Evaluating Cognitive Impairment in a Large Health Care System: The Cognition in Primary Care Program.

Background: The prevalence of Alzheimer's disease and related disorders (ADRD) is rising. Primary care providers (PCPs) will increasingly be required to play a role in its detection but lack the training to do so.

Objective: To develop a model for cognitive evaluation which is feasible in primary care and evaluate its implementation in a large health system.

What Makes a Better Life for People Facing Dementia? Toward Dementia-Friendly Health and Social Policy, Medical Care, and Community Support in the United States.

Taking steps to build a more dementia-friendly society is essential for addressing the needs of people experiencing dementia. Initiatives that improve the quality of life for those living with dementia are needed to lessen controllable factors that can negatively influence how people envision a future trajectory of dementia for themselves. Programs that provide better funding and better coordination for care support would lessen caregiver burden and make it more possible to imagine more people being able to live what they might consider a "good life" with dementia.

Guiding the Future: Rethinking the Role of Advance Directives in the Care of People with Dementia.

When people lose capacity to make a medical decision, the standard is to assess what their preferences would have been and try to honor their wishes. Dementia raises a special case in such situations, given its long, progressive trajectory during which others must make substituted judgments. The question of how to help surrogates make better-informed decisions has led to the development of dementia-specific advance directives, in which people are given tools to help them communicate what their preferences are while they are still able.

Developing a cognitive assessment toolkit for primary care: qualitative assessment of providers' needs and perceptions of usability in clinical practice.

Background: Burden of dementia is expected to substantially increase. Early dementia is underdiagnosed in primary care. Given the benefits of active management of dementia, earlier detection in primary care is imperative.

The effect of medication cost transparency alerts on prescriber behavior.

Objective: The purpose of this study was to determine if medication cost transparency alerts provided at time of prescribing led ambulatory prescribers to reduce their use of low-value medications.

Materials And Methods: Provider-level alerts were deployed to ambulatory practices of a single health system from February 2018 through April 2018. Practice sites included 58 primary care and 152 specialty care clinics totaling 1896 attending physicians, residents, and advanced practice nurses throughout western Washington.

Teaching evidence-based medicine at complementary and alternative medicine institutions: strategies, competencies, and evaluation.

Background: As evidence-based medicine (EBM) becomes a standard in health care, it is essential that practitioners of complementary and alternative medicine (CAM) become experts in searching and evaluating the research literature. In support of this goal, the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) provided R25 funding to nine CAM colleges to develop individual programs focused on teaching EBM. An overarching goal of these research education grants has been to provide CAM faculty and students with the skills they need to apply a rigorous evidence-based perspective to their training and practice.

Integrative medicine at academic health centers: a survey of clinicians' educational backgrounds and practices.

Background And Objectives: Integrative medicine is a relatively new field that seeks to combine conventional and nonconventional approaches to patient care. Many academic health centers have now established integrative medicine clinics, yet little is known about the clinicians who practice at them. We used a nationwide survey to characterize the backgrounds, clinical practices, and involvement in research and education of clinicians who practice integrative medicine at academic health centers.

East meets West: current issues relevant to integrating Chinese medicine.

This article describes the challenges that integration of Chinese medicine (CM) and biomedicine are likely to bring for improving safety, research, education, and cross-disciplinary communication. Potential strategies to meet these challenges are suggested, including the use of accessible language for the Western biomedical community, and further development of whole-system randomized controlled trials that support individualized treatment approaches.

Building bridges: qualitative assessment of a clinical faculty exchange between a naturopathic and an allopathic medical training program.

Research Question: What are the perceived benefits of a clinical exchange experience designed as part of a program to promote acceptance and use of evidence-based medicine (EBM) in naturopathic clinical practice?

Methods: Nine faculty members participated in a focus group (n = 6) or a structured interview (n = 3) to assess experience in the program. Investigators independently analyzed transcribed notes for common experience themes. ANALYSIS AND INTERPRETATION: Six major themes emerged: integrating EBM into naturopathic clinical teaching, strengthening of professional relationships, exposure to clinical experiences outside the usual naturopathic scope, reaffirmation of naturopathic training and profession, observation of clinical and administrative resources and practices, and recommendations for future clinical exchanges.

Patient-centered discussions about prostate cancer screening: a real-world approach.

National guidelines recommend that primary care providers discuss the risks and benefits of prostate cancer screening with their patients but give little guidance on how to fit such a complex discussion into a busy clinic encounter. The authors propose a process-oriented approach (Ask-Tell-Ask) that promotes tailored conversations and value-based recommendations. The Ask-Tell-Ask approach includes diagnosing a patient's informational needs, providing targeted education based on those needs, and making a shared decision about testing.

Randomized trial of web-based training about opioid therapy for chronic pain.

Objectives: The treatment of chronic noncancer pain with chronic opioid therapy has increased rapidly, but medicine residents receive little training concerning this therapy. Therefore we conducted a trial to determine if an interactive web-based training focusing on shared decision-making for chronic opioid therapy improves knowledge and competence compared with exposure to practice guidelines.

Methods: A randomized controlled educational trial of 213 internal medicine residents from 5 medicine residencies participating in the Residency Review Committee for Internal Medicine's Educational Innovations Project comparing access to interactive web-based training (COPE: Collaborative Opioid Prescribing Education) or access to the Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain.

What should students learn about complementary and alternative medicine?

With thousands of complementary and alternative medicine (CAM) treatments currently being used in the United States today, it is challenging to design a concise body of CAM content which will fit into already overly full curricula for health care students. The purpose of this article is to outline key principles which 15 National Center for Complementary and Alternative Medicine-funded education programs found useful when developing CAM course-work and selecting CAM content. Three key guiding principles are discussed: teach foundational CAM competencies to give students a framework for learning about CAM; choose specific content on the basis of evidence, demographics and condition (what conditions are most appropriate for CAM therapies?); and finally, provide students with skills for future learning, including where to find reliable information about CAM and how to search the scientific literature and assess the results of CAM research.

Dietary supplements for the prevention and treatment of coronary artery disease.

Purpose: With the recent growth in the use of dietary supplements, it is increasingly important for clinicians to be familiar with the evidence for and against their efficacy. We set out to systematically review the dietary supplements available for the prevention and treatment of coronary artery disease.

Methods: Between May 2004 and May 2006, we searched MEDLINE, the Cochrane Library, and Pro-Quest using the MeSH terms hypertension, hypercholesterolemia, myocardial infarction, dietary supplements, and herb-drug interactions.

Brief report: Training internists in shared decision making about chronic opioid treatment for noncancer pain.

Background: The use of chronic opioids for noncancer pain is an increasingly common and difficult problem in primary care.

Objective: To test the effects on physicians' self-reported attitudes and behavior of a shared decision-making training for opioid treatment of chronic pain.

Design: Randomized-controlled trial.

PrimeAnswers: A practical interface for answering primary care questions.

This paper describes an institutional approach taken to build a primary care reference portal. The objective for the site is to make access to and use of clinical reference faster and easier and to facilitate the use of evidence-based answers in daily practice. Reference objects were selected and metadata applied to a core set of sources.

Creating a note classification scheme for a multi-institutional electronic medical record.

How notes are categorized in an electronic medical record (EMR) influences how rapidly users can locate documents and enter new ones, whether algorithmic search for chart deficiencies is possible, and the ease of incorporating collections of existing notes. We balanced these competing needs when developing a note classification scheme for the Online Record of Clinical Activity (ORCA) electronic medical record at the University of Washington.

Systematic review of antidepressants in the treatment of chronic low back pain.

Background: Three previous reviews have reached conflicting conclusions regarding the efficacy of antidepressants for patients with back pain.

Objectives: To systematically review the efficacy of antidepressants for the treatment of patients with back pain and to determine whether there is evidence that outcomes vary between classes of antidepressants.

Materials And Methods: Best evidence synthesis of randomized, placebo-controlled trials of oral antidepressive agents in patients with back pain.

Physicians' use of and attitudes toward electronic mail for patient communication.

To assess physicians' use of and attitudes toward electronic mail (e-mail) for patient communication, we conducted a mail-in survey of physicians who see patients in outpatient clinics affiliated with a large academic medical center (N = 283). Seventy-two percent of physicians reported using e-mail to communicate with patients, averaging 7.7 e-mails from patients per month.