DOCSLIB.ORG

Managing Advanced Chronic Kidney Disease: a Primary Care Guide

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Managing Advanced Chronic Kidney Disease: a Primary Care Guide REVIEW CME EDUCATIONAL OBJECTIVE: Readers will optimize the care of their patients who have chronic kidney disease CREDIT ANKIT SAKHUJA, MD JENNIFER HYLAND, RN, MSN, CNP JAMES F. SIMON, MD Division of Nephrology and Hyperten- Department of Nephrology and Hypertension, Program Director, Nephrology Fellowship, Department sion, Mayo Clinic, Rochester, MN Glickman Urological and Kidney Institute, of Nephrology and Hypertension, Glickman Urological Cleveland Clinic and Kidney Institute, Cleveland Clinic; Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH Managing advanced chronic kidney disease: A primary care guide ABSTRACT ccountable-care organizations are be- A coming more prominent in the United Chronic kidney disease (CKD) is a common disorder that States, and therefore health care systems in the requires close collaboration between the primary care near future will be reimbursed on the basis of physician and nephrologist. Most aspects of early CKD their ability to care for patient populations rath- can be managed in the primary care setting with ne- er than individual patients. As a result, primary phrology input. As the disease progresses, many aspects care physicians will need to be well versed in the of care should be transitioned to the nephrologist, espe- care of patients with common chronic diseases cially as the patient nears end-stage renal disease, when such as chronic kidney disease (CKD). By one dialysis and transplantation must be addressed. estimate, patients with CKD constitute 14% of the US population age 20 and older, or more KEY POINTS than 31 million people.1 An earlier article in this journal reviewed Steps to stabilize renal function include blood pressure how to identify patients with CKD and how and diabetes control. to interpret the estimated glomerular filtration rate (GFR).2 This article examines the care of Patients have a very high risk of cardiovascular disease, patients with advanced CKD, how to manage and one should try to reduce modifiable risk factors their health risks, and how to optimize their such as hypertension (which is also a risk factor for the care by coordinating with nephrologists. progression of CKD) and hyperlipidemia. ■ GOALS OF CKD CARE In addition to controlling blood pressure, angiotensin-con- CKD is defined either as renal damage (which verting enzyme inhibitors and angiotensin receptor block- is most commonly manifested by proteinuria, ers reduce proteinuria, a risk factor for progression of CKD. but which may include pathologic changes on biopsy or other markers of damage on se- rum, urine, or imaging studies), or as a GFR Patients with CKD develop secondary hyperparathyroid- less than 60 mL/min/1.73 m2 for at least 3 3 ism, hyperphosphatemia, and, in advanced CKD, hypo- months. It is divided into five stages (TABLE 1). calcemia, all leading to disorders of bone mineral metab- Since most patients with CKD never reach olism. Low vitamin D levels should be raised with supple- end-stage renal disease, much of their care is ments, and high phosphorus levels should be lowered aimed at slowing the progression of renal dys- with dietary restriction and phosphate binders. function and addressing medical issues that arise as a result of CKD. To these ends, it is important to detect CKD early and refer these patients to a nephrology team in a timely manner. Their care doi:10.3949/ccjm.81a.13046 can be separated into several important tasks: CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 81 • NUMBER 5 MAY 2014 289 Downloaded from www.ccjm.org on September 23, 2021. For personal use only. All other uses require permission. ADVANCED KIDNEY DISEASE Studies discussed in this article shown to go longer without CKD progression than those referred in later stages.4 Early refer- AASK—African American Study of Kidney Disease and Hypertension40 ral to a nephrologist has also been associated 5 ACCORD— Action to Control Cardiovascular Risk in Diabetes37 with a decreased mortality rate. The studies that found these trends, however, were limited 78 CHOIR—Correction of Hemoglobin and Outcomes in Renal Insufficiency by the fact that patients with stage 3 CKD are CREATE —Cardiovascular Reduction Early Anemia Treatment Epoetin79 less likely to progress to end-stage renal dis- ease or to die of cardiovascular disease than HOPE —Heart Outcomes Prevention Evaluation16 patients with stage 4 or 5 CKD. IDEAL—Initiating Dialysis Early and Late99 Once stage 4 CKD develops, the nephrolo- IDNT—Irbesartan Diabetic Nephropathy Trial46 gist should take a more active role in the care plan. In this stage, cardiovascular risk rises, 17 PREVEND—Prevention of Renal and Vascular End-stage Disease and the risk of developing end-stage renal dis- SHARP—Study of Heart and Renal Protection28 ease rises dramatically.6 With comprehensive care in a CKD clinic, even patients with ad- TREAT—Trial to Reduce Cardiovascular Events With Aranesp Therapy80 vanced CKD are more likely to have a stabili- zation of renal function.7 Kinchen et al8 found that patients referred to a nephrologist within • Identify the cause of CKD, if possible; ad- 4 months of starting dialysis had a lower sur- dress potentially reversible causes such as vival rate than those referred earlier. There- obstruction or medication-related causes. fore, if a nephrologist was not involved in the If a primarily glomerular process (marked patient’s care prior to stage 4, then a referral by heavy proteinuria and dysmorphic red must be made. blood cells and red blood cell casts in the Recommendation. Patients with stage 3 urine sediment) or interstitial nephritis CKD can be referred for an initial evaluation (manifested by white blood cells in the and development of a treatment plan, but most Most patients urine) is suspected, refer to a nephrologist of the responsibility for their care can remain early. with the primary care provider. Once stage 4 with CKD • Provide treatment to correct the specific CKD develops, the nephrologist should as- never reach cause (if one is present) or slow the dete- sume an increasing role. However, if glomeru- rioration of renal function. lar disease is suspected, we recommend referral end-stage • Address cardiovascular risk factors. to a nephrologist regardless of the estimated renal disease • Address metabolic abnormalities related GFR. to CKD. • If the CKD is advanced, educate the pa- ■ ELEVATED CARDIOVASCULAR RISK tient about end-stage renal disease and its Patients with stage 3 CKD are 20 times more treatment options, and guide the patient likely to die of a cardiovascular event than to through the transition to end-stage renal 6 disease. reach end-stage renal disease. This increased risk does not quite reach the status of a car- diovascular disease risk equivalent, as does ■ WHEN SHOULD A NEPHROLOGIST 9,10 BE CONSULTED? diabetes, but cardiovascular risk reduction should be a primary focus of care for the CKD The ideal timing of referral to a nephrologist is patient. not well defined and depends on the comfort The cardiovascular risk in part is at- level of the primary care provider. tributed to a high prevalence of traditional Treatments to slow the progression of CKD cardiovascular risk factors, including diabe- and decrease cardiovascular risk should begin tes mellitus, hypertension, and hyperlipid- early in CKD (ie, in stage 3) and can be man- emia.11,12 About two-thirds of CKD patients aged by the primary care provider with guid- have metabolic syndrome, which is a risk fac- ance from a nephrologist. Patients referred tor for cardiovascular disease and is associ- to a nephrologist while in stage 3 have been ated with more rapid progression of CKD.13 290 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 81 • NUMBER 5 MAY 2014 Downloaded from www.ccjm.org on September 23, 2021. For personal use only. All other uses require permission. SAKHUJA AND COLLEAGUES TABLE 1 Stages of chronic kidney disease Glomerular filtration rate (GFR) Stage Description (mL/min/1.73 m2) 1 Kidney damage with normal or increased GFR ≥ 90 2 Kidney damage with mild decrease in GFR 60–89 3 Moderately decreased GFR 30–59 4 Severely decreased GFR 15–29 5 Kidney failure < 15 (or dialysis) Chronic kidney disease is defined as either kidney damage or GFR < 60 mL/min/1.73 2m for ≥ 3 months. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies. NATIONAL KIDNEY FOUNDATION, INC. KDOQI CLINICAL PRACTICE GUIDELINES FOR CHRONIC KIDNEY DISEASE: EVALUATION, CLASSIFICATION, AND STRATIFICATION. HTTP://WWW.KIDNEY.ORG/PROFESSIONALS/KDOQI/GUIDELINES_CKD/P4_CLASS_G1.HTM. ACCESSED MARCH 5, 2014. REPRINTED WITH PERMISSION FROM THE NATIONAL KIDNEY FOUNDATION, INC. In addition, renal dysfunction, proteinuria, with various stages of CKD, including ad- and hyperphosphatemia are also risk factors vanced CKD, had fewer major vascular 14–19 for cardiovascular disease. events if they received the combination of The risk of death from a cardiovascular low-dose simvastatin (Zocor) and ezetimibe event increases as kidney function declines, (Zetia). However, the evidence does not sug- with reported 5-year death rates of 19.5% in gest that statin therapy slows the progression Patients in stage 2, 24.3% in stage 3, and 45.7% in stage of CKD.28–31 stage 3 CKD 4 CKD. However, imbalance between mor- Recommendation. Manage hyperlipidemia are roughly tality risk and progression to end-stage renal aggressively using statin therapy with or with- 20 disease may be age-dependent. Younger pa- out ezetimibe, with a target low-density lipo- 20 times more tients (age 45 and younger) are more likely protein cholesterol level below 100 mg/dL.32 likely to die of to progress to end-stage renal disease, where- as in older patients (over age 65), the rela- Manage other cardiovascular risk factors a cardiovascular tive risk of dying of cardiovascular disease is Because hypertension and proteinuria are risk event than higher.
Load more

Recommended publications
  • How Many Physicians Do You Need?
    How Many Physicians Do You Need? Dear Reader: I hope you enjoy the following excerpt from the HealthLeaders Media book, The Hospital Executive’s Guide to Physician Staffing Complete with proven staffing models and current data on physician supply and demand, this book helps answer a ORDER question that healthcare analysts and policymakers have YOUR COPY debated for nearly 30 years: How many physicians do we need? ONLINE! This insightful, data-rich, and timely resource outlines proven approaches for determining physician need for a broad range of markets and specialties. The book also offers sound strategies for building productive relationships with physicians by creating a culture that embraces high-quality physicians and gives them a significant role in shared decision-making. Choose one of the following ways to order you copy today » Online: At HealthLeaders Media—www.healthleadersmedia.com/books » By phone: Call our customer service department at 800/753-0131 » By fax: Complete the order form on the last page and fax to 800/639-8511 Thank you, Matthew G. Cann Group Publisher HealthLeaders Media A division of HCPro, Inc P.O. Box 1168 | Marblehead, MA 01945 | 800/753-0131 | www.healthleadersmedia.com C HAPTER 4 How Many Physicians Make a Health System? As noted at the beginning of Chapter 3, determining community physician need is an important task for hospitals and health systems, especially those seeking to enhance clinical programs or dealing with current or anticipated physician shortages. However, there are many aspects of medical staff plan- ning and development that are outside the scope of a community need analy- sis or require more detailed investigation.
    [Show full text]
  • Enhancing Health Care Through Telehealth
    Enhancing Health Care through Telehealth Telehealth is making a difference UnityPoint Health is using telehealth to provide greater access to high-quality care while driving down overall health care costs. ENHANCED ACCESS TO CARE Telehealth keeps patients and families connected to vital health care services. Over the last seven months, UnityPoint Health has: • Seen an increase in telehealth visits of more than 1,700%. • Grown the number specialties offering telehealth from 15 to 51. • Equipped more than 1,800 clinicians to provide telehealth services. Visits Specialties Clinicians 250,000 60 2000 1860 210,841 51 50 200,000 1500 40 150,000 30 1000 100,000 20 15 500 50,000 11,336 10 78 - 0 0 Pre During Pre During Pre During Pre = Aug 2019 - Jan 2020 During = Feb - Jul 2020 EXPANDING THE USE OF TELEHEALTH UnityPoint Health is making telehealth available in homes, workplaces, clinics, hospitals, emergency rooms, nursing facilities and much more. Direct to patient virtual care services, both on-demand and scheduled • Urgent care visits • Follow up visits with a primary care physician • Behavioral health visits • More than 50 other types of specialist visits Provider to provider telehealth services • Inpatient hospital support • Intensive care unit support • Emergency room support EMPHASIS ON PATIENT-CENTERED CARE A Patient's Perspective When it came time for his annual wellness visit, Scott Frank considered cancelling due to his busy schedule. He then learned he could have his visit virtually. Soon after scheduling his appointment, he was disking a field when he stopped his tractor to talk with his primary care provider.
    [Show full text]
  • Update: Virginia Physician Workforce Shortage
    UPDATE: VIRGINIA PHYSICIAN WORKFORCE SHORTAGE Joint Commission on Health Care September 17, 2013 Stephen W. Bowman Senior Staff Attorney/Methodologist 2 House Joint Resolution 687 (Del. Purkey) 1. Determine whether a shortage of medical doctors exists in the Commonwealth, by specialty and by geographical region 2. Project the future need for medical doctors in Virginia over the next 10 years by field of specialty 3. Identify and assess factors that contribute to the shortage of medical doctors 4. Identify the medical specialty fields primarily affected by the shortage of doctors 5. Recommend ways to alleviate shortages 1 3 Agenda • Physician Supply, Shortages, and Maldistribution • Medical School Graduates, Residencies, and Geriatric Training • Recent Impacts and State Policies • Policy Options 4 PHYSICIAN SUPPLY, SHORTAGES, AND MALDISTRIBUTION 2 5 Virginia Has Over 16,000 Practicing Physicians and 48% Are Primary Care Providers Specialty Number Percentage Family Medicine 2782 17% General Internal Medicine 2008 12% Pediatric 1744 11% Radiology 1255 8% Obstetrics and Gynecology 1236 8% Psychiatry 1209 7% Other* 6151 38% Total Physicians 16,385 100% *See Appendix for additional breakout of physician specialty counts Primary care specialties are highlighted Source: Virginia Health Chart Book at http://www.vahealthchartbook.org/ and email correspondence with GeoHealth Innovations. 6 46% of Physicians that Manage Patient Load Primary Work Practices Are “Far from Full” Primary Work Location (n= 11,621) 5% Secondary Work Location (n=2,602) 5% Practice is far from full 46% Practice is almost full 36% 49% Practice is full 59% Note: Number and percentage are weighted estimates of physicians that manage patient load from Department of Health Professions Physician Survey Source: Virginia Department of Health Professions, Healthcare Workforce Data Center, Virginia’s Physician Workforce: 2012, July 2013.
    [Show full text]
  • (APC- APM) for Delivering Patient-Centered, Longitudinal, and Coordinated Care
    Advanced Primary Care: A Foundational Alternative Payment Model (APC-APM) for Delivering Patient-Centered, Longitudinal, and Coordinated Care A Proposal to the Physician-Focused Payment Model Technical Advisory Committee From the American Academy of Family Physicians April 14, 2017 AAFP Contact: Kent Moore Senior Strategist for Physician Payment American Academy of Family Physicians 11400 Tomahawk Creek Parkway Leawood, KS 66211 Phone: 800-274-2237, extension 4170 Email: [email protected] April 14, 2017 Physician-Focused Payment Model Technical Advisory Committee c/o Assistant Secretary of Planning and Evaluation Office of Health Policy U.S. Department of Health and Human Services 200 Independence Avenue S.W. Washington, DC 20201 Proposal – Advanced Primary Care: A Foundational Alternative Payment Model (APC- APM) for Delivering Patient-Centered, Longitudinal, and Coordinated Care Dear PTAC Committee Members: The American Academy of Family Physicians (AAFP) is fully supportive of the Physician- Focused Payment Model Technical Advisory Committee’s (PTAC) role in evaluating physician-focused payment models (PFPMs) and making subsequent recommendations about those models to the U.S. Department of Health and Human Services (HHS). The AAFP believes that to be truly successful in improving care and reducing cost, PFPMs and alternative payment models (APMs) need a strong foundation of primary care. Therefore, on behalf of the AAFP, which represents 124,900 family physicians and medical students, I am particularly pleased to submit the following proposal—Advanced Primary Care: A Foundational Alternative Payment Model (APC-APM) for Delivering Patient-Centered, Longitudinal, and Coordinated Care. We request that the PTAC review the model, provide feedback to the AAFP on it, and promptly recommend it to HHS for approval and nationwide expansion.
    [Show full text]
  • Supply and Demand of Primary Care Physicians by Region, 2017-2030
    Texas Projections of Supply and Demand for Primary Care Physicians and Psychiatrists, 2017 - 2030 As Required by Texas Health and Safety Code Section 105.009 Department of State Health Services July 2018 Table of Contents Executive Summary ............................................................................... 1 1. Introduction ...................................................................................... 3 2. Background ....................................................................................... 5 2.1 Objectives .......................................................................................8 3. Methodology for Supply and Demand Projections .............................. 9 3.1 Supply Model ...................................................................................9 3.2 Demand Model .............................................................................. 10 4. Supply and Demand for Primary Care Physicians ............................ 12 4.1 Supply and Demand for Primary Care Physicians in Texas ................... 12 4.2 Supply and Demand Projections for Primary Care Physicians by Region 15 5. Supply and Demand for Psychiatrists .............................................. 16 5.1 Supply and Demand Projections for Psychiatrists in Texas ................... 16 5.2 Supply and Demand Projections for Psychiatrists by Region ................. 16 6. Strengths and Limitations ............................................................... 18 7. Discussion ......................................................................................
    [Show full text]
  • Desirable Characteristics of Consulting Cardiologists for Sustained Referrals by Primary Care Physicians
    International Cardiovascular Forum Journal 6 (2016) 36 | Original Article DOI: 10.17987/icfj.v6i0.187 Desirable Characteristics of Consulting Cardiologists for Sustained Referrals by Primary Care Physicians Phillip Ribeiro1, Swetal Patel1, Krystal Carlos2, Sumit Sehgal1, Ramdas G Pai3 , Paulo A Ribeiro4, 1. Department of Internal Medicine, University of Nevada SOM, Las Vegas, NV 2. Department of Emergency Medicine, University of Toledo, Toledo, Ohio 3. Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 4. Department of Cardiology, Arkansas Heart Hospital, Little Rock, AR Address for correspondence: Paulo A. Ribeiro, MD, PhD, FACC Department of Cardiology Arkansas Heart Hospital Tel: (949) 698-3130 Email: [email protected] Abstract Background Accountable care organization and high quality affordable patient care requires impeccable team work between primary and specialist care physicians. Limited data exists on evaluation of factors that lead to termination of referrals between primary care physicians and cardiologists. Methods Using an 11 point questionnaire of potential factors for cause of termination of referrals to cardiologists, 103 primary care providers were interviewed. Each response was graded by the interviewee on a scale of 1 (least important) to 10 (most important). Mean scores were computed for each of the responses and validated using ANOVA and Tukey’s multiple comparison method. Results Out of 103 primary care providers interviewed in Little Rock, Arkansas and Chicago, Illinois, 84 providers were practicing in the city limits and 19 in the rural areas. The average years in practice for the primary care physicians were 20.9 years. The most important factors for termination of referrals in the order of decreasing importance were cardiologist’s bedside manners as perceived by the patient (7.9 ± 2.1), poor feedback to the primary care provider from the cardiologist (7.8 ± 2.3), and patients not getting their questions fully answered by the cardiologist during the visit (7.8 ± 1.9).
    [Show full text]
  • Management of Chronic Kidney Disease in Primary Health Care: Position Paper of the European Forum for Primary Care Mai Rosenberg Nephrologist and Ass
    Quality in Primary Care 2008;16:279–94 # 2008 European Forum for Primary Care International exchange Management of chronic kidney disease in primary health care: position paper of the European Forum for Primary Care Mai Rosenberg Nephrologist and Ass. Professor, Department of Internal Medicine Ruth Kalda Family Doctor and Ass. Professor, Department of Family Medicine University of Tartu, Estonia Vytautas Kasiulevicˇius Family Doctor and Ass. Professor, Department of Family Medicine, University of Vilnius, Lithuania Margus Lember Professor of Internal Medicine, University of Tartu, Estonia Introduction Chronic kidney disease (CKD) is a worldwide public the development of renal failure among those in whom health problem that is often underdiagnosed and the original illness is either inactive or cured.4 The cost undertreated. CKD is a ‘silent’ disease and goes un- of the advanced renal failure and renal replacement noticed because it may not be ‘felt’. Yet it affects many therapy is enormous.5,6 Therefore, early diagnosis and more people than we might imagine: 1 out of 10 adults optimal management of CKD affords many challenges in the world has some form of kidney damage.1 for primary health care in helping to maintain health However, as many as 90% of those who have CKD and quality of life among the population at risk. remain unidentified. High blood pressure and dia- This position paper is based on published reviews betes are the main causes of CKD. It is projected that about CKD management in different stages, and focuses diabetes will increase by 70% by 2025. Therefore, early on key references published since the year 2000.
    [Show full text]
  • Adult Kidney Disease: Referral to Nephrologist
    Adult Kidney Disease: Referral to Nephrologist NQF Endorsement Status Not Endorsed NQF ID 9999 Measure Type Process Measure Content Last Updated 2021-06-30 Info As Of Not Available Properties Description Percentage of patients aged 18 years and older with a diagnosis of CKD (not receiving RRT) with an eGFR <30 and proteinuria who are referred to a nephrologist and have documentation that an appointment was made for a nephrology consultation within a 12-month period Numerator Patients who are referred to a nephrologist AND have documentation that an appointment was made for a nephrology consultation within a 12-month period Denominator All patients aged 18 years and older with a diagnosis of CKD* (not receiving RRT) with an eGFR < 30 and proteinuria Definitions: *For the purposes of this measure, the diagnosis of CKD can be identified in one of two ways: a diagnosis of CKD Stage 3, 4, or 5, CKD NOS, OR two eGFR lab results < 60 more than 90 days apart Proteinuria: 1. >300mg of albumin in the urine per 24 hours OR 2. ACR >300 mcg/mg creatinine OR 3. Protein to creatinine ratio > 0.3 mg/mg creatinine RRT (Renal Replacement Therapy)-For the purposes of this measure, RRT includes hemodialysis, peritoneal dialysis, and kidney transplantation Denominator Exclusions Documentation of system reason(s) for patient not being referred to a nephrologist (eg, patient already received a nephrology consultation, other system reasons) Rationale Frequently the primary care provider will make the diagnosis of chronic kidney disease. Referral to a nephrologist or other specialist for consultation or co- management should be made after diagnosis under the following Report Generated: Fri Oct 01 10:23:07 EDT 2021 | Page 1 Adult Kidney Disease: Referral to Nephrologist circumstances: a clinical action plan cannot be prepared based on the stage of the disease, the prescribed evaluation of the patient cannot be carried out, or the recommended treatment cannot be carried out.
    [Show full text]
  • Primary Care for the 21St Century White Paper
    Primary Care for the 21st Century Ensuring a Quality, Physician-led Team for Every Patient September 18, 2012 Executive Summary The United States is adopting a new model of primary care built around patients and delivered by teams. As a key element of this approach, primary care medical practices are being called upon to do more, and to do it better, while managing resources ever more wisely. This approach is generally known as the patient-centered medical home (PCMH).1 It has proven to increase quality of care for the patient and cost-effectiveness for the health care system.2 Within a medical home, each patient has an ongoing relationship with a personal physician trained to provide first contact, complex diagnosis, and continuous, comprehensive care. The personal physician leads a team of professionals at the practice level who are collectively responsible for the ongoing care of patients— many of whom are living with one or more chronic conditions. This reorganization puts primary care at the center of the patient’s team and better enables doctors, nurse practitioners (NPs), physician assistants, nurses, and other health care professionals to work side by side in caring for patients. Yet even as the role and complexity of primary care practice expands, there has been a significant amount of discussion within the health care and public policy communities about advanced practice nurses directing primary care practices on their own, without a physician on staff. This effort to have nurses practice i 1 independent of physicians comes at the very same moment that medical practice itself is changing to an integrated, team-based approach that includes physicians and other health professionals.
    [Show full text]
  • Physician & Physician Assistant Workforce Capacity Report
    GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH BOARD OF MEDICINE PHYSICIAN & PHYSICIAN ASSISTANT WORKFORCE CAPACITY REPORT 3.0 A Summary of Findings from the Physician and Physician Assistant 2014 Workforce Survey in the District of Columbia September 2015 www.doh.dc.gov/bomed GOVERNMENT OF THE DISTRICT OF COLUMBIA MURIEL BOWSER, MAYOR D.C. Board of Medicine Physician & Physician Assistant Workforce Capacity Report Mission Statement “To protect and enhance the health, safety, and well-being of District of Columbia residents by promoting evidence-based best practices in health regulation, high standards of quality care and implementing policies that prevent adverse events.” 2 D.C. Board of Medicine Physician & Physician Assistant Workforce Capacity Report ACKNOWLEDGEMENTS Healthcare Workforce Workgroup Members: • Rikin S. Mehta, PharmD, JD, LLM – Senior Deputy Director • Janis M. Orlowski, MD, MACP – Chairperson, Board of Medicine • Andrea A. Anderson, MD – Physician Member, Board of Medicine • Jacqueline A. Watson, DO, MBA – Department of Health Chief of Staff • Rita A. Habib, PharmD, MPH – Health Policy Fellow, Health Regulation and Licensing Administration • Rowena Samala – Supervisory Statistician- CPPE • Marvin Romero – Health Licensing Specialist • Aisha Nixon, MA – Health Licensing Specialist • Deniz Soyer, MBA – Data Analyst – Health Care Finance • Eva Stern, GISP – GIS Analyst and Training Specialist – OCTO • Aaron Young, PhD – Assistant Vice President, Research and Data Integration- FSMB D.C. Department of Health Staff: • Sheila Ford-Murphy – Executive Assistant to the Senior Deputy Director, Health Regulation and Licensing Administration • Yonatan Berhe D.C. Board of Medicine Members: • Andrea A. Anderson, MD • Kelly Ann Colden, MD, MPH • Thomas J. Dawson, III, Esq. • Anitra Denson, MD, MPH • Vikisha Fripp, MD • Treazure R.
    [Show full text]
  • Arizona Primary Care Physician Workforce Report 2019
    Arizona Primary Care Physician Workforce Report OCTOBER 2019 Acknowledgements The Arizona Center for Rural Health appreciates the guidance from Tom Ricketts at the University of North Carolina Cecil G. Sheps Center for Health Service Research, the timely data processing provided by the Arizona Medical Board, and the support of the Arizona Area Health Education Center Program. This report sponsored by support from the Arizona Center for Rural Health and the Arizona Area Health Education Center at the University of Arizona Health Sciences. Suggested citation: Koch B, Coates S, Campos-Outcalt D, Carter H, and Derksen D. Arizona Primary Care Physician Workforce Report 2019. For questions or comments about this report contact: Bryna Koch [email protected] . Contents Executive Summary: Arizona Primary Care Physician Workforce 2019 ......................................................... 3 Primary Care Physician Workforce ................................................................................................................ 5 The Medical and Osteopathic UME and GME Physician Education Pipeline ............................................. 6 Workforce Ratio Standards and Physician Shortages ................................................................................ 7 Access and Coverage ................................................................................................................................. 7 Methods .......................................................................................................................................................
    [Show full text]
  • Internal Medicine Recruiting Trends and Recommendations
    A resource provided by Internal Medicine Recruiting Trends and Merritt Hawkins, the nation’s leading physician Recommendations search and consulting firm and a company of AMN Healthcare (NYSE: AMN, Introduction the largest healthcare Merritt Hawkins is the nation’s leading physician search and consulting firm and is workforce solutions company in the United a company of AMN Healthcare (NYSE: AMN) the largest healthcare staffing States. organization in the country and the innovator of healthcare workforce solutions. As the thought leader in its field, Merritt Hawkins produces a series of surveys, Corporate Office: white papers, speaking presentations and other resources intended to provide Merritt Hawkins insight into physician supply and demand, physician compensation, practice 8840 Cypress Waters patterns, recruiting strategies and related trends. Blvd #300 Dallas, Texas 75019 800-876-0500 This white paper examines trends in the recruitment of internal medicine physicians, including current supply and demand projections, compensation in the specialty, the expanding role of internal medicine physicians and Eastern Regional Office: recommendations for recruiting these highly sought-after health professionals. Merritt Hawkins 100 Mansell Ct. E Suite 500 Roswell, Georgia 30076 Internal Medicine: A Definition 800-306-1330 Physicians practicing general internal medicine are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and care of adults from general wellness to the management of complex diseases.
    [Show full text]