Biomedical subjects

Roger S Luckmann

Publications and source records attributed to Roger S Luckmann.

3 recordsLinked to original sources

PubMed2006

Primary care provider concerns about management of chronic pain in community clinic populations.

BACKGROUND: Chronic pain is a common patient complaint in primary care, yet providers and patients are often dissatisfied with treatment processes and outcomes. OBJECTIVE: To assess provider satisfaction with their training for and current management of chronic pain in community clinic settings. To identify perceived problems with delivering chronic pain treatment and issues with opioid prescribing for chronic pain. DESIGN: Mailed survey to primary care providers (PCPs) at 8 community clinics. RESULTS: Respondents (N=111) included attendings, residents, and nurse practioners (NPs)/physician assistants (PAs). They reported 37.5% of adult appointments in a typical week involved patients with chronic pain complaints. They attributed problems with pain care and opioid prescribing more often to patient-related factors such as lack of self-management, and potential for abuse of medication than to provider or practice system factors. Nevertheless, respondents reported inadequate training for, and low satisfaction with, delivering chronic pain treatment. CONCLUSIONS: A substantial proportion of adult primary care appointments involve patients with chronic pain complains. Dissatisfaction with training and substantial concerns about patient self-management and about opioid prescribing suggest areas for improving medical education and postgraduate training. Emphasis on patient-centered approaches to chronic pain management, including skills for assessing risk of opioid abuse and addiction, is required.

Adult↗

PubMed2003

A method for subdividing clinical guidelines into process modules with associated triggers and objectives to facilitate implementation.

Representation of multi-step clinical guidelines (CG) and their implementation in computerized decision support (DS) systems are complex and logistically challenging tasks. However, many simple rules based on CGs (e.g., medical logic modules), have been successfully implemented through a few popular DS models (e.g., prevention reminders, order entry systems). To facilitate mapping of CGs to practical DS models, we propose an empirical method for sub-dividing CGs into modules according to the locus in a clinical process flow model where implementation would be most effective (e.g., post-encounter provider order entry). We further propose a classification of triggers and objectives for CG modules that provides a framework for a DS system to implement the module Successful application of the method to ten diverse CGs in the outpatient setting is described.

Decision Support Systems, Clinical↗

PubMed2002

Assessing third-year medical students' breast cancer screening skills.

PURPOSE: This study assesses the relationship between students' confidence and competency in breast screening practices, compares different measurement approaches to these competencies, and assesses the effect on clinical breast examination (CBE) performance of an additional training session with a standardized patient. METHOD: In the spring of 1998, 96 third-year medical students (47 men and 49 women) at the University of Massachusetts Medical School completed knowledge items on breast cancer epidemiology and on perceived confidence in their counseling and CBE skills. The students were also rated on their performances of counseling and CBE skills. RESULTS: Higher levels of confidence in mammography counseling skills and higher interview skills scores were associated with higher mammography counseling scores. Confidence levels in performing CBE, however, were not related to the actual performances of CBE. Students' knowledge of breast cancer was modestly related to their CBE scores. Finally, the students with one extra training session with a standardized patient performed significantly better on the CBE. CONCLUSIONS: It is important to directly measure students' breast cancer screening and physical examination skills because students' reported self-confidence for some skills might not accurately reflect their actual levels of performance. Additionally, while knowledge may be an important step to acquiring skills, knowledge may not be a good indicator of students' performances of risk assessment, counseling, or physical examination. Although confidence in counseling was related to counseling performance, the stability of this perception and how that translates into future cancer-control practices remain in question.

Adult↗