ABSTRACT
Yes for exacerbations, no for hospitalizations. Prophylactic azithro-mycin reduces the number of exacerbations by about 25%. It also extends the time between exacerbations by approximately 90 days for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). Azithromycin benefits patients who are >65 years, patients with Global Initiative for Obstructive Lung Disease (GOLD) stage II or III COPD, former smokers, and patients using long-term oxygen; it doesn't benefit patients ≤65 years, patients with GOLD stage IV COPD, current smokers, or patients not using oxygen (strength of recommendation [SOR]: B, randomized controlled trials [RCTs]). Prophylactic azithromycin doesn't reduce hospitalizations overall (SOR: B, single small RCT).
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis/methods , Erythromycin/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Adult , Age Factors , Aged , Aged, 80 and over , Azithromycin/therapeutic use , Female , Humans , Male , Middle AgedABSTRACT
Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology.
Subject(s)
Internship and Residency/methods , Multi-Institutional Systems , Patient-Centered Care , Colorado , Documentation , Humans , Primary Health Care , Program Evaluation/methods , Surveys and QuestionnairesABSTRACT
BACKGROUND AND OBJECTIVES: In 2010, the US Department of Health and Human Services, under the Affordable Care Act, appropriated over $167 million to the Health Resources and Services Administration (HRSA) for the Primary Care Residency Expansion (PCRE) program. In 2011, grants from the PCRE program were provided to residency programs in the specialties of family medicine, internal medicine, and pediatrics, allowing them to increase the number of residents in their programs. Seventy-seven programs received grant funding, and 504 primary care resident positions were created. The grants provide 5 years of funding for these positions. There is no provision for federal funding of these positions after 2016. The purpose of this study was to determine the number of residencies that had identified funding that would allow them to continue training these new positions after the PCRE grant period ends. METHODS: Programs receiving PCRE funding were identified through the HRSA data warehouse website.1 Program directors were surveyed by email between January and March of 2013. RESULTS: A total of 55 programs responded, for a 71.4% response rate. Of those programs, 17.5% had identified funding that would allow them to continue training the increased number of positions beyond 2016. CONCLUSIONS: This one-time funding exhibits challenges to sustainability. This information will help inform policy makers that sustainable expansion of primary care graduate medical education (GME) training will require strategies other than time-limited funding mechanisms.
