RESUMEN

BACKGROUND: Musculoskeletal (MSK) pain is common in people living with HIV (PLWH). Health care providers sometimes prescribe opioids to control pain, which may lead to opioid misuse. An interdisciplinary approach that includes physical therapy has been successful in managing MSK pain in various health care settings. Therefore, we sought to find the impact of recruiting a physical therapist (PT) on the number of opioid prescriptions and physical therapy referrals made by physicians in training to manage MSK pain in PLWH. METHODS: We performed a retrospective chart review of patients seen by Internal Medicine physicians in training in an HIV clinic in Detroit before (2017) and after (2018) recruiting a PT to the health care team and collected demographic and clinical data. We also surveyed the trainees to assess how the PT addition influenced their learning. Institutional review board waiver was obtained. RESULTS: Results showed that of all PLWH seen at the clinic, 28/249 (11%) and 37/178 (21%) had chronic MSK pain in the 2017 and 2018 data sets, respectively. In 2017, all 28 patients with MSK pain were prescribed opioids. This decreased in 2018 after the PT addition (10/37 patients; P < .0001). The number of physical therapy referrals significantly increased after the PT addition (2017: 5/28 patients; 2018: 17/37 patients; P = .03). Trainees felt that the PT helped improve their examination skills and develop a treatment plan for patients. CONCLUSIONS: The addition of a PT encouraged physicians in training to utilize nonopioid management of MSK pain in PLWH and enhanced their learning experience, as perceived by the trainees.

RESUMEN

BACKGROUND: Vascular access device placement is one of the most routinely performed procedures in the emergency department. Despite its high usage, most patients have limited knowledge about vascular access device placement. Patient decision aids have been utilized heavily in non-emergency department settings to provide basic clinical information regarding a patient's medical care options. In this study, we investigated whether exposure to a patient decision aid on vascular access devices and patients' experiences with vascular access devices would influence their vascular access device preference during an acute care episode. METHODS: Patients in this institutional review board-approved study were enrolled prospectively in the emergency department at a busy level 1 trauma institution. A patient decision aid on vascular access device was constructed using criteria developed by the International Patient Decision Aid Standards. All participants were exposed to the patient decision aid and were asked to complete two questionnaires, and two tests. RESULTS: Fifty subjects (50) were enrolled prospectively in the emergency department. The mean pretest score was 17.2% (95% confidence interval, 0.54-1.18), while the mean post-test score was 72.4% (95% confidence interval, 3.15-4.09). We found that patients who were exposed to the patient decision aid preferred landmark-based peripheral intravenous lines over ultrasound-guided peripheral intravenous lines in this data set. CONCLUSION: The result from this analysis indicated that most patients visiting the emergency department are not knowledgeable about their options related to vascular access device placement. The observed increase in the average correct responses on the post-test indicates that a patient decision aid can be an effective educational tool in the emergency department.

Asunto(s)

Cateterismo Periférico/instrumentación , Conducta de Elección , Técnicas de Apoyo para la Decisión , Servicio de Urgencia en Hospital , Conocimientos, Actitudes y Práctica en Salud , Prioridad del Paciente , Dispositivos de Acceso Vascular , Adulto , Puntos Anatómicos de Referencia , Cateterismo Periférico/efectos adversos , Toma de Decisiones Conjunta , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios , Ultrasonografía Intervencional

RESUMEN

The role of a visiting professor (VP) has long been used as a model to share medical knowledge and new advances between different teaching institutions. As with all subspecialties, breast imaging has institution-specific differences in resources and faculty. Sharing of resources between programs can have a profound impact on enriching educational experiences for learners. Our conceptual design of a VP lecture exchange program was between two academic medical centers, Virginia Commonwealth University Health System (VCU) and MedStar Georgetown University Hospital University (MGUH), in the subspecialty of breast imaging. The program was designed to supplement potential areas of weakness in the breast imaging educational curriculum at each respective institution. The program also sought to create opportunities for long-term mentorship and collaboration between institutions. Three faculty members from VCU and three faculty members from MGUH participated for a total of six lectures (three lectures at each site). Participating residents and faculty completed anonymous surveys following each lecture regarding the lecture exchange program experience. The survey responses showed that the VP exchange was well received at both institutions. The VP exchange process was relatively easy to arrange, benefits both institutions, and could even be expanded to the virtual environment.