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Biomedical subjects

John M Westfall

Publications and source records attributed to John M Westfall.

27 records · Page 2Linked to original sources
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Are frequent callers to family physicians high utilizers?

PURPOSE: Our objective was to describe patients who telephone frequently after hours to physicians (frequent callers) and categorize their medical problems and resource utilization. METHODS: Charts of frequent callers were reviewed and compared with those of a systematically selected group from the same family medicine residency practice (control group). Data collected included demographic and clinical information, as well as information on utilization of office, emergency department, and hospital services. In addition, 4 family physicians reviewed the patient information and identified the primary diagnosis for frequent callers. RESULTS: Frequent callers were predominately female; had 3 times as many office visits, diagnoses, and medications; and had 8 times as many hospital admissions as the control group. The most common primary diagnostic categories were psychiatric disorders (36%), pain (21%), chronic illnesses (16%), pregnancy (13%), and common problems of childhood (9%). CONCLUSIONS: Frequent callers represent a unique group of patients with high utilization of health care services. Better targeted patient education and referral to other support services may decrease the number of calls and utilization of health services. Alternatively, among high utilizers, frequent telephone calls may be a substitute for other forms of care.

Ambulatory Care↗
PubMedDate not supplied

Event reporting to a primary care patient safety reporting system: a report from the ASIPS collaborative.

BACKGROUND: We examined reports to a primary care, ambulatory, patient safety reporting system to describe types of errors reported and differences between anonymous and confidential reports. METHODS: Applied Strategies for Improving Patient Safety (ASIPS) is a demonstration project designed to collect and analyze medical error reports from clinicians and staff in 2 practice-based research networks: the Colorado Research Network (CaReNet) and the High Plains Research Network (HPRN). A major component of ASIPS is a voluntary patient safety reporting system that accepts reports of errors anonymously or confidentially. Reports are coded using a multiaxial taxonomy. RESULTS: Two years into this project, 33 practices with a total of 475 clinicians and staff have participated in ASIPS. Participants submitted 708 reports during this time (66% using the confidential reporting form). We successfully followed up on 84% of the confidential reports of interest within the allotted 10-day time frame. We ended up with 608 relevant, codable reports. Communication problems (70.8%), diagnostic tests (47%), medication problems (35.4%), and both diagnostic tests and medications (13.6%) were the most frequently reported errors. Confidential reports were significantly more likely than anonymous reports to contain codable data. CONCLUSION: A safe and secure reporting system that relies on voluntary reporting from clinicians and staff can be successfully implemented in primary care settings. Information from confidential reports appears to be superior to that from anonymous reports and may be more useful in understanding errors and designing interventions to improve patient safety.

Confidentiality↗
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Facilitating collaboration among academic generalist disciplines: a call to action.

To meet its population's health needs, the United States must have a coherent system to train and support primary care physicians. This goal can be achieved only though genuine collaboration between academic generalist disciplines. Academic general pediatrics, general internal medicine, and family medicine may be hampering this effort and their own futures by lack of collaboration. This essay addresses the necessity of collaboration among generalist physicians in research, medical education, clinical care, and advocacy. Academic generalists should collaborate by (1) making a clear decision to collaborate, (2) proactively discussing the flow of money, (3) rewarding collaboration, (4) initiating regular generalist meetings, (5) refusing to tolerate denigration of other generalist disciplines, (6) facilitating strategic planning for collaboration among generalist disciplines, and (7) learning from previous collaborative successes and failures. Collaboration among academic generalists will enhance opportunities for trainees, primary care research, and advocacy; conserve resources; and improve patient care.

Cooperative Behavior↗
PubMedDate not supplied

Triage and diagnosis of chest pain in rural hospitals: implementation of the ACI-TIPI in the High Plains Research Network.

PURPOSE: The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) has been shown to improve diagnostic accuracy of acute cardiac ischemia (ACI) and decrease coronary care unit admissions in urban emergency departments. The purpose of this study was to determine the impact of the ACI-TIPI on triage and diagnosis of patients with chest pain in rural hospitals. METHODS: We undertook a controlled trial of the impact ACI-TIPI use in the High Plains Research Network (HPRN). Main outcome measures were the triage of patients in emergency departments (admission, transfer, or discharge home) and diagnostic accuracy. RESULTS: There were 1,861 patients seen during a 10-month period. Forty-five percent of all patients complaining of chest pain were discharged home from the emergency department. Eight percent were transferred from the emergency department, and another 10% were transferred later after admission. Among patients with acute myocardial infarction or unstable angina, 22.2% were transferred directly from the emergency department and only 3% were discharged home when ACI-TIPI was available, compared with 18.7% transferred and 5.2% discharged home when not available (P = .4). Diagnostic accuracy was high and not statistically different with the addition of the ACI-TIPI score (86.8% ACI-TIPI off vs 89.0% ACI-TIPI on, P = .15), CONCLUSIONS: Physicians in the HPRN provided appropriate diagnosis and triage to patients with chest pain. Routine addition of the ACI-TIPI score did not improve diagnostic accuracy or significantly change triage. Further research on ACI-TIPI in rural hospitals is necessary before recommending routine use of the ACI-TIPI.

Biomarkers↗
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Community-based participatory research in practice-based research networks.

PURPOSE: We wanted to describe community-based participatory research in practice-based research networks in the United States. METHODS: We surveyed all identified practice-based research networks (PBRNs) in the United States to find out whether they had a mechanism for obtaining feedback or involvement from the community of patients served by PBRN physicians. We asked open-ended questions on how they involve community members and whether they had plans for future involvement of community members and/or patients. RESULTS: We received 46 completed questionnaires (71% response rate). Twenty-four reported that they have some mechanism to involve community members and/or patients in their research. No PBRN reported full participatory methods; however, several PBRNs reported active involvement by community members to generate research ideas, review research protocols, interpret results, and disseminate findings. CONCLUSION: While perhaps not meeting the classical definition of CBPR, some PBRNs are involving community members and patients in their research. There is a wide spectrum of involvement by community members in PBRN research. Many PBRNs reported plans to involve community members in their research. We believe that community involvement will enhance PBRN research.

Community Participation↗
PubMedDate not supplied

Pharmacy clarification of prescriptions ordered in primary care: a report from the Applied Strategies for Improving Patient Safety (ASIPS) collaborative.

INTRODUCTION: Prescription errors threaten patient safety and pharmacists often contact providers for prescription clarification. This study describes the principal reasons pharmacies call primary care practices to clarify prescriptions and subsequent implications for quality and patient safety improvement. METHODS: A cross-sectional study of 22 primary care practices participating in a patient safety study was performed. Callbacks from pharmacies were logged for 2 weeks to determine reasons for callbacks, most frequently involved drug classes, whether issues were resolved on the same day of the call, and variability of callbacks among practice types. Analyses were performed using frequencies, t tests, and chi(2) tests. RESULTS: Practices recorded 567 clarification calls, most frequently for prior authorization issues (n = 209; 37%), formulary issues (n = 148; 26%), and unclear/missing prescription dosages (n = 117; 21%). Drug classes most frequently requiring clarifications were gastrointestinal (n = 122; 21.7%), cardiovascular (n = 278; 13.9%), and analgesic/anesthetic (n = 74; 13.2%) agents. Issues were resolved on the same day 62% of the time. Residency practices averaged more issues per call (P < .001). CONCLUSIONS: Clarification calls made to primary care practices involve administrative and clinical issues, potentially impacting patient safety. Pharmacy callback data can identify potential prescription concerns, thereby helping practices develop interventions aimed at reducing errors and improving patient safety.

Cooperative Behavior↗
PubMedDate not supplied

Harm resulting from inappropriate telephone triage in primary care.

PURPOSE: Our objective was to assess and categorize harm occurring to patients who called their physicians' office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency. METHODS: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders. RESULTS: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change. CONCLUSIONS: Harm may occur when patients' calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

Adult↗