Discover and read the best of Twitter Threads about #primarycare

Most recents (24)

🧵 1/5
Will "time modifiers"
added to family doctors fees
help more people in BC
access primary care?

🩺❤️‍🩹Probably not

2006-14, BC spent a BILLION $$ (!!)
with incentive fees family doctors for work that typically takes more time (e.g. mental health)

#bcpoli #primarycare
2/5
The new fees were "on top" of the usual "fee-for-service"

The stated aim:
💥to encourage family doctors to return to a traditional model of "full-service family practice"💥

And acknowledged that some work was taking doctors MORE TIME⌚️
@globeandmail
theglobeandmail.com/opinion/was-bc…
3/5
The result?😢

-family doctors got paid more
-family doctors saw fewer patients

⁉️But maybe patient outcomes like hospitalizations improved, she types hopefully (see next tweet...)

ref: longwoods.com/content/23782/…
Read 5 tweets
28-AUG-2022 UPDATE
1/23

Incidence of #COVID19 in 🇺🇸 kids increased 10% during the week ending 26-AUG-2022. More than 17,000 new cases every day; ADIR = 21.8/100,000.

#epitwitter #PedsICU #LongCovidKids

covkidproject.org Image
28-AUG-2022 UPDATE
2/23

The highest #COVID19 new daily incidence rates for kids are concentrated in the #Southeast.

covkidproject.org/hot-spots Image
28-AUG-2022 UPDATE
3/23

States with adverse trends ( ⬆️ incidence) of #COVID19 in kids for the week ending 26-AUG-22 are red/orange on the map.

covkidproject.org/hot-spots Image
Read 23 tweets
26-AUG-22 UPDATE
1/25

In this 🧵, we update #COVID19 incidence, hospitalizations, deaths, and disparities for 🇺🇸 children and adolescents.

Please share this 🧵 #epitwitter #PedsICU #tweetiatrician #SARSCoV2 #Omicron #LongCovidKids

covkidproject.org
26-AUG-22 UPDATE
2/25

covkidproject.org Image
26-AUG-22 UPDATE
3/25

covkidproject.org/hot-spots Image
Read 25 tweets
1/ Why I am worried about these emergency funds and why I think they probably won't help improve primary care access, a thread #bcpoli #PrimaryCare
2/ 💯Primary care is in a terrible state in BC (has been worsening for 20 years), and this money might "stem the bleeding" but it won't remedy the sharp objects causing the bleeding🩸🩸🩸
3/ Imagine public education in the same state, a million kids don't have a school to go to and teachers quitting everywhere because they are burnt out, and the cost of running their own school is unsustainable
Read 19 tweets
🤔
How much time should a primary care doctor
SEE a patient (direct)
v.
THINK/MANAGE a patient's care (indirect)

This recent paper looked at all the EXPECTED work of primary care providers w large #'s of patients

@BCFamilyDoctors @DoctorsOfBC @JournalGIM
link.springer.com/article/10.100…
🐘 US Study

US & 🇨🇦 primary care recommendations are similar (NOT same, but similar)

Doctor-only care = 26.7 hours/day to provide "recommended" care (IMPOSSIBLE)

In a team-based environment (few in 🇨🇦) doctors need to work = 9.3h/day (Still a v. long day)

#primarycare #bcpoli Image
INDIRECT care in

doctor only model = 3.2 hours/d
= 12% of the IMPOSSIBLE day

team model = 2.6h/d
=28% of the very long day

INDIRECT CARE=
notes written
labs reviewed
forms filled
care coordinated
emails read
etc

HOW MANY PRIMARY CARE MODELS CONSIDER THIS WORK?
#primarycare
Read 6 tweets
The #FamilyDoctorShortage
Can we fix it with more walk-in clinics?

A 🧵 about access hours
for (episodic) primary care in BC
based on our recent pre-print paper

#Cdnhealth #primarycare #bcpoli #tweetorial
@ircoopy @LindsayKHedden @UBCISU @sarah_fletch

medrxiv.org/content/10.110…
1⃣ What's the difference
between seeing a family doctor at a walk-in clinic
versus
a "regular" family doctor's office?

There are two typical kinds of "relationships" people have with a family doctor - EPISODIC + LONGITUDINAL #Cdnhealth #primarycare
A LONGITUDINAL relationship
with a doctor, NP, clinic,
ie you get to know each other

Research has shown that LONGITUDINAL primary care
improves the health of a community +
reduces overall costs of the system.

🪄Magic, right? #Cdnhealth #primarycare
pubmed.ncbi.nlm.nih.gov/16202000/
Read 20 tweets
Join us tomorrow for the launch of a new #accredited #tweetorial on the primary care management of #hyperlipidemia covering the relationship between #LDL_C & major #CV events, CV risk categories, recommended LDL-C treatment goals, & oral therapeutic options for lipid-lowering
1) Welcome to a new #tweetorial on the primary care management of #hyperlipidemia. Our returning @cardiomet_CE expert author is dedicated #SoMe education advocate Kevin Fernando, FRCGP FRCP Edin, FAcadMEd MSc Diabetes @drkevinfernando
2a) This is the next instalment of @cardiomet_CE's 10-part #tweetorial foundational series on #lipid management! It is accredited for #CME/CE and intended for #physicians #physicianassociates #nurses #nursepractitioners #pharmacists.
#FOAMed @MedTweetorials #cardiotwitter
Read 45 tweets
Impact of #D2B mobile communication program on reproductive and child health outcomes #RCT in India @Amnesty_LeFevre @kerfully @priydee @GlobalHealthBMJ @BMGFIndia #kilkari #mhealth #DigitalHealth gh.bmj.com/content/6/Supp… Image
For those interested in digital innovations for community and primary health in India do check out gh.bmj.com/content/6/Supp… @GlobalHealthBMJ #DigitalHealth #primarycare #Community
Read 3 tweets
1/
Ever have a patient with pain refractory to Acetaminophen or Ibuprofen?

Did you reach for a skeletal muscle relaxant (SMR)?

If so why that one? was there a better choice?

Apparently there's no good answer🧵

#Physiatry #PrimaryCare #SportsMedicine #OrthoTwitter #primarycare
2/
Learning Outcomes:

✅Review muscle tone

✅Categorize the two different classes of SMRs and

✅Outline why this difference is important

✅Briefly introduce safety data regarding specific SMRs

✅Identify gaps in the SMR evidence-base

❓How are spasm & spasticity related?
3/
Answer: A

A spasm is a brief ⬆️ in muscle tone, probably d/t local microischemia. It's mechanistically different from spasticity, which results from an upper motor neuron lesion. They're Rx'd differently

(I explain spasticity in greater detail here⤵️)
Read 17 tweets
1/14 I hesitated at voicing my opinion on this rather contentious issue…

But I feel that without individual testimonies, we will fail to understand why some GPs (myself included) feel mainstream primary care is no longer for them.

#GPCrisis
@HelenRSalisbury @MartinRCGP @rcgp
2/ Obvs the relentless vilification from the MSM hasn’t helped, esp the claim by some that the number of ‘part-time’ GPs is the problem.

Those on the inside know that a typical day is 11-12hrs long & a ‘half-day’ is regularly 7-8, but hey, let’s not let facts get in the way.
3/ & I don’t suppose those of us who volunteered to work f2f in acute #COVID services within the community in spring 2020 will forget that our pleas for effective #PPE were repeatedly ignored & dismissed by govt, PHE, NHSE, HSE & senior advisors.

@CMO_England @MattHancock @UKHSA
Read 15 tweets
Is #NHS #dentistry beyond crisis? Like rest of #primarycare, .@NHSEngland in its dominant position as market regulator has failed to manage the market. #NHS manages contracts, funding, nhs regulations, clinical policy, nhs #tech +entry & exit of workforce .@guardian 1/19
There will be those out there that’ll say but number of registrants has increased. That’ll suit nhs policy makers. Doesn’t account for people leaving NHS, working less hours for NHS, taking a career break or going into private practice or people taking up other careers 2/19
Certainly my experience in London is that many dentists don’t want stress of high needs #nhs practice. Are less likely to work full time & don’t want to work on abysmal NHS rates on offer in places like London. Many won’t be able to pay their rent /indemnity/ travel costs 3/19
Read 18 tweets
As we dig out from the last two years & transition to endemicity, we must invest in the unmet physical, behavioral & #mentalhealth needs of millions of Americans.

My ode to #primarycare & my latest for @thehill

A 🧵...

thehill.com/opinion/health…
Last week, a federal judge overturned the Biden administration’s mask mandate for public transportation. When a reporter asked whether ppl should wear masks on flights, President Biden responded, “That’s up to them,” signaling another step toward the “new normal” ... 2x
... and a shift from government-issued mandates to individual decision-making.

Lifting mask mandates at this moment makes sense. COVID isn’t going away, yet vaccines, therapeutics and tests are widely available. Deaths and hospitalizations are low. 3x
Read 25 tweets
🎉 Podcast announcement 🎉

Over the past few months, I’ve had the pleasure of being a guest on podcasts of friends, colleagues, & people I admire ...

A 🧵 ...
... For example, I spoke with my friend & colleague @VPrasadMDMPH about the relevance of mental health to our physical health, the harms of moralizing human behavior, & how to approach & appreciate varying/diverse POVs during a global health crisis. 1x

My dear friend and ICU doctor @kwadwo777 & I discussed navigating risk during COVID, getting teens & kids back to normal life, & the mental health impacts of the pandemic.... 2x

podcasts.apple.com/us/podcast/cov…
Read 9 tweets
FAQs from some of my low-risk patients this week:

Wouldn't a 4th shot prevent me from...

... getting COVID?
... sickening my unvax'd child/immunosuppressed son/elderly parent?

These are excellent questions but demonstrate how woefully we've messaged the vaccine.

A 🧵 ...
Sure, some patients are anxious. That's normal.

Sure, some patients get told by Google/a neighbor/TV pundit to get a 4th shot regardless of age & health. That's our world.

Sure, some patients truly *need* a 4th shot to reduce the risk for severe COVID. That's my job.

2x
But when so many of my patients call w the very same question, I want to know why. 🙋‍♀️

After all, my pts are smart, well-intended, & paying attn. I've been writing a free weekly C19 newsletter x 2 yrs trying to help ppl understand nuance & contextualize data.

So what's up?

3x
Read 10 tweets
Important & sobering read by Jennifer Abbasi, featuring @patientrev Fellow, Dr. Mark Linzer, on
#burnout, #mentalhealth & #primarycare.
Summary 🧵 1/5
ja.ma/377QsPM via @JAMA_current part of @JAMANetwork
The #healthcare workforce is feeling hopeless. This is incredibly worrisome.
Scary stats:
20% of MDs want to leave practice
60% are burnout
20% know a colleague that has considered/attempted/completed suicide.
We are NOT OKAY. 2/5
@JillianHortonMD @AlikaMD @KatharineSmart
What makes us feel burnout & hopeless: Not being valued or supported.
More than words are needed.
Organizations need to think seriously about how to relieve exhausted staff & give space and time to heal.
Think structures & systems, not just workshops & modules.
3/5
Read 5 tweets
I was honored to speak in front of @HouseScience committee yesterday abt the importance of trusted messengers in a crisis— & what we need to do for the next phase of #Covid_19.

Here is my opening statement … 🧵 1x

#Vaccines #VaccinesSaveLives #PrimaryCare
As we inevitably face more C19 waves & variants, I worry abt the ongoing devastation from the virus *and* abt the collateral damage from the mitigations themselves. Mostly I worry abt ppls’ confusion & resulting anxiety abt not knowing who to trust in a global health crisis.2x
I’m here to share with you what I’ve learned firsthand caring for patients almost every day during COVID—real people on the receiving end of often confusing public health guidance & the unfortunate politicization of science. 3x
Read 21 tweets
And others.

"Need to effectively utilize #CNMs has never been greater," says Kohl from midwife.org

Finding a supervising provider may prove difficult.
Body of evidence has consistently shown that although these barriers do not improve care.
Kohl:
"Time to follow the economics and evidence and remove supervision of practice"

Notes that team based care is the "future of #healthcare in the US"
Read 56 tweets
I was honored to testify today in front of congressional @EnergyCommerce committee:

"Lessons from the Front-Line: #COVID19's Impact on American Health Care."

My opening statement ... followed by congressional member questions...

#mentalhealthishealth

🧵 1x
Mental, physical & behavioral health are inseparable.

The pandemic has laid bare our vast vulnerabilities.

#Primarycare is where ppl can be fully seen & heard, where trust is born & where we apply broad public health advice to pts' unique medical issues & lived experience ...2x
Approx 80M Americans don't have a primary care provider.

We must scale up/increase access to needed #primarycare services, as a hub for problem-solving for medical conditions like obesity, diabetes & depression, in order to heal from trauma & prepare for the next pandemic...3x
Read 13 tweets
#medtwitter #primarycare

1/4 I like to share my 🎹 on here, trying to brush up mid career for peace/decompression, #wellness. Wrote some lyrics to Imagine and put it out, thought I’d share lyrics &video (see attached at end):

Imagine there’s no covid
And all it forced to see
2/
No white and brown between us
Within reach equity

Imagine all the people
Livin’ for that day

Imagine there’s no despots
And all disparity
Nothin to kill or suppress for
No tribes or chambers be

Imagine all the people
Livin’ lives safely

You may say God’s a dreamer
3/
But dreams need to take some hold
She hopes some day you’ll heed Her
And we will then be as one

Imagine there’s no covid
I wonder if you can
No need for hater leaders
All worldly life adored

Imagine all the people
Breathing our free world

You may say Gods a dreamer
Read 4 tweets
Despite the #gpcrisis we've gone from: Struggling with unmanageable 'demand', exhaustion & low morale.
⬇️
A thriving & hopeful team with excellent patient feedback.
How? Dozens of factors.
This thread describes 1 subtle essential ingredient
#TeamGP
1
link.medium.com/JpbZd1BQHnb
Primary care is over worked and overwhelmed. The GP crisis is exasperating for staff and patients. GP numbers continue to tumble. Part of the solution is before our very eyes: the receptionist. But perhaps not as we know them.
2
How much of a GPs frantic day is spent solving problems that could have been better solved by someone else? Either by a GP who knows them better, another service or an additional PCN role? GPs also waste time untangling messy tasks like old referrals, prescriptions/ sick notes
3
Read 18 tweets
Just bc #mentalhealth is harder to quantify doesn't mean it's any less important to our physical health ... or to policy-making.

After talking teens & parents for the past 2 yrs, it's never been more clear to me (& my #primarycare colleagues) that #mentalhealth is health. 1x
Not every child, teen, or parent is suffering from mental health issues. Our lived experiences during COVID have been varied & diverse. Indeed, some kids are pandemic-proof. Some of my teen patients have actually thrived during COVID... but 2x
I think it's fair to say that the absence of normalcy has been hard for many kids, adolescents, & parents - & the disruptions to school life have disproportionately affected the same populations who have tragically been disproportionately devastated by COVID-19. 3x
Read 8 tweets
#medtwitter #meded #primarycare @primarycarechat

Sorry going long, not sorry

1/?

Letterhead

From: All primary care docs (community, employed in large network, academic medical centers)

To: #healthcare system writ large, administrators/financial lever pullers
2/

Primary care docs are in a precariously fatigued way

We deliver longitudinal relational care, which is foundational to the whole person rewarding work we need to be professionally happy, and to the revenue and reputational growth you need to maintain community market
3/

Primary care docs fulfill an indispensable role not just in the local setting, but we provide what all the country and our society desperately needs - coordination and high value care in a system that overspends and doesn’t provide universal access nor competitive outcomes
Read 23 tweets
*NEW* Our latest study @AnnFamMed @RickGlazier1 shows that team-based primary care, coupled with payment reform, can improve patient outcomes & reduce ED use

annfammed.org/content/20/1/24

We desperately need to expand team-based primary care in Canada

(a mega 🧵)
#Primarycare is the foundation of a high-performing health system. Yet, primary care has been in crisis for the last 2 decades—challenged by an outdated payment model, growing patient need, rapidly growing evidence, and dysfunctional electronic medical record systems
Sharing the care with an interprofessional team has been seen for some time as an antidote to this crisis

Pharmacists, social workers, nurses and others can provide additional expertise and support to patients, particularly those with chronic mental and physical health issues
Read 30 tweets
Thank you to everyone who responded to our call below.

All signposts to resources/networks/committees will appear in the following Wiley texts (if proposals accepted), see thread 🧵👇🏻

#AdvancedPractice #ACP #ACCP #SCP #CNS #FCP #ANP @HonoraryGeordi_
📕#ACP at a glance - approved, due in print Autumn/Winter 2022
📙#AdvancedPractice Framework (APF) for UK practice - approved, due in print Autumn/Winter 2022
📘 APF for Acute, Emergency & Crit Care - proposal under peer review

#CriticalCare #emergencymedicine #ACCP #ECACP
📗 APF for #Paediatric & Child Health - proposal in development
📙 APF for MH, LD & Autism - initial expressions of interest (EOIs)
📕 APF for #PrimaryCare - initial EOIs
📘 APF for #Frailty , Rehabilitation & community-based care - (initial EOIs!)

#AdvancedPractice #ACP #AP
Read 4 tweets

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