Primary Care Workforce Shortages and Career Recommendations From Practicing Clinicians

DesRoches, Catherine M.; Buerhaus, Peter I.; Dittus, Robert S.; Donelan, Karen

doi:10.1097/acm.0000000000000591

Cited by 19 publications

(14 citation statements)

References 24 publications

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“…A study conducted in the United States within the context of the private PHC system showed that the generation of innovative actions was indicative of professional satisfaction, knowledge employed in daily practices, and procedures based on therapeutic care and patient-centered comprehensive and decisive actions (10) . Some of these actions were also reported by the nurses in the present study as reasons to work in PHC, as well as the positive impact perceived in the lives of their patients.…”

Section: Discussionmentioning

confidence: 99%

Primary health care: the experience of nurses

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Primary health care: the experience of nurses

et al. 2018

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“…Cost-effective strategies are needed to address this problem. Primary care practitioners are the first line for both primary and secondary obesity prevention efforts but must be equipped with adequate tools, training, and capacity to provide appropriate care [10–14]. Large-scale trials such as the Diabetes Prevention Program [15] and the Look-AHEAD [16] trials have been shown to be effective in achieving sustained weight loss, following a frequent, structured behavioral intervention.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

2017

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BackgroundThe growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity.DiscussionWe describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models.ConclusionsRecommendations to extend the benefit’s coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity.

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“…[2][3][4] Remote and distant communities demonstrate higher rates of the five leading causes of death in the United States, 5,6 attributed, in part, to the lack of resources 2,5 in the ambulatory setting, 7 limited access to specialists and specialized resources, fewer transportation options, and socioeconomic disparities. [8][9][10][11][12] Rural healthcare is especially problematic in vulnerable populations, including persons with disabilities, 13 children, 14 and older adults. 11 Information and communication technologies provide an opportunity to improve rural healthcare delivery in older adults, the fastest growing user group of technology, 15 particularly in an era of burgeoning rural broadband and cellular connectivity.…”

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confidence: 99%

Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review

Batsis

DiMilia

Seo

et al. 2019

J American Geriatrics Society

176

160

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BACKGROUND Disparities in healthcare access and delivery, caused by transportation and health workforce difficulties, negatively impact individuals living in rural areas. These challenges are especially prominent in older adults. DESIGN We systematically evaluated the feasibility, acceptability, and effectiveness in providing telemedicine (TMed), searching the English‐language literature for studies (January 2012 to July 2018) in the following databases: Medline (PubMed); Cochrane Library (Wiley); Web of Science; CINAHL; EMBASE (Ovid); and PsycINFO (EBSCO). PARTICIPANTS Older adults (mean age = 65 years or older, and none were younger than 60 years). INTERVENTIONS Interventions consisted of live, synchronous, two‐way videoconferencing communication in nonhospital settings. All medical interventions were included. MEASUREMENTS Quality assessment, using the Cochrane Collaboration's Risk‐of‐Bias Tool, was applied on all included articles, including a qualitative summary of all articles. RESULTS Of 6616 citations, we reviewed the full text of 1173 articles, excluding 1047 that did not meet criteria. Of the 17 randomized controlled trials, the United States was the country with the most trials (6 [35%]), with cohort sizes ranging from 3 to 844 (median = 35) participants. Risk of bias among included studies varied from low to high. Our qualitative analysis suggests that TMed can improve health outcomes in older adults and that it could be used in this population. CONCLUSIONS TMed is feasible and acceptable in delivering care to older adults. Research should focus on well‐designed randomized trials to overcome the high degree of bias observed in our synthesis. Clinicians should consider using TMed in routine practice to overcome barriers of distance and access to care. J Am Geriatr Soc 67:1737–1749, 2019

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Primary Care Workforce Shortages and Career Recommendations From Practicing Clinicians

Cited by 19 publications

References 24 publications

Primary health care: the experience of nurses

Primary health care: the experience of nurses

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review

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