Update in Primary Care, Feb 2019- Part 2

Here’s the second half of the Update in Primary Care, presented with Peter Phan at the Southern SGIM meeting in Houston, TX.

I summarized some of this evidence in a recent post on diabetes drugs- check this if you (like me) can’t keep the acronyms straight. This paper was published in JAMA in April.

This was a network meta-analysis designed to compare outcomes of SGLT-2 Inhibitors, GLP-1 Agonists, and DPP-IV Inhibitors. There were A LOT of results here, but the main takaway for me is that SGLT-2 inhibitors and GLP-1 receptor agonists have a mortality benefit in diabetics. The reduced mortality is more pronounced in SGLT-2 Inhibitors, and this class also showed significant reduction of heart failure events.

This video from JAMA provides a great overview of the study.

Switching gears, this paper compared vaginal estradiol and a fancy vaginal gel with placebo estradiol and placebo gel for patients with vulvovaginal atrophy symptoms. All patients got a vaginal tablet and a gel- either active tablet/placebo gel, active gel/placebo tablet, or dual placebo.

Women reported significant symptoms at baseline- including 50% reporting that they frequently felt distressed with sexual functioning.

Most women had improved symptoms, no matter the treatment. But it didn’t matter which treatment they got, so a cheaper OTC lubricant seems just as good as an expensive prescription for topical estradiol.

Finally, a paper about primary care workflow. There is a lot of burnout in medicine, and in primary care. One reason is the clerical burden that doctors have- entering orders, signing forms, and writing notes for billing purposes. Scribes have been proposed as a potential answer to this clerical overload.

This study gave scribes to 18 primary care physicians (IM and Family Med) in the Kaiser Permanente system. All the practices had 3 month alternating blocks of time with a scribe, and time without a scribe. They measured MD satisfaction, patient satisfaction, perceived time working in the EMR outside of work hours, and actual time in the EMR.

During their time with the scribe, MDs were much more likely to report spending <1 hour per day and <1 hour per weekend working in the electronic medical record. Patients felt that doctors were spending more time interacting with them rather than the computer. Objectively, MDs were more likely to get phone and clinic encounters done on time (perhaps important to your C-suite) and spent 77 minutes less time per half day of clinic in documentation. They actually only spent 17 minutes fewer per week logged into the EMR during off hours.

Take homes for Part 2

  • Think about SGLT-2 inhibitors and GLP-1 Inhibitors for your diabetic patients. They seem to have a mortality and cardiovascular benefit over other agents
  • Try OTC topical lubricants first for vulvovaginal atrophy symptoms.
  • Think about scribes in your primary care practice if you are feeling overwhelmed by clerical work.
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