullying scores in EMS are similar or higher than numbers in other fields. Five questions on the NAQ-R were 94% accurate in identifying victims of bullying in EMS providers.     

Older Youth Nearing Their Exit from Congregate Care: Current Innovative Programs

The present paper reviews literature on older youth in foster care with a focus on those older youths in residential. We aim to examine what has been written in the scholarly literature about this specific group. Literature was reviewed from the last decade on the problems these youths face and potential solutions for them in the program literature. A literature review was done utilizing keywords. Further, this paper presents highlights from two informational interviews with residential agencies. Here we aim to describe what the Executive Directors and staff members believe older youths need, how they work with them and the important components of a residential facility for older youth. Findings uncovered that both agencies highlighted the importance of pro-social attachments, or caring relationships, along with education and safety. Also, the critical importance of preparing youths enough so that when they leave residential they will have reduced the gap between their skills and others their age, so as to be able to compete in society for jobs and further education. Limitations include lack of generalizability, among others.     

A new role for nurses as Primary Care Cancer Lead Clinicians in Primary Care Trusts in England

AIM: The aim of this study was to evaluate the Primary Care Cancer Lead Clinician initiative in England. One of the objectives was to examine the impact of the Primary Care Cancer Lead Clinicians' clinical background on how they perform their role. This study compares nurses and General Practitioners in the Primary Care Cancer Lead Clinician role. BACKGROUND: The Primary Care Cancer Lead Clinician initiative developed from the National Health Service Cancer Plan. Primary Care Cancer Lead Clinicians are expected to work strategically to raise the standards of cancer care within primary care. METHODS: A postal questionnaire survey was sent to Primary Care Cancer Lead Clinicians and one manager in each Primary Care Trust in England. Telephonic interviews were also undertaken with a range of stakeholders in six case study areas. RESULTS: There were striking similarities between nurses and General Practitioners in the Primary Care Cancer Lead Clinician role. Differences related to the wider roles of the two groups. Nurses placed greater emphasis on fitting in whereas General Practitioners were more likely to expect to take charge and look for administrative support. CONCLUSIONS: There is evidence to show that whether the Primary Care Cancer Lead Clinician was a nurse or a General Practitioner was less important than having local credibility and the support of their Primary Care Trust.     

Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care

The objective of this study was to identify conditions that influence primary care clinicians' referral decisions related to depression care. Forty primary care clinicians (15 general internists, 10 nurse practitioners, and 15 family practice physicians) were included in this study. The clinicians participated in semistructured interviews and completed two quantitative instruments (with 33 items on depression treatment decision making and 32 items on provider attitudes toward psychosocial care). Data analysis revealed that several conditions influence a clinician's decision to refer a depressed patient to a mental health specialist: the patient's resources, the clinician's comfort in prescribing antidepressants and counseling patients with depression, and familiarity with a mental health specialist and practice environment. The decision to refer a patient with depression to a mental health specialist is a complex process involving the clinician, patient, and practice‐related issues. Understanding these relationships may provide strategies to improve depression care management and lead to the design of depression care quality‐improvement interventions that accommodate primary care practice context. The findings from this study suggest a need to increase mental health training opportunities for primary care clinicians to strengthen their skills and comfort level in managing depressed patients and encourage the development of relationships between primary care clinicians and mental health specialists to facilitate timely and accessible mental health care for patients.     

Exploring Suicide Risk History Among Youth in Residential Care

Adolescents in residential care settings have double the national average of suicide risk histories (attempts, threats, and ideation). However, little is known about youth with specific suicide-risk histories. This study explored differences in demographic characteristics and mental health variables for 509 youth in residential care with high and low suicide-risk histories. Overall, nearly 40% of participants had a high suicide-risk history, and significant differences between low and high suicide-risk history groups were found for multiple variables (e.g., gender, ethnicity, number of diagnoses). This study highlights a need for research into areas associated with suicide-risk history in residential care.     

Bariatric Surgery: Comprehensive Strategies for Management in Primary Care

Bariatric surgery is an alternative for long-term weight loss that improves quality of life and decreases mortality by reducing or eliminating obesity and the associated chronic diseases. The nurse practitioner’s role is vital in promoting positive long-term outcomes in view of the increased prevalence of patients with bariatric surgery and their need for management in the primary care setting. The obesity epidemic, weight-loss surgery options, and strategies to manage risks, benefits, and complications need to be considered in providing primary care. As primary care providers, we must address the gap between the psychological benefits of weight-loss surgery and strategies to prevent weight regain and chemical dependency.     

Polymyositis: Essential Information for Primary Care Providers

Polymyositis is one of a rare group of skeletal muscle diseases known as idiopathic inflammatory myopathies. The etiology is not fully understood, and its clinical presentation is often vague yet similar to more common neuromuscular diseases, making diagnosis difficult. A number of different tests are available to assist providers in making an accurate diagnosis. Once a diagnosis is made, there are a number of various treatment modalities available. Nurse practitioners must be familiar with treatment protocols and follow-up. The focus of this article is on polymyositis; its presentation, signs, and symptoms; the process of accurate diagnosis; and common treatment strategies.