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  1. Article ; Online: A patient follow-up intervention to improve medical decision making at an internal medicine residency program.

    Chockalingam, Leela / Keniston, Angela / McBeth, Lauren / Mutter, Marina

    Diagnosis (Berlin, Germany)

    2024  Volume 11, Issue 2, Page(s) 142–150

    Abstract: Objectives: Practice-based learning and improvement (PBLI) is an ACGME (Accreditation Council for Graduate Medical Education) core competency. Learning and reflecting on patients through follow-up is one method to help achieve this competency. We ... ...

    Abstract Objectives: Practice-based learning and improvement (PBLI) is an ACGME (Accreditation Council for Graduate Medical Education) core competency. Learning and reflecting on patients through follow-up is one method to help achieve this competency. We therefore designed a study evaluating a structured patient follow-up intervention for senior internal medicine (IM) residents at the University of Colorado Hospital (UCH).
    Methods: Trainees completed structured reflections after performing chart review of prior patients during protected educational time. Two-month follow-up surveys evaluated the exercise's potential influence on clinical and reflective practices.
    Results: Forty out of 108 (37 %) eligible residents participated in the exercise. Despite 62.5 % of participants lacking specific questions about patient outcomes before chart review, 81.2 % found the exercise at least moderately helpful. 48.4 % of participants believed that the review would change their practice, and 60.9 % felt it reinforced their existing clinical practices. In our qualitative data, residents learned lessons related to challenging clinical decisions, improving transitions of care, the significance of early goals of care conversations, and diagnostic errors/strategies.
    Conclusions: Our results indicate that IM residents found a structured patient follow-up intervention educational, even when they lacked specific patient outcomes questions. Our results underscore the importance of structured self-reflection in the continuous learning process of trainees and suggest the benefit of dedicated educational time for this process.
    MeSH term(s) Humans ; Internal Medicine/education ; Internship and Residency ; Clinical Decision-Making ; Education, Medical, Graduate ; Clinical Competence ; Surveys and Questionnaires ; Male ; Follow-Up Studies ; Female
    Language English
    Publishing date 2024-02-06
    Publishing country Germany
    Document type Journal Article
    ISSN 2194-802X
    ISSN (online) 2194-802X
    DOI 10.1515/dx-2023-0135
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Medication prescribing for alcohol use disorders during alcohol-related encounters in a Colorado regional healthcare system.

    Chockalingam, Leela / Burnham, Ellen L / Jolley, Sarah E

    Alcoholism, clinical and experimental research

    2022  Volume 46, Issue 6, Page(s) 1094–1102

    Abstract: Rationale: Investigations show that medications for alcohol use disorders (MAUD) reduce heavy drinking and relapses. However, only 1.6% of individuals with alcohol use disorders (AUD) receive MAUD across care settings. The epidemiology of MAUD ... ...

    Abstract Rationale: Investigations show that medications for alcohol use disorders (MAUD) reduce heavy drinking and relapses. However, only 1.6% of individuals with alcohol use disorders (AUD) receive MAUD across care settings. The epidemiology of MAUD prescribing in the acute care setting is incompletely described. We hypothesized that MAUD would be under prescribed in inpatient acute care hospital settings compared to the outpatient, emergency department (ED), and inpatient substance use treatment settings.
    Methods: We evaluated electronic health record (EHR) data from adult patients with an International Classification of Diseases, 10th revision (ICD-10) alcohol-related diagnosis in the University of Colorado Health (UCHealth) system between January 1, 2016 and 31 December, 2019. Data from patients with an ICD-10 diagnosis code for opioid use disorder and those receiving MAUD prior to their first alcohol-related episode were excluded. The primary outcome was prescribing of MAUD, defined by prescription of naltrexone, acamprosate, and/or disulfiram. We performed bivariate and multivariate analyses to identify independent predictors of MAUD prescribing at UCHealth.
    Results: We identified 48,421 unique patients with 136,205 alcohol-related encounters at UCHealth. Encounters occurred in the ED (42%), inpatient acute care (17%), inpatient substance use treatment (18%), or outpatient primary care (12%) settings. Only 2270 (5%) patients received MAUD across all settings. Female sex and addiction medicine consults positively predicted MAUD prescribing. In contrast, encounters outside inpatient substance use treatment, Hispanic ethnicity, and black or non-white race were negative predictors of MAUD prescribing. Compared to inpatient substance use treatment, inpatient acute care hospitalizations for AUD was associated with a 93% reduced odds of receiving MAUD.
    Conclusions: AUD-related ED and inpatient acute care hospital encounters in our healthcare system were common. Nevertheless, prescriptions for MAUD were infrequent in this population, particularly in inpatient settings. Our findings suggest that the initiation of MAUD for patients with alcohol-related diagnoses in acute care settings deserves additional evaluation.
    MeSH term(s) Adult ; Alcoholism/drug therapy ; Alcoholism/epidemiology ; Colorado/epidemiology ; Delivery of Health Care ; Ethanol/therapeutic use ; Female ; Humans ; Naltrexone/therapeutic use ; Opioid-Related Disorders
    Chemical Substances Ethanol (3K9958V90M) ; Naltrexone (5S6W795CQM)
    Language English
    Publishing date 2022-06-20
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 428999-7
    ISSN 1530-0277 ; 0145-6008
    ISSN (online) 1530-0277
    ISSN 0145-6008
    DOI 10.1111/acer.14837
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Strengthening value-based medication management in a free clinic for the uninsured: Quality interventions aimed at reducing costs and enhancing adherence.

    Arao, Robert K / O'Connor, Michelle Y / Barrett, Thomas / Chockalingam, Leela / Khan, Farrah / Kumar, Anirudh / Leader, Andrew / Leven, Emily / Power, John R / Shuham, Benjamin / Rifkin, Robert / Thomas, David / Meah, Yasmin / Shah, Brijen J

    BMJ open quality

    2017  Volume 6, Issue 2, Page(s) e000069

    Abstract: Skyrocketing costs of prescription medications in the USA pose a significant threat to the financial viability of safety net clinics that opt to supply medications at low to no out-of-pocket costs to patients. At the East Harlem Health Outreach ... ...

    Abstract Skyrocketing costs of prescription medications in the USA pose a significant threat to the financial viability of safety net clinics that opt to supply medications at low to no out-of-pocket costs to patients. At the East Harlem Health Outreach Partnership clinic of the Icahn School of Medicine at Mount Sinai, a physician-directed student-run comprehensive primary care clinic for uninsured adults of East Harlem, expenditures on pharmaceuticals represent nearly two-thirds of annual costs. The practice of minimising costs while maintaining quality, referred to as
    Language English
    Publishing date 2017-10-31
    Publishing country England
    Document type Journal Article
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2017-000069
    Database MEDical Literature Analysis and Retrieval System OnLINE

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