Research Proves Useful in Primary Care!

Clinical Pearls Award Winners From the 50th Annual Meeting of NAPCRG – November 18-22, 2022

At the NAPCRG Annual Meeting, the Community Clinicians Advisory Group reviewed the completed research abstracts and selected the top 10 abstracts that have an impact on clinical care as the “Clinical Pearls” Award Winners. These research projects highlight the diversity of topics and research methodology displayed at the NAPCRG Annual Meeting. The full authorship and titles of each abstract are provided in Table 1.

Infectious Disease

Temte, et al’s research described the detection of influenza in long-term care facilities. Rapid influenza testing of residents resulted in an increased use of prophylactic oseltamivir and reduced all-cause emergency department (ED) visits and hospitalizations. Mortality was not impacted. Use rapid testing early!

In their single-center study, the Hospital at Home (HAH), by Wilkins, et al, 200 patients were randomized to HAH or normal treatment. HAH enrollees had a shorter inpatient stay and reduced costs, including their HAH cost, controlling for age, sex, and severity of illness. Overall, the program saved the health system $1.1 million for the 100 patients enrolled. Think about virtual options for your patients that might benefit from HAH.

H. pylori antibiotic resistance may be on the rise. In this observational cohort study from the Netherlands, H. pylori treatment with clarithromycin and/or metronidazole failed, requiring repeat antibiotic treatment in 12 months in 8% of those with treated H. pylori. In patients with continued upper gastrointestinal symptoms, consider retesting for H. pylori.

Pediatrics

Newborn weight loss in the first 6 months of life can be predicted by weight loss of >7% at the first newborn visit (OR = 16.7) and documented difficulty with feeding (OR = 5.45), according to this single-center study by Ringwald and Gorman. The use of weight loss alone has a specificity of 85.6% and a sensitivity of 74.3%; clinicians should see infants with these issues more frequently to monitor weight gain.

Wellness and Preventive Care

Home-based test kits for cervical cancer screening using a human papillomavirus (HPV) self-swab and colorectal cancer using a fecal immunochemical test (FIT) work. Patients were more likely to complete screening in the mailed home FIT test kit arm compared to the standard of care reminder arm (89% vs 11%, P <0.001). Acceptability was high. Home testing could be a mechanism to reach patients historically marginalized from care and reduce disparities.

The 4-question SaFETy score questionnaire may be a valid predictor of gun violence in adolescents. Batish and colleagues reviewed SaFETy scores and their relationship with gun access and violent gun exposures by friends, parents, and the community. They identified a high correlation between positive SaFETy scores and adverse childhood experiences (ACE). If you encounter patients with adverse childhood experiences, consider inquiring about gun violence and gun ownership as well.

E-mail and smartphone notifications are an effective reminder system for preventive care and health monitoring. In Lesser et al’s cohort study, diabetic patients who received an electronic notification that they were overdue for lab monitoring were more likely to have these labs completed compared to their matched peers receiving standard of care (11.3% vs 3.2%). If electronic health records (EHRs) accurately record needed preventive health services, automated outreach could help improve screening rates without clinician offices requiring additional resources.

While patients are obviously concerned about their functional abilities, function as a concept can be overlooked in primary care. However, Cutforth et al’s qualitative research looked at the utility of measuring overall function as a health indicator in Canada. This work showed the potential value of measuring function in a primary care setting.

Dermatology

A survey was conducted to compare clinician identification of worrisome skin findings through either visual inspection photographs alone or with electrical impedance spectroscopy (EIS). Clinicians were more likely to correctly identify and recommend biopsy for melanomas and dysplastic nevi with EIS. However, EIS systems may be prohibitively expensive ($5,000) compared to a classic dermatoscope (mid-range, $100-$400).

Geriatrics

Morley et al described an approach to deprescribing medications in skilled nursing facilities (SNF). Through an interdisciplinary effort including education, guideline implementation, and individual chart review, unsafe medications such as antipsychotics, opioids, and diuretics were used less frequently by clinicians, and safer alternatives, such as antidepressants, were used more frequently. Small steps can help reduce unnecessary and unsafe medicines for those living in SNFs.

The NAPCRG Awards Committee and Community Clinicians congratulate this excellent group of research teams and authors, with a special note that Student and Resident colleagues led 2 of the projects. Submissions for the 51st Annual Meeting of NAPCRG being held October 30-November 3, 2023 in San Francisco, California will open in the spring and close May 14, 2023. The Student, Resident, and Fellow submissions remain open until September, and we encourage learners to submit their work!