Our main findings suggest that rest is underused by health care providers, recommendations for rest are broad and not specific to individual patients, an initial period of moderate physical and cognitive rest (eg, limited physical activity and light mental activity) may improve outcomes during the acute postinjury phase, significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists, and additional research is needed to empirically evaluate the effectiveness of graded return-to-activity progressions. Furthermore, there is a significant need to translate knowledge of best practices in concussion management to primary care providers.

BackgroundThe social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America’s highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH.MethodsInvestigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers’ perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors.ResultsThe results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code.ConclusionsAn obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0526-8) contains supplementary material, which is available to authorized users.

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BackgroundLecture capture technology is widely available in undergraduate medical education and seems to impact class attendance. Further, there is limited understanding about faculty perceptions related to lecture capture and student attendance and how faculty advise students on issues of attendance in an environment where lecture capture is available and attendance is not required.ObjectiveThe purpose of the current study was to characterize faculty perceptions and preferences about student attendance, investigate faculty advising practices about attendance, and evaluate the potential impacts of low student attendance on faculty job satisfaction and teaching.MethodA 15-min electronic survey was created and emailed to all on-campus teaching faculty at a medical school. The survey included demographic, close-ended (with Likert and Likert-like scales), and open-ended questions.ResultsAll 35 faculty members were invited to participate in the survey, and 26 (77%) responded. Faculty advising practices on student attendance varied, but most faculty indicated they advised students to attend class if the student expressed loneliness. A majority (15/26, 58%) disagreed or strongly disagreed that student attendance indicated level of professionalism, and many (12/26, 46%) believed that lecture capture was an effective alternative to attending class. Most faculty (19/26, 73%) agreed or strongly agreed they felt more job satisfaction with higher student attendance. A majority (15/26, 58%) also agreed or strongly agreed they would prefer to incorporate active learning in large-group sessions when student attendance was mandatory.ConclusionFaculty member willingness to incorporate active-learning sessions and job satisfaction were influenced by student classroom attendance in the current study. Given the varied options for content delivery, these factors should be taken into account when institutions create attendance policies. These policies should balance the satisfaction of the faculty with the need to encourage autonomy and flexibility for the adult student learners.

Introduction Self-measured blood pressure monitoring (SMBP) helps diagnose and manage hypertension from outside the clinic, which has implications for patient empowerment and outcomes, continuity of care, and resilience in care communities catering to vulnerable populations. Methods We instituted a protocol for SMBP among hypertensive patients at 9 community health centers in 3 states and administered questionnaires to patients before and after the protocol was instituted to assess knowledge and engagement with disease management, beliefs and attitudes towards, and experience doing SMBP. Questionnaires included 16 items designed to evaluate patient perceptions and beliefs about SMBP. These included a series of questions using a 5-point Likert scale, binary questions related to their perceived ability to comply with specific SMBP guidelines and open-ended questions to obtain descriptions of experiences with SMBP. Results The pre-questionnaire was completed by 478 patients and the post-questionnaire was completed by 372. Seventy-seven percent of respondents knew their ideal blood pressure and their engagement with blood pressure management increased significantly (p=0.0024) after completing the protocol. Additionally, 85% of respondents said that they had a positive experience doing SMBP. Open-ended responses revealed insight regarding why patients chose to do SMBP and factors patients appreciated about SMBP. Discussion When trained properly and supported, community health center patients are capable of and motivated to perform accurate SMBP. Our study provides evidence that health center patients can follow detailed SMBP protocols and monitor their own blood pressure from the safety of their homes, which is critical to their care continuum, particularly in days of a pandemic.