Browsing by Subject "ambulatory care"

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic.
    (BMJ open quality, 2018-01) Sadun, Rebecca E; Wells, Melissa A; Balevic, Stephen J; Lackey, Victoria; Aldridge, Erica J; Holdgagte, Nicholas; Mohammad, Samya; Criscione-Schreiber, Lisa G; Clowse, Megan EB; Yanamadala, Mamata
    Teratogenic medications are often prescribed to women of childbearing age with autoimmune diseases. Literature suggests that appropriate use of contraception among these women is low, potentially resulting in high-risk unintended pregnancies. Preliminary review in our clinic showed suboptimal documentation of women's contraceptive use. We therefore designed a quality improvement initiative to target three process measures: documentation of contraception usage and type, contraception counselling and provider action after counselling. We reviewed charts of rheumatology clinic female patients aged 18-45 over the course of 10 months; for those who were on teratogenic medications (methotrexate, leflunomide, mycophenolate and cyclophosphamide), we looked for evidence of documentation of contraception use. We executed multiple plan-do-study-act (PDSA) cycles to develop and evaluate interventions, which centred on interprofessional provider education, modification of electronic medical record (EMR) templates, periodic provider reminders, patient screening questionnaires and frequent feedback to providers on performance. Among eligible patients (n=181), the baseline rate of documentation of contraception type was 46%, the rate of counselling was 30% and interventions after counselling occurred in 33% of cases. Averaged intervention data demonstrated increased provider performance in all three domains: documentation of contraception type increased to 64%, counselling to 45% and provider action to 46%. Of the patients with documented contraceptives, 50% used highly effective, 27% used effective and 23% used ineffective contraception methods. During this project, one unintentional pregnancy occurred in a patient on methotrexate not on contraception. Our interventions improved three measures related to contraception counselling and documentation, but there remains a need for ongoing quality improvement efforts in our clinic. This high-risk population requires increased provider engagement to improve contraception compliance, coupled with system-wide EMR changes to increase sustainability.
  • Thumbnail Image
    ItemOpen Access
    Lessons Learned from the Development and Implementation of Virtual and Telehealth Interprofessional Educational Clinics.
    (Advances in medical education and practice, 2021-01) Leiman, Erin R; Waite, Kathleen A; Ostrovsky, Daniel A

    Purpose

    The Interprofessional Educational (IPE) Clinic at Duke is a clinical experience that has allowed an interprofessional team, including health professions students, to care for patients in the emergency department (ED) since 2015. COVID-19 presented fundamental challenges to the structure of this experience, such as student restrictions on attending clinical experiences and limitations on the number of providers in a patient room, which necessitated a transition from face-to-face encounters to virtual ones.

    Materials and methods

    As a result, two virtual experiences were implemented; one was based in the ED with in-person faculty and patients with virtual learners and one staffed by ambulatory providers engaging in telehealth clinics. These experiences sought to provide an interprofessional clinical experience for students while following appropriate safety guidelines. Surveys were distributed to students post-clinic to gather student demographics and their feedback regarding the experience. Additionally, faculty preceptors provided insight into the experience, especially regarding logistics and infrastructure.

    Results

    The virtual experiences successfully allowed teams of students to participate remotely in aspects of care including history taking, physical assessments, and medical decision-making. Additionally, the virtual care team structure allowed for senior students to mentor junior learners and for faculty members to provide point of care feedback. Students gained practical experience in telehealth that included logistics and challenges of providing virtual care and appreciating how technological barriers such as lack of access to internet-connected devices can be a source of disparity.

    Conclusion

    The COVID-19 pandemic required the reconfiguration of an in-person clinical experience to a virtual experience and this pivot was well received by students and faculty. The lessons learned can be generalizable to other professional schools who may be seeking to develop an interprofessional clinical experience and are exploring telehealth options.