Impact of establishing a Geriatrics Workforce Enhancement Program clinic on preventive health and Medicare Annual Wellness Visits

We established a Geriatrics Workforce Enhancement Program (GWEP) clinic to enhance resident training on comprehensive preventive care and chronic disease management, and to increase the number of older patients who received Medicare Annual Wellness Visit (AWV) preventive services. A total of 1,104 patients were tracked at baseline and during the intervention period. Patients were grouped into two categories: Adult (aged 55-64) and Senior (aged 65+). Clinical quality measures were monitored by electronic health record and tracked through monthly reports at baseline (May 2018) and during the intervention period (July 2018-June 2019). In the Senior group, the proportion of patients receiving the Medicare AWV increased after GWEP began (p <.001). Additionally, the Senior group showed significant improvements in the frequency of body mass index assessments (p = .04), colorectal cancer screenings (p < .001), advance directive documentation (p < .001), cognitive screenings (p < .001), and pneumococcal vaccinations (p < .001). In the Adult group, a trending increase was seen in influenza vaccinations (p = .06). Curricular innovations including the establishment of a GWEP clinic in our residency outpatient center, development of new educational materials, and use of a nurse coordinator resulted in significant improvements in the percentage of older adults who received the Medicare AWV benefit and preventive health performance metrics.

Tuberculosis: an overview

Tuberculosis (TB) is still a public health issue; it continues to reign as one of the world's deadliest diseases. One-third of the world's population has been infected with TB. Identified cases of mycobacterium must be notified in an attempt to reduce the public health impact of TB on the population. TB transmission occurs via inhalation of droplet nuclei. The most common site for the development of TB is the lungs. Treatment of TB depends on whether latent TB or active TB is treated.

The effect of insurance-driven medication changes on patient care

PURPOSE

Insurance plans periodically change their formularies to enhance medical efficacy and cost savings. Patients face challenges when formulary changes affect their treatment. This study assessed the impact of insurance-driven medication changes on primary care patients and examined implications for patient care.

METHODS

We mailed questionnaires to a cross-sectional random sample of 1200 adult patients who had visited one of 3 family medicine practices within the past 6 months, asking them to describe problems they had encountered in filling medication prescriptions. We performed descriptive analyses of the frequency and distribution of demographic variables and conditions being treated. Using logistic regression analysis, we identified demographic and health-related variables independently associated with patient-reported problems caused by formulary changes.

RESULTS

Three variables-a greater number of prescription medications taken, younger patient age, and reliance on government insurance-were independently associated with an increased likelihood of encountering a problem filling a medication. Patients who reported an insurance-related issue filling a new or existing prescription over the past year (23%) encountered an average of 3 distinct problems. Patients experienced adverse medical outcomes (41%), decreased satisfaction with the health care system (68%), and problems that burdened the physician practice (83%). Formulary changes involving cardiac/hypertension/lipid and neurologic/psychiatric medications caused the most problems.

CONCLUSIONS

Insurance-driven medication changes adversely affect patient care and access to treatment, particularly for patients with government insurance. A better understanding of the negative impact of formulary changes on patient care and indirect health care expenditures should inform formulary change practices in order to minimize cost-shifting and maximize continuity of care.