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Kacew AJ, Jacobson S, Sheade J, Patel AA, Hlubocky FJ, Lee NK, Henderson TO, Schneider JA, Strohbehn GW. Provider-Level Barriers to Human Papillomavirus Vaccination in Survivors of Childhood and Young Adult Cancers. J Adolesc Young Adult Oncol 2021; 11:284-289. [PMID: 34403603 DOI: 10.1089/jayao.2021.0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We sought to understand clinician-level barriers to providing HPV vaccination to survivors of childhood and young adult cancers (CYACs). Methods: We conducted 30-minute qualitative interviews with primary care and specialty clinicians who care for survivors of CYACs at our academic medical center. Blinded reviewers analyzed transcripts and used an inductive approach to identify barriers to vaccination in this population. Results: We conducted 24 interviews (n = 11 primary care clinicians, n = 13 oncology clinicians). Thematic analysis revealed that primary care clinicians are universally viewed as holding ultimate responsibility for human papillomavirus (HPV) vaccination among survivors of CYACs. Both primary care and oncology clinicians believed vague, inconsistent HPV guidelines engendered uncertainty toward HPV vaccination's role and timing following completion of CYAC therapies. As such, compared with other vaccines, the HPV vaccination is not as consistently offered to survivors. Respondents identified direct guidance from oncologists to primary care clinicians and to patients as a potential strategy for improving HPV vaccination rates in this population. Finally, oncology clinicians frequently deprioritize the issue of preventing second, noniatrogenic cancers and consequently miss opportunities to discuss vaccination's merits with their patients. Conclusions: Despite not holding ultimate responsibility for vaccination, oncology clinicians have an opportunity to play an important role in ensuring access and overcoming hesitancy among survivors of CYACs. Developing clearer and more collaborative guidelines, helping to integrate vaccination into institutional electronic health record protocols, offering direct guidance to primary care colleagues, and participating in conversations with survivors of CYACs may help improve vaccination rates.
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Affiliation(s)
- Alec J Kacew
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Sofia Jacobson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jori Sheade
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Anand A Patel
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Fay J Hlubocky
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Tara O Henderson
- Section of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - John A Schneider
- Section of Infectious Diseases, Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA.,Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Garth W Strohbehn
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Veterans Affairs Ann Arbor Medical Center, Center for Clinical Management and Research, Ann Arbor, Michigan, USA.,Rogel Comprehensive Cancer Center, University of Michigan Medicine, Ann Arbor, Michigan, USA
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Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs. J Gen Intern Med 2017; 32:667-672. [PMID: 28197967 PMCID: PMC5442016 DOI: 10.1007/s11606-017-4005-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/30/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. OBJECTIVES The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. DESIGN Nationwide survey. PARTICIPANTS All internal medicine program directors registered with APDIM. MAIN MEASURES Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. KEY RESULTS Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. CONCLUSIONS Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.
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Yoshida H. Capsule Commentary on Phillips et al., Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs Running Title: National Survey of Year-End Clinic Handoffs. J Gen Intern Med 2017. [PMID: 28255800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Hirofumi Yoshida
- Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho 2, Yamashina-ku, Kyoto, Japan.
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Pincavage AT, Donnelly MJ, Young JQ, Arora VM. Year-End Resident Clinic Handoffs: Narrative Review and Recommendations for Improvement. Jt Comm J Qual Patient Saf 2016; 43:71-79. [PMID: 28334565 DOI: 10.1016/j.jcjq.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Year-end clinic handoffs in resident continuity clinics are an important patient safety issue. METHODS Intervention articles addressing the year-end resident clinic handoff were identified in a targeted literature search. These articles were reviewed and abstracted to summarize the current literature. On the basis of these reviews and consensus expert opinion, recommendations to improve year-end clinic handoffs were developed. RESULTS Of 23 identified articles, 10 intervention articles in the fields of internal medicine, internal medicine-pediatrics, psychiatry, and family medicine were ultimately included. The additional 13 nonintervention studies were used as background material. There were 12 clinic handoff recommendations for improvement: (1) focus on patients most at risk during the handoff, (2) educate residents, (3) consider balancing caseloads for the residents, (4) prepare patients for the handoff and perform patient-centered outreach, (5) standardize a written method of sign-out and require verbal communication for a subset of patients, (6) use a standardized template or technology solution for the handoff, (7) identify specific tasks that require follow-up, (8) enhance attending supervision during the handoff, (9) make patient assignments clear after the handoff, (10) have patients establish care with the new provider as soon as possible after the handoff, (11) establish care with telephone contact prior to the first visit, (12) perform safety audits to ensure that sign-out occurs, patients receive appointments, no-shows are rescheduled, and task follow-up is completed. CONCLUSION There is emerging evidence for interventions to improve year-end resident clinic handoffs, and the recommendations provided are a starting point to guide training programs.
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Adams DR, Flores A, Coltri A, Meltzer DO, Arora VM. A Missed Opportunity to Improve Patient Satisfaction? Patient Perceptions of Inpatient Communication With Their Primary Care Physician. Am J Med Qual 2016; 31:568-576. [PMID: 26157063 DOI: 10.1177/1062860615593339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Improving patient satisfaction is a major focus of hospitals. Patient satisfaction could be driven by patient perception of hospital team communication with their primary care physician (PCP). A retrospective mixed methods approach was used to characterize the relationship between patient satisfaction and patient perception of hospital team-PCP communication. Data were obtained through general medicine inpatient and postdischarge interviews, oversampling "vulnerable elders," and a faxed PCP survey. Among 1044 patients and their PCPs, 22.3% of PCPs were not aware of their patient's hospitalization. Among PCPs who reported that communication did not occur, half (49.2%) of their patients thought communication had occurred, implying a lack of patient awareness of discontinuity of care and possibly impeding safety. Patients who perceived that communication occurred were more satisfied with care (70.0% vs 53.1%, P < .001). Therefore, hospitals could potentially improve patient safety and satisfaction by seizing a missed opportunity to improve patient awareness of communication.
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Pincavage AT, Lee WW, Venable LR, Prochaska M, Staisiunas DD, Beiting KJ, Czerweic MK, Oyler J, Vinci LM, Arora VM. "Ms. B changes doctors": using a comic and patient transition packet to engineer patient-oriented clinic handoffs (EPOCH). J Gen Intern Med 2015; 30:257-60. [PMID: 25186160 PMCID: PMC4314496 DOI: 10.1007/s11606-014-3009-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few patient-centered interventions exist to improve year-end residency clinic handoffs. AIM Our purpose was to assess the impact of a patient-centered transition packet and comic on clinic handoff outcomes. SETTING The study was conducted at an academic medicine residency clinic. PARTICIPANTS Participants were patients undergoing resident clinic handoff 2011-2013 PROGRAM DESCRIPTION: Two months before the 2012 handoff, patients received a "transition packet" incorporating patient-identified solutions (i.e., a new primary care provider (PCP) welcome letter with photo, certificate of recognition, and visit preparation tool). In 2013, a comic was incorporated to stress the importance of follow-up. PROGRAM EVALUATION Patients were interviewed by phone with response rates of 32 % in 2011, 43 % in 2012 and 36 % in 2013. Most patients who were interviewed were aware of the handoff post-packet (95 %). With the comic, more patients recalled receiving the packet (44 % 2012 vs. 64 % 2013, p< 0.001) and correctly identified their new PCP (77 % 2012 vs. 98 % 2013, p< 0.001). Among patients recalling the packet, most (70 % 2012; 65 % 2013) agreed it helped them establish rapport. Both years, fewer patients missed their first new PCP visit (43 % in 2011, 31 % in 2012 and 26 % in 2013, p< 0.001). DISCUSSION A patient-centered transition packet helped prepare patients for clinic handoffs. The comic was associated with increased packet recall and improved follow-up rates.
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Affiliation(s)
- Amber T Pincavage
- Department of Medicine, University of Chicago, 5841 S. Maryland Avenue MC 3051, L326, Chicago, IL, 60637, USA,
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