Discover and read the best of Twitter Threads about #primarycare

Most recents (24)

1/ Curriculum #Medthread about our Global Health Track & Scholars Program!

The OHSU IM Global Health Program endorses a broad definition of #GlobalHealth rooted in interdisciplinary collaboration to promote better health for all

ohsu.edu/school-of-medi…

2/ As the program has grown over the years, one of the highlights of the program was a rotation at Scottish Livingstone Hospital in Molepolole, Botswana through our Harvard/Beth Israel Deaconess partnership

3/ Program alumnus @AdamRodmanMD (host of @BedsideRounds) was a program participant, and then completed a #GlobalHealth fellowship!

Watch him talk about his experience at Scottish Livingstone Hospital here:

Read 10 tweets
0.1% = rate of fatal #OD in the medical use of #opioids acc'g to 2019 research from Kaiser Permanente (link below).

Bwn 2006-2014, 41 of 31,142 died of OD, a rate of 5 per year. Risk stratification did not lower OD rates. Dose reductions were "inconsistent" (VonKorff). /thread
2,887 #vets died by #overdose or #suicide after their #opioid medicine was stopped by the VHA in FY2013 (90 fewer than on 9/11) (Oliva et al 2020).

Patients whose rx opioid was stopped were 3 times MORE likely to die by OD than those whose medicine continued (James 2019).
4.9% of discontinued patients died of OD.
1.7% of continued patients died of OD.

Discontinuation of rx #opioids was associated with 1.35 times the risk of death & 2.94 times the risk of fatal OD compared to patients whose rx continued (James et al 2019).
Read 12 tweets
2019 study in the AMA journal reports that reducing access to rx #opioids has "failed" to reduce overdoses.

OD crisis is projected to become "substantially worse" if public policy continues to wrongly target medical use. (thread) filtermag.org/rate-of-opioid…
Chen et al (JAMA 2019): Analyses of programs designed to reduce overdoses by reducing the medical use of #opioids "have failed to demonstrate a consistent benefit on fatal or nonfatal opioid overdoses." jamanetwork.com/journals/jaman… Image
JAMA> #OD rates are projected to soar 149% above 2015's crisis levels by 2025. Overdose deaths from 2016-25 could reach as high as 1.21 million if the crisis doesn't soon stabilize.

🟡 Continuing prescription restrictions will have a "modest effect, at best" on reducing ODs. Image
Read 13 tweets
2017 Review: “Expert guidelines recommend reducing or discontinuing long-term #opioid therapy when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed.” / #cpp thread.
🟠 How can guidelines be "expert" recommendations if researchers haven't carefully investigated how patients will react when their rx #opiod med is stopped or reduced?

Are we going to feel better or worse? Are we going to live or die?
In 2017, #VA-funded researchers identified 67 studies about #opioid dosage reduction or discontinuation.

Study quality was deemed “poor” in 76% of the 67, the lowest rating.
Read 21 tweets
To all of us in the health sector, I pray we manage PATIENTS/PEOPLE not #COVID19 🙏🏾 To the President, the tragedy, SIR,will not be in how many got infected but in how many lost their lives UNCOUNTED as we COUNTED 😔YES to #primarycare capacity - #NotLockdown @StateHouseKenya
1. Information and patient management guidelines and health workers support starting at the lowest health facility upwards #NotLockdown @MOH_Kenya
2. Pulse oximeters at all health facilities to identify patients in IMMEDIATE danger who need referral or high flow oxygen - patients are collapsing waiting for results 😢 - temperature scanners at hospitals casualty inadequate on their own #NotLockdown @MOH_Kenya
Read 8 tweets
@BrianMannADK I was stunned to see your @NPR piece on rx #opioids. I direct @headsUPmigraine & have been writing a paper reviewing research on rx restrictions. Limits haven't just failed to reduce ODs, they've contributed to an INCREASE in ODs, suicide, disability.
AMA Jnl 2019: Efforts to curb ODs "have principally focused on restricting the supply" of rx #opioids. They've "failed to demonstrate a consistent benefit on fatal or nonfatal opioid overdoses." Continuing them "may have a modest effect, at best," on ever-rising illegal-drug ODs.
Since peak in 2012, scripts are down 35% but overdoses are up 250%. That's because #addiction in medical use is "very rare," as @AmericanCancer Society explains. Even #CDC 2016 put unremarkable use at 97%, w/ 3% incl'g non-addictive "long use" & physical dependence.
Read 25 tweets
I just finished my first week back as a psychologist in #primarycare after 12 weeks of mat leave. I feel like an astronaut returning to earth after a challenging, yet cuddly mission. Here are my impressions about how Healthcare has/hasn't changed
1. People. Are. Tired.
Some of my colleagues work on the #COVID19 "front lines." many don't. but their work is essential, tireless, and often thankless. The heroism garnered in March and April has passed, along with any adrenaline that bolstered work then.
1a. Also healthcare staff are tired because they are caring for patients WHILE ALSO embodying roles of homeschooling their kids, troubleshooting new tech, and making masks (often w less income).
Read 9 tweets
1/ Had a really interesting day on #medtwitter today, re: #advocacy #activism #primarycare courtesy of @MParshleyMD @sagar_ankita @EricLast3 @gabrieldane @meggerber @mmteacherdoc @sulane7 @SusanHingle @dhpomerantz @UREssien

... and of course that made me think #baseballcards ->
2/ I was reminded that one hobby I have to relax me when pandemics, hubris, RVUs and #disparities are driving me bonkers 😜 = old ⚾️ cards.

On my recent B day my nieces/nephew bought me a pack of 2020 (?lost season) cards. Decided to open them ->
3/ they are new, shiny, the photography is awesome. Look at that Bryce Harper! The Laureano catch!

Rizzo for the Cubbies. Alfonzo of my Mets. -> getting back to the #advocacy in the environs of our institutions, promise ... Image
Read 10 tweets
Dearest colleagues, friends, public (anyone who wants to know), I’m going to tell you about an urban family doctor’s job before & during #COVID19 Here’s my story as told in 16 tweets (1/17): #medtwitter #onpoli @ontarionurses @OntariosDoctors @OntarioCollege
I take care of 1400 patients in @ottawacity in a #patientcentredcare clinic with a rainbow flag and the words “Common Ground.” I have many #LGBTQ patients, and also #Indigenous patients and #mentalhealth and many who live with physical/cognitive disabilities. (2/17) @CBCOttawa
Before the pandemic, I’d start at 9am with #Pediatrics, immunizations, answering questions, addressing parental #depression and #anxiety. Then I’d see other patients with infections, injuries, #diabetes, chronic illnesses. My clinics ended at 6pm, then paperwork. 5 days/wk (3/17)
Read 17 tweets
1/Many of my colleagues and I have not been redeployed to the hospital during the #COVID pandemic. We have been doing the ambulatory care of pre/non hospitalized patients, helped w admitted pts and starting to see post discharge pts.

Many thoughts/advice points:

A 🧵THREAD
2/ First our #primarycare triage function in this process is crucial.

Workflows/teamwork/infrastructure have to be worked out and optimized.

An updated list of daily follow up #telehealth covid pts must be kept. Day of illness, daily update notes and tracking has to happen
3/ Key points:

Age, comorbidities matter. And yet, there are those healthier patients that get sicker, hypoxemic/stormy as well

Don’t completely know (like so much in this illness) the grouped likelihood ratios for the following but these are things to ask to be complete ..
Read 20 tweets
1/ Ready for some hopeful signs? We’ve been following the trends for independent #PCP practices very closely during COVID and there’s some truly bright spots to share this week.
2/ Our community of independent practices includes 14,000 clinicians in both #FFS and #DPC practices. In early March, there was panic as some practices told us they would be out of business as early as May with appointments cancelling at a dramatic rate.
3/ Thankfully @CMSgov listened. And they offered help. Quickly. Arranging up to 3 months of advance payment for Medicare providers in just one week. My dad’s solo primary care practice got its advance last week:
Read 16 tweets
THREAD: Primary care is in crisis. Independent & small practices are now in jeopardy as the #COVID19 pandemic has led patients to cancel visits and postpone elective procedures. This put an almost immediate stop to physicians’ payments.
latimes.com/politics/story…
We need primary care but haven’t paid for what we value. PC practices have been underfunded for decades, while other countries invest heavily in primary care with lower costs and better health outcomes. The #COVID19 crisis just reinforces why primary care is an urgent priority.
This moment comes with opportunities, and it's long past time to scale up telehealth and digital technologies to expand access and workforce capacity. #COVID19 should mark a “new normal,” and we now need to develop consistent coverage and payment policies for telehealth.
Read 7 tweets
#primarycare teams working through same issues around #COVID19:

😷PPE
💊Antibiotics
🛡️Contacting shielding & vulnerable patients
❤️Conversations for treatment escalation
🩺Patients not accessing care when they need it

Some of my best picks for the week ahead

Thread 1/10
PPE @PHE_uk @AoMRC:
Where sustained transmission of #COVID19 & contact with patient not currently possible/confirmed it’s 🧤apron, fluid resistant mask & eye protection. So, for all face to face contacts.

More details & updates 👇
gov.uk/government/pub…
Thread 2/10
@NICEComms guidance on differentiating viral #COVID19 pneumonia from bacterial pneumonia. History is key.

Don't offer abx treatment/prevention of pneumonia if #COVID19 likely cause & mild symptoms

If abx needed, 1st choice doxycycline
Do not routinely use dual abx

Thread 3/10
Read 10 tweets
1/
ATOPIC DERMATITIS - a #dermatology #tweetorial/#medthread!

For all the #tweetiatricians, #primarycare, #medtwitter, & #dermtwitter! #MedEd #FOAMEd pc:@dermnetnz

1st, a question:
How do you think of the term atopic dermatitis (AD) in relation to the term eczema?
2/
If you're a purist, "eczema" is a description. When a #dermatologist says something looks eczematous, it doesn't mean it's AD. It means it has a certain appearance.

So the right answer for purists is "AD can cause eczema."

That said, we so often just use eczema to mean AD🤷🏻‍♂️
3/
As annoying as that might be, it's an important distinction. If you see an eczematous rash, you need to consider possible causes:

- Atopy
- Allergy/irritant contact
- Medications
- Venous stasis
- Dry skin

For more on contact dermatitis, check out @patchtestYu!
Read 16 tweets
As a physician, and a patient, I am deeply frustrated and saddened that our government chooses to prioritize elective surgical waitlists over our primary care system in order to achieve savings. Primary care is the foundation of the Canadian health care system. (1/12)
Alberta is the highest ranked for #PatientMedicalHome in Canada. Innovations like complex modifiers, which compensate physicians for spending the time required, enable us to provide comprehensive and preventative care. The value to our system is there if you look for it.  (2/12)
HQCA reported that by providing comprehensive care we can save the system more money than our physicians cost it. Patients have fewer ER visits and hospital admissions. If each Albertan received excellent comprehensive care, it could save the system $1B per year. (3/12)
Read 12 tweets
Join in and share your insights!
Today, I’ll be tweeting ideas & thoughts about #Integrating #ONhealth care as part of an amazing learning conversation with @wwodchis @JodemeGoldhar @Dr_KerryK @jayshaw29, @baker_ross, @Dr_SteeleGray @wwodchis & @Anne_Wojtak from @ihpmeuoft
A map of our current #ONhealth system shows various functions, structures and organizations, but without a clear shared purpose:
So then, without a clear shared purpose, how can #patients, caregivers & providers have an experience of an #integrated #ONhealth system?

Start by building up from the core of care delivery:
Read 23 tweets
1/ Fatigue in Primary Care

It’s that time of year, many of us (myself included!) feel fatigued 🥱

Fatigue is one of the most common presentations in #PrimaryCare yet can be challenging to investigate & manage 🤔

Here’s a #tweetorial on an approach to fatigue 😴

#MedTwitter
2/ Intended Learning Outcomes

💡To recognise fatigue red flags

💡To develop a diagnostic approach to fatigue

💡To outline a fatigue management plan for those with no red flags
3/ What is fatigue?

‘A state characterised by a lessened capacity/motivation for work usually accompanied by feeling weary🥱, sleepy😴, or a loss of ambition😔’

Fatigue is the most common unexplained complaint in #PrimaryCare, but remember it’s a symptom, not a diagnosis!
Read 11 tweets
1/ Cognitive Bias in Clinical Medicine

I love teaching #MedStudents about #CognitiveBias & #DiagnosticErrors & so thought I would create my debut #tweetorial on cognitive biases in clinical medicine 🧑🏻‍⚕️👩🏽‍⚕️👨🏼‍⚕️

🤔Now which bias that?!

#MedTwitter
2/ Intended Learning Outcomes

💡To recognise common cognitive biases in clinical medicine

💡To identify strategies to overcome them

#MedTwitter Ready? Let’s go!
3/ Cognitive Biases

💡Are cognitive shortcuts
💡Used to aid decision-making
💡AKA heuristics

✅Helpful time-savers
❎Risk leading to diagnostic errors
❎Diagnostic error rate in Australian #PrimaryCare is ~15%

qualitysafety.bmj.com/content/22/Sup…

Let’s look at common cognitive biases 🧐
Read 12 tweets
PACKED start to our #WRES event with @yvonnecoghill1 @Prerana_Issar - proud to prioritise this event with my team 💪🏾 @WRES_team @NHSEngland
Infant mortality globally and in England - shocking figures however many times you see it #WRES @WRES_team @NHSEngland @yvonnecoghill1 @Prerana_Issar
AND this is echoed in the death rate more broadly, with disadvantaged populations are also AGEING faster ‘premature ageing’ #WRES @WRES_team @yvonnecoghill1 @DrHNaqvi @NHSEngland @matthew_cripps1
Read 28 tweets
QUICK RANDOM HANDOM TWEETORIAL TIME

attention every1 in #primarycare #urgentcare #emergency care #EM or #ortho #radiology

Here's an injury that gets missed SO FREQUENTLY

but not by you anymore, bc now YOU'RE GONNA CATCH IT!

Hx: punched a wall, pain
1/3
#medtwitter #foamed
What's that? You want another view?

BRILLIANT SUGGESTION, here it is
Think you spot the problem?

Keep scrolling!
2/3
#medtwitter #foamed
CMC DISLOCATION

The MC5-hamate articulation is outlined in orange dots

Best appreciated on a 30 deg pronated oblique

Sometimes these are subtle on AP and LAT but always a dead giveaway on the oblique

Remember THREE VIEW HAND>>TWO VIEW HAND
#2viewisNoVIew
#medtwitter #foamed
Read 5 tweets
#TRIBECON begins #Pravara; felicitations to #AbhayBang @SearchGad & #sudarshan #VGKK for their inspiring work on #TribalHealth; @DrLahariya @whoindia among others felicitated
#abhayBang #healthsystem design for tribal communities need to be relooked for #UHC; strategies & schemes must adapt with local social & cultural context; recollects #Brainstorming with @DesirajuKeshav at @SearchGad leading to #ExpertCommittee #tribalhealth @TribalHealthIND
#TRIBECON #AbhayBang notes with happiness increasing interest in #tribalhealth research, yet this continues to be “off the beaten path”; congratulations to #pravara medical college in bringing this together; the proposed #Bandardhara declaration to improve #tribalhealth research
Read 81 tweets
Yesterday I gave a talk to my #primarycare residency on PTSD in ICU Survivors. It's a topic I've learned a lot about here on Twitter (special thx to @Potato_Chip and @brookevitti), so feels appropriate to share as my first #Tweetorial. #PCCM #MedHumChat #TraumaInformedCare
Modern medicine has developed the tools to bring people back from the brink of death. What is life like for patients after surviving the previously unsurvivable? How can we provide better care for them?
~10% of ICU patients die during their hospitalization. 90% survive. (ncbi.nlm.nih.gov/pubmed/28800866)

~20% of ICU survivors will develop symptoms of PTSD by 12 months (ncbi.nlm.nih.gov/pubmed/31186070)
Read 14 tweets
I listen to ~90 #Podcasts on a (semi) regular basis. Let me give you a rundown of ALL of them and why you should listen to some amazing #FOAMed, especially for all the new #EmergencyMedicine interns. #FOAMed #MedEd #medtwitter
First of all, you need a good podcast app. I absolutely love Downcast. Great app, gives you more control over playback, downloading, and allows you to categorize your podcasts into playlists (picture 2). This is where you get to customize your #FOAMed experience! #medtwitter
In no particular order,

- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
Read 88 tweets
1/6 What is the usefulness of inflammatory markers such as CRP, ESR and PV in #primarycare? My #PhD findings may make you think carefully about doing these tests. A thread 👇bjgp.org/content/early/…
2/6 Inflammatory markers have an overall sensitivity of <50% so are not a useful 'rule out' test:
3/3 1000 inflammatory marker tests generates:
236 false-positives ...resulting in an additional
710 GP appointments
229 phlebotomy appointments
and 24 referrals
....in the following 6 months
Read 7 tweets

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