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Schøler PN, Søndergaard J, Rasmussen S, Nielsen AS. Adjusting the 15-method to Danish general practice: identification of barriers, facilitators, and user needs. BMC PRIMARY CARE 2024; 25:248. [PMID: 38971738 DOI: 10.1186/s12875-024-02508-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The 15-method is an opportunistic screening and brief intervention tool for alcohol-related problems in primary healthcare. A Danish feasibility study of the 15-method indicated that adjustments were needed to improve its contextual fit to Danish general practice. This adjustment process was conducted in two parts. The first part focused on identifying barriers, facilitators, and user needs for addressing alcohol using the 15-method. The second part will address the identified barriers and user needs to finalize a Danish version of the method. This study reports on part one of the adjustment process. METHODS Semi-structured individual interviews and focus group interviews with healthcare professionals (n = 8) and patients (n = 5) from general practice in Denmark. Data analysis was conducted using thematic content analysis. The results were condensed into two focus areas that will form the basis for user workshops in part two of the adjustment process. RESULTS The main barriers for addressing alcohol using the 15-method were patients and healthcare professionals not having the same agenda, having difficulty opening a conversation on alcohol, and workflow in the practices. Main facilitators included high interpersonal skills, taking the patient's perspective, and good routines and interdisciplinary work. Suggested adjustments and additions to the method included digitalization, visual icebreakers, quotes and examples, and development of a quick guide. The identified focus areas for user workshops were Communication and Material, and Integration to Workflows. CONCLUSION Healthcare professionals found the opportunistic screening approach exemplified by the 15-method to be beneficial in identifying and addressing alcohol-related problems. They appreciate the method's structured framework that assists in presenting treatment options. Identified adjustment areas to the 15-method will lay the groundwork for future efforts to develop a finalized Danish version of the 15-method.
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Affiliation(s)
- Peter Næsborg Schøler
- Unit for Clinical Alcohol Research, Research Unit of Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice Odense and Esbjerg, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Department of Psychiatry Odense, Mental Health Services Region of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice Odense and Esbjerg, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice Odense and Esbjerg, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Research Unit of Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- BRIDGE, Brain Research - Inter Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
- Department of Psychiatry Odense, Mental Health Services Region of Southern Denmark, Odense, Denmark
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Byhoff E, Rudel R, Taylor LA. Thoughtful Investing in Social Care Management: The Cause of, and Solution to, All of Life's Problems. J Ambul Care Manage 2024; 47:203-211. [PMID: 38771174 DOI: 10.1097/jac.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Elena Byhoff
- Author Affiliations: Division of Health Systems Science, Department of Medicine, Division of Health Information and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts (Dr Byhoff); Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York.; Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Moqueet N, Cornacchi SD, Antony J, Khalil I, Manca D, Fernandes C, Paszat L, Aubrey-Bassler K, Grunfeld E, Sopcak N, Pinto A, Konkin J, Nykiforuk C, Rabeneck L, Selby P, Wall B, O'Brien MA, Lofters A. BETTER LIFE- guidelines for chronic disease preventive care for people aged 18-39 years: a literature review. BMC PRIMARY CARE 2024; 25:224. [PMID: 38909200 PMCID: PMC11193284 DOI: 10.1186/s12875-024-02471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND The original 'BETTER' (Building on Existing Tools To Improve Chronic Disease Prevention and Screening in Primary Care) approach consisted of a prevention-focused visit between participants aged 40-65 years and a "Prevention Practitioner" (PP), who empowered the participant to set achievable prevention and screening goals for cancers and chronic diseases. BETTER was successfully adapted for economically deprived communities (BETTER HEALTH) in Canada. Our objective was to conduct a review of guidelines in preparation for adapting the 'BETTER HEALTH' approach for younger adults aged 18-39 years living with lower income, a group known to have earlier mortality due to a higher prevalence of preventable chronic diseases than their peers with higher income. METHODS We searched multiple electronic databases and grey literature for clinical practice guidelines on prevention/screening and included those that met the following criteria: published in English from 2008-2020 in Canada or any of the following countries (Australia, Ireland, New Zealand, Scotland, United States and England); and addressed prevention or screening. We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and extracted data (publication details, recommendations, and Quality/Level of evidence as reported by authors) from sources with overall scores of 5 or higher. Final recommendations were compiled after harmonization with input from diverse stakeholders (co-investigators, PPs, and the Community Advisory Committee). RESULTS We included a total of 85 guidelines, and developed a final list of 42 recommendations for 18-39 year-olds across 21 topics. Specific recommendations fell under the following topics: cancers, cardiovascular disease, diabetes, obesity, lifestyle (alcohol; healthy nutrition/physical activity); healthy relationships and healthy sexuality, immunization, oral health, social determinants of health, and substance use. CONCLUSION We identified evidence-based guidelines on individual-level prevention/screening actions for adults 18-39 years old and relevant for those living with lower income which will directly inform development and implementation of the BETTER LIFE intervention.
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Affiliation(s)
| | | | - Jesmin Antony
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Ielaf Khalil
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Donna Manca
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lawrence Paszat
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andrew Pinto
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jill Konkin
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Candace Nykiforuk
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Linda Rabeneck
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Becky Wall
- Durham Region Health Department, Whitby, ON, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Aisha Lofters
- Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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Schøler PN, Volke KH, Andréasson S, Rasmussen S, Søndergaard J, Nielsen AS. The identification and treatment of alcohol problems in primary care (iTAPP) study: protocol for a stepped wedge cluster randomized control trial testing the 15-method in a primary care setting. Addict Sci Clin Pract 2024; 19:49. [PMID: 38872214 PMCID: PMC11170864 DOI: 10.1186/s13722-024-00474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The 15-method is a targeted screening and treatment approach for alcohol problems in primary care. The 15-method used in primary care has proven as effective as specialized treatment for mild to moderate alcohol dependence in Sweden. A feasibility study of the 15-method in Danish primary care found the method acceptable and feasible. AIMS To evaluate the effectiveness of the 15-method in a Danish primary care setting in (1) lowering the proportion of patients exceeding the Danish low-risk alcohol consumption limit of ten standard units per week and a maximum of four standard units on a single day for men and women, and (2) increasing the likelihood of alcohol use being addressed during a consultation in general practice. Further, the rate of prescribed pharmacological treatment for alcohol problems (Disulfiram, Naltrexone, Acamprosate, and Nalmefene) will be measured along with the use of the biomarkers Alanine Transaminase and Gamma-Glutamyl Transferase. METHODS Stepped wedge cluster randomized controlled trial in sixteen general practices in the Region of Southern Denmark. Following a three-month baseline, the practices are randomly assigned to launch dates in one of four clusters. General practitioners and nurses receive three hours of training in the 15-method before launch. Patient questionnaires will collect data on alcohol consumption levels among patients affiliated with the practices. The healthcare professionals will register consultations in which alcohol is addressed in their patient filing system. Pharmacological treatment rates and the use of biomarkers will be collected through Danish national registries. The study follows the Medical Research Council's guidelines for developing and evaluating complex interventions. DISCUSSION From the patient's perspective, the 15-method may help identify alcohol-related problems at an earlier stage with flexible treatment offers in a familiar setting. For healthcare professionals, it addresses a traditionally challenging topic by equipping them with concrete tools, communication training, and clear treatment directives. From a societal perspective, primary care holds a unique position to identify hazardous and harmful alcohol use across different age groups, with potential public health and economic benefits through early identification and intervention. TRIAL REGISTRATION Clinicaltrials.gov NCT05916027. Retrospectively registered 22 June 2023.
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Affiliation(s)
- Peter Næsborg Schøler
- The Unit for Clinical Alcohol Research, Department of Clinical Research, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark.
- The Research Unit for General Practice in Odense and Esbjerg, Department of Public Health, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark.
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark.
| | - Kristina Hasselbalch Volke
- The Unit for Clinical Alcohol Research, Department of Clinical Research, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
| | - Sven Andréasson
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sanne Rasmussen
- The Research Unit for General Practice in Odense and Esbjerg, Department of Public Health, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- The Research Unit for General Practice in Odense and Esbjerg, Department of Public Health, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- The Unit for Clinical Alcohol Research, Department of Clinical Research, Faculty of Health Sciences, The University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- Brain Research - Inter-Disciplinary Guided Excellence, BRIDGE, University of Southern Denmark, Odense, Denmark
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Robson B, Deed G, Phoon RK. Improving the Detection and Management of Kidney Health in Primary Care. J Patient Exp 2024; 11:23743735241256464. [PMID: 38882946 PMCID: PMC11179444 DOI: 10.1177/23743735241256464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Chronic kidney disease (CKD) is a major cause of morbidity and mortality, contributing to approximately 20 000 deaths in 2021 in Australia. Importantly, progression of CKD can be substantially reduced if it is detected and treated early. Here we present the perspectives of a general practitioner (primary care physician), a nephrologist and a patient advocate on how the diagnosis and management of CKD in primary care could be improved. Early detection and treatment of CKD are impeded by limited patient awareness and knowledge, communication challenges between patients and doctors, and psychosocial issues, with these factors also interacting with, and exacerbating, each other. We make the following recommendations to help improve outcomes in patients with CKD: (1) identifying people at increased risk of CKD and ensuring they have a complete kidney health check (including estimated glomerular filtration rate, urine albumin-creatinine ratio and a blood pressure check) every 1-2 years; (2) using simple, nonconfrontational language and supportive resources to communicate with patients about kidney health; (3) implementing early treatment to slow the progression of CKD and avoid adverse cardiovascular disease outcomes; and (4) asking patient-orientated questions to support shared decision-making and empower patients to be active partners in their healthcare. We acknowledge that limited time is a major barrier to implementing these recommendations in primary care. Utilizing the expertise of the whole practice team, and adopting supportive technology to introduce efficiencies, are likely to be of benefit. By adopting these recommendations, we believe general practitioners have the opportunity to drive improved outcomes and quality of life for people living with CKD in Australia.
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Affiliation(s)
| | - Gary Deed
- Healthcare Plus Medical Centre, Coorparoo, Queensland, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Richard Ks Phoon
- Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Galán M, Sellarès J, Monteserín R, Vicuña J, Moral I, Brotons C. [Effectiveness of the clinical assistant in the control of hypertensive and diabetic patients in primary care]. Aten Primaria 2024; 56:102853. [PMID: 38244288 PMCID: PMC10831181 DOI: 10.1016/j.aprim.2023.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To evaluate the effectiveness of the incorporation of the clinical assistant in improving the control of type 2 diabetes mellitus and hypertension in a primary care center. DESIGN Quasi-experimental study (pre-post), with a control group, with a 1-year follow-up. SETTING Primary care center. PARTICIPANTS Patients between the ages of 18 and 85 with a diagnosis of diabetes type 2 and/or hypertension were selected. INTERVENTION Incorporation of the figure of the clinical assistant, previously trained. The latter contacted the patient to explain their role and obtain informed consent, assessed compliance with the protocols, and when they were incomplete and/or detected warning signs, referred the patient directly to medicine and/or nursing. RESULTS Three thousand and sixty-four patients participated, 30.74% assigned to the intervention group. Fifty percent were women. The mean age was 68.5 years (SD 11.07). 93.59% of diabetic patients in the intervention group had at least one determination of glycosylated hemoglobin compared to 86.83% in the control group (p=0.003). Fundus and diabetic foot screening was significantly higher in the intervention group (94.31% and 85.41% vs. 83.49% and 72.38%). 88.43% of the patients in the intervention group had registered blood pressure figures compared to 62.06% of the patients in the control group (p<0.05). There were not statistically significant differences in the control of blood pressure between the patients with recorded measures (p=0.478). CONCLUSIONS Clinical assistants can facilitate the implementation and compliance with chronic diseases protocols, and in the long run improve the degree of control of these patients and the quality of care.
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Affiliation(s)
- Marisa Galán
- EAP Sardenya, Barcelona, España; Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària ACEBA, Barcelona, España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España.
| | - Jaume Sellarès
- EAP Sardenya, Barcelona, España; Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària ACEBA, Barcelona, España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España
| | - Rosa Monteserín
- EAP Sardenya, Barcelona, España; Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària ACEBA, Barcelona, España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España
| | - Johanna Vicuña
- Servicio de Epidemiología Clínica y Salud Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Irene Moral
- EAP Sardenya, Barcelona, España; Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària ACEBA, Barcelona, España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España
| | - Carlos Brotons
- EAP Sardenya, Barcelona, España; Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària ACEBA, Barcelona, España; Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, España
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Fernandes C, Campbell-Scherer D, Lofters A, Grunfeld E, Aubrey-Bassler K, Cheung H, Latko K, Tink W, Lewanczuk R, Shea-Budgell M, Heisey R, Wong T, Yang H, Walji S, Wilson M, Holmes E, Lang-Robertson K, DeLonghi C, Manca DP. Harmonization of clinical practice guidelines for primary prevention and screening: actionable recommendations and resources for primary care. BMC PRIMARY CARE 2024; 25:153. [PMID: 38711031 PMCID: PMC11071261 DOI: 10.1186/s12875-024-02388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations. We describe the process used to harmonize high-quality cancer and chronic disease prevention and screening (CCDPS) CPGs to update the BETTER program. METHODS A review of CPG databases, repositories, and grey literature was conducted to identify international and Canadian (national and provincial) CPGs for CCDPS in adults 40-69 years of age across 19 topic areas: cancers, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hepatitis C, obesity, osteoporosis, depression, and associated risk factors (i.e., diet, physical activity, alcohol, cannabis, drug, tobacco, and vaping/e-cigarette use). CPGs published in English between 2016 and 2021, applicable to adults, and containing CCDPS recommendations were included. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and a three-step process involving patients, health policy, content experts, primary care providers, and researchers was used to identify and synthesize recommendations. RESULTS We identified 51 international and Canadian CPGs and 22 guidelines developed by provincial organizations that provided relevant CCDPS recommendations. Clinical recommendations were extracted and reviewed for inclusion using the following criteria: 1) pertinence to primary prevention and screening, 2) relevance to adults ages 40-69, and 3) applicability to diverse primary care settings. Recommendations were synthesized and integrated into the BETTER toolkit alongside resources to support shared decision-making and care paths for the BETTER program. CONCLUSIONS Comprehensive care requires the ability to address a person's overall health. An approach to identify high-quality clinical guidance to comprehensively address CCDPS is described. The process used to synthesize and harmonize implementable clinical recommendations may be useful to others wanting to integrate evidence across broad content areas to provide comprehensive care. The BETTER toolkit provides resources that clearly and succinctly present a breadth of clinical evidence that providers can use to assist with implementing CCDPS guidance in primary care.
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Affiliation(s)
- Carolina Fernandes
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Heidi Cheung
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Katherine Latko
- College of Physicians and Surgeons of Ontario, Toronto, ON, Canada
| | - Wendy Tink
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Richard Lewanczuk
- Alberta Health Services, Alberta, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Ruth Heisey
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
- Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Tracy Wong
- Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada
| | | | - Sakina Walji
- Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | - Margo Wilson
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | | | | | - Donna Patricia Manca
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Steel A, Foley H, Graham K, Harnett J, Adams J. Patient experiences of information-sharing and patient-centred care across the broad landscape of primary care practice and provision: a nationally representative survey of Australian adults. BMC PRIMARY CARE 2024; 25:151. [PMID: 38704562 PMCID: PMC11070095 DOI: 10.1186/s12875-024-02359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Australian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists. METHODS Data about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP's information-sharing behaviour or perceived experience of patient-centredness. RESULTS Across 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study. CONCLUSIONS Public health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended.
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Affiliation(s)
- Amie Steel
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia.
| | - Hope Foley
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
| | - Kim Graham
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
| | - Joanna Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jon Adams
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
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Hoffer EP. Primary Care in the United States: Past, Present and Future. Am J Med 2024:S0002-9343(24)00163-3. [PMID: 38499134 DOI: 10.1016/j.amjmed.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
Even though a well-functioning primary care system is widely acknowledged as critical to population health, the number of primary care physicians (PCPs) practicing in the United States has steadily declined, and PCPs are in short supply. The reasons are multiple and include inadequate income relative to other specialties, excessive administrative demands on PCPs and the lack of respect given to primary care specialties during medical school and residency. Advanced practice nurses can augment the services of primary care physicians but cannot substitute for them. To change this situation, we need action on several fronts. Medical schools should give preference to students who are more likely to enter the primary care specialties. The income gap between primary care and other specialties should be narrowed. The administrative load placed on PCPs, including cumbersome electronic medical records, must be lessened. Insurers, including Medicare and Medicaid, must provide the resources to allow primary care physicians to act as leaders of multidisciplinary teams.
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Balán IC, Marone RO, Barreda V, Naar S, Wang Y. Integration of an Electronic Screening, Brief Intervention, and Referral to Treatment Program Into an HIV Testing Program to Reduce Substance Use and HIV Risk Behavior Among Men Who Have Sex With Men: Protocol for Intervention Development and a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56683. [PMID: 38483463 PMCID: PMC10979339 DOI: 10.2196/56683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionally affected by HIV and drug and alcohol use; however, few effective HIV prevention interventions for MSM who use substances exist. Screening, Brief Intervention, and Referral to Treatment is an early intervention for non-treatment-seeking individuals with problematic substance use and for timely referral to treatment for those with substance use disorders. Electronic screening and brief interventions (e-SBIs) reduce implementation challenges. An e-SBI tailored for MSM at the time of HIV testing might be particularly opportune to strengthen their motivation to reduce substance use and HIV risk behavior. OBJECTIVE This study aims to develop a tailored e-SBI program to reduce substance use and HIV risk behavior among MSM seeking HIV testing at Nexo Asociación Civil, our community partners in Argentina (primary); assess the feasibility and acceptability of integrating the e-SBI into the Nexo HIV testing program (primary); assess the feasibility and acceptability of implementing an adapted Men's Health Project (MHP) at Nexo (secondary); and finally, explore preliminary findings on substance use and sexual risk reduction outcomes (exploratory). METHODS This mixed methods study has 2 stages. During stage 1 (development), we will use the User Centered Rapid App Design process consisting of focus groups (n=16), individual interviews (n=24), and a pilot deployment of the e-SBI (n=50) to iteratively develop the e-SBI. Quantitative and qualitative assessments at each step will inform the revision of the e-SBI. Furthermore, we will use the assessment, decision, administration, production, topic experts, integration, training, testing framework to adapt MHP. During stage 2 (pilot randomized controlled trial [RCT]), we will randomize 200 MSM coming to Nexo for HIV testing. They will complete a baseline assessment and then their assigned intervention (e-SBI vs screening only) and will be followed-up for 6 months. We will also conduct in-depth interviews with up to 45 participants: 15 participants from either study condition who entered or completed MHP or other substance abuse treatment and 15 from each arm who met the criteria for MHP but did not request it. RESULTS The study began recruitment in October 2022, and the stage-1 pilot study is near completion. Preliminary findings from stage 1 show high e-SBI acceptability. Data analysis of the stage-1 pilot is now beginning. The stage-2 pilot RCT will be launched in March 2024, with all data collection completed by May 2025. CONCLUSIONS This study will allow us to assess the acceptability and feasibility of e-SBI implementation during HIV testing encounters. We will also build the necessary research infrastructure for a subsequent RCT to assess the efficacy of e-SBIs in reducing substance use and HIV sexual risk behavior among MSM in this setting. TRIAL REGISTRATION ClinicalTrials.gov NCT05542914; https://tinyurl.com/yyjj64dm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56683.
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Affiliation(s)
- Iván C Balán
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
| | | | | | - Sylvie Naar
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
| | - Yuxia Wang
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
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11
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Osborne MC, Guastaferro K, Banks S, Vedantam H, Self-Brown S. Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare ® providers in the U.S. Front Public Health 2024; 12:1324656. [PMID: 38515599 PMCID: PMC10954817 DOI: 10.3389/fpubh.2024.1324656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Background Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs. Methods Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors. Results Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury. Conclusion SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.
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Affiliation(s)
- Melissa C. Osborne
- Wellstar School of Nursing, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, United States
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Shelden Banks
- Department of Social Work and Human Services, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, United States
| | - Hari Vedantam
- Department of Psychological Science, Norman J. Radow College of Humanities and Social Sciences, Kennesaw State University, Kennesaw, GA, United States
| | - Shannon Self-Brown
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
- National SafeCare Training and Research Center, Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, United States
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12
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Beatty JR, Zelenak L, Gillon S, McGoron L, Goyert G, Ondersma SJ. Risk Identification in Perinatal Health Care Settings via Technology-Based Recruitment Methods: Comparative Study. JMIR Form Res 2024; 8:e48823. [PMID: 38437004 PMCID: PMC10949130 DOI: 10.2196/48823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Digital screening and intervention tools have shown promise in the identification and reduction of substance use in health care settings. However, research in this area is impeded by challenges in integrating recruitment efforts into ongoing clinical workflows or staffing multiple study clinics with full-time research assistants, as well as by the underreporting of substance use. OBJECTIVE The aim of the study is to evaluate pragmatic methods for facilitating study recruitment in health care settings by examining recruitment rates and participant characteristics using in-person-based versus flyer approaches. METHODS This study compared recruitment rates at a Women's Health clinic in the Midwest under 2 different recruitment strategies: in person versus via a flyer with a QR code. We also examined the disclosure of substance use and risk screener positivity for the 2 strategies. We also obtained information about the current use of technology and willingness to use it for study participation. RESULTS A greater percentage of patients recruited in person participated than those recruited via flyers (57/63, 91% vs 64/377, 17%). However, the final number recruited in each group was roughly equal (n=57 vs n=64). Additionally, participants recruited via flyers were more likely to screen positive for alcohol use risk on the Tolerance, Annoyed, Cut Down, Eye-Opener alcohol screen than those recruited at the clinic (24/64, 38% vs 11/57, 19%; χ21=4.9; P=.03). Participants recruited via flyers were also more likely to screen positive for drug use risk on the Wayne Indirect Drug Use Screener than those recruited at the clinic (20/64, 31% vs 9/57, 16%; χ21=4.0; P=.05). Furthermore, of the 121 pregnant women, 117 (96.7%) reported owning a smartphone, 111 (91.7%) had an SMS text message plan on their phone, and 94 (77.7%) reported being willing to receive SMS text messages or participate in a study if sent a link to their phone. CONCLUSIONS The distribution of flyers with a QR code by medical staff appears to be an efficient and cost-effective method of recruitment that also facilitates disclosure while reducing the impact on clinic workflows. This method of recruitment can be useful for data collection at multiple locations and lead to larger samples across and between health systems. Participant recruitment via technology in perinatal health care appears to facilitate disclosure, particularly when participants can learn about the research and complete screening using their own device at a place and time convenient for them. Pregnant women in an urban Midwestern hospital had access to and were comfortable using technology.
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Affiliation(s)
- Jessica R Beatty
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Logan Zelenak
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Spencer Gillon
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Lucy McGoron
- Merrill Palmer Skillman Institute for Child & Family Development, Wayne State University, Detroit, MI, United States
| | - Gregory Goyert
- Maternal Fetal Medicine, Women's Health Services, Henry Ford Health, Detroit, MI, United States
| | - Steven J Ondersma
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
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13
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Barqawi HJ, Samara KA, Haddad ES, Bakkour LM, Amawi FB. Attitudes and practices to adult vaccination among physicians before and after COVID-19 pandemic in the United Arab Emirates. Vaccine X 2024; 17:100455. [PMID: 38356876 PMCID: PMC10865396 DOI: 10.1016/j.jvacx.2024.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/15/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Vaccination remains underutilised worldwide with low vaccine uptake rates across the board with many adults remaining unprotected. Across the Arab world, attitudes towards vaccines vary but high rates of vaccine hesitancy have been found. This study aims to explore the adult vaccination attitudes and practices by physicians in the UAE, both before and after the introduction of the COVID-19 vaccines. Methodology This cross-sectional, descriptive study used convenience and snowball sampling to collect comprehensive data from UAE physicians. A self-administered questionnaire was distributed in two stages: the first (pre-COVID-19 vaccines) between the months of June and October 2020 and the second between the months of November 2022 and March 2023. Results 1000 responses, 500 from each time period, were collected. Nearly a third were family physicians or internists with more than 70% of the physicians working in governmental hospitals. 95% agreed that vaccines are safe in both cohorts but 74.4% reported not having enough time to advise about vaccines. 80.8% of physicians in the 2022 cohort reported safety concerns as the most common reason for patients to refuse vaccines. The most recommended vaccines were influenza (68.6%), Hepatitis B (66.0%) and HPV (61.4%), with pneumococcal coming in close at 57.8%. Family medicine physicians showed the highest utilisation of preventive practices across both cohorts. Nearly half of all family medicine physicians did not regularly evaluate both the influenza and general immunisation status of their patients. 54.6% of physicians reported having patients with VPDs in the last five years (not including COVID-19) in 2022. Conclusion Physicians have overly positive attitudes, but their practices reflect a more superficial appreciation of vaccines and lack of initiative. Physicians need to adopt a pro-vaccine stance, armed with the proper tools and the right mentality and beliefs.
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Affiliation(s)
- Hiba J. Barqawi
- Department of Clinical Sciences, College of Medicine, University of Sharjah, United Arab Emirates
| | - Kamel A. Samara
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Enad S. Haddad
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Layane M. Bakkour
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Firas B. Amawi
- Dr. Sulaiman Al Habib Hospital, Dubai, United Arab Emirates
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Li H, Rotenstein L, Jeffery MM, Paek H, Nath B, Williams BL, McLean RM, Goldstein R, Nuckols TK, Hoq L, Melnick ER. Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine. J Gen Intern Med 2024; 39:557-565. [PMID: 37843702 DOI: 10.1007/s11606-023-08428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The gender gap in physician compensation has persisted for decades. Little is known about how differences in use of the electronic health record (EHR) may contribute. OBJECTIVE To characterize how time on clinical activities, time on the EHR, and clinical productivity vary by physician gender and to identify factors associated with physician productivity. DESIGN, SETTING, AND PARTICIPANTS This longitudinal study included general internal medicine physicians employed by a large ambulatory practice network in the Northeastern United States from August 2018 to June 2021. MAIN MEASURES Monthly data on physician work relative value units (wRVUs), physician and practice characteristics, metrics of EHR use and note content, and temporal trend variables. KEY RESULTS The analysis included 3227 physician-months of data for 108 physicians (44% women). Compared with men physicians, women physicians generated 23.8% fewer wRVUs per month, completed 22.1% fewer visits per month, spent 4.0 more minutes/visit and 8.72 more minutes on the EHR per hour worked (all p < 0.001), and typed or dictated 36.4% more note characters per note (p = 0.006). With multivariable adjustment for physician age, practice characteristics, EHR use, and temporal trends, physician gender was no longer associated with productivity (men 4.20 vs. women 3.88 wRVUs/hour, p = 0.31). Typing/dictating fewer characters per note, relying on greater teamwork to manage orders, and spending less time on documentation were associated with higher wRVUs/hour. The 2021 E/M code change was associated with higher wRVUs/hour for all physicians: 10% higher for men physicians and 18% higher for women physicians (p < 0.001 and p = 0.009, respectively). CONCLUSIONS Increased team support, briefer documentation, and the 2021 E/M code change were associated with higher physician productivity. The E/M code change may have preferentially benefited women physicians by incentivizing time-intensive activities such as medical decision-making, preventive care discussion, and patient counseling that women physicians have historically spent more time performing.
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Affiliation(s)
- Huan Li
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
- Computational Biology and Bioinformatics, Yale School of Medicine, New Haven, CT, USA
| | - Lisa Rotenstein
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Molly M Jeffery
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
| | - Hyung Paek
- Information Technology Services, Yale New Haven Health System, New Haven, CT, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Robert M McLean
- Northeast Medical Group, Stratford, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Teryl K Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lalima Hoq
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward R Melnick
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT, USA.
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Satterwhite S, Nguyen MLT, Honcharov V, McDermott AM, Sarkar U. "Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety. J Gen Intern Med 2024:10.1007/s11606-024-08658-1. [PMID: 38360962 DOI: 10.1007/s11606-024-08658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. OBJECTIVE To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. DESIGN Qualitative study based on semi-structured interviews. PARTICIPANTS Twenty-five primary care physicians practicing in the USA. APPROACH Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. KEY RESULTS Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. CONCLUSIONS Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.
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Affiliation(s)
- Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, CA, USA
| | - Michelle-Linh T Nguyen
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Vlad Honcharov
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Aoife M McDermott
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
- UCSF Pride Hall, San Francisco, CA, USA.
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Verbunt EJ, Newman G, Creagh NS, Milley KM, Emery JD, Kelaher MA, Rankin NM, Nightingale CE. Primary care practice-based interventions and their effect on participation in population-based cancer screening programs: a systematic narrative review. Prim Health Care Res Dev 2024; 25:e12. [PMID: 38345096 PMCID: PMC10894721 DOI: 10.1017/s1463423623000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
AIM To provide a systematic synthesis of primary care practice-based interventions and their effect on participation in population-based cancer screening programs. BACKGROUND Globally, population-based cancer screening programs (bowel, breast, and cervical) have sub-optimal participation rates. Primary healthcare workers (PHCWs) have an important role in facilitating a patient's decision to screen; however, barriers exist to their engagement. It remains unclear how to best optimize the role of PHCWs to increase screening participation. METHODS A comprehensive search was conducted from January 2010 until November 2023 in the following databases: Medline (OVID), EMBASE, and CINAHL. Data extraction, quality assessment, and synthesis were conducted. Studies were separated by whether they assessed the effect of a single-component or multi-component intervention and study type. FINDINGS Forty-nine studies were identified, of which 36 originated from the USA. Fifteen studies were investigations of single-component interventions, and 34 studies were of multi-component interventions. Interventions with a positive effect on screening participation were predominantly multi-component, and most included combinations of audit and feedback, provider reminders, practice-facilitated assessment and improvement, and patient education across all screening programs. Regarding bowel screening, provision of screening kits at point-of-care was an effective strategy to increase participation. Taking a 'whole-of-practice approach' and identifying a 'practice champion' were found to be contextual factors of effective interventions.The findings suggest that complex interventions comprised of practitioner-focused and patient-focused components are required to increase cancer screening participation in primary care settings. This study provides novel understanding as to what components and contextual factors should be included in primary care practice-based interventions.
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Affiliation(s)
- Ebony J Verbunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Grace Newman
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicola S Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kristi M Milley
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Jon D Emery
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Margaret A Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claire E Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Pautrat M, Barbier E, Lebeau JP. Identifying available substance use disorder screening tests feasible for use in primary care: A systematic review. Prev Med Rep 2024; 38:102610. [PMID: 38375183 PMCID: PMC10874871 DOI: 10.1016/j.pmedr.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Substance use disorders substantially contribute to the global burden of disease. Early detection in primary care is recommended, and numerous screening tests are available. However, barriers to addictive disorder screening exist and the feasibility of using these tests in primary care is unclear. This study aims to identify available addictive disorder screening tests whose feasibility has been evaluated in primary care. This systematic literature review was performed using Pubmed, PsycINFO, and the Cochrane Library databases. The search strategy included four research topics: addictive disorders, screening, primary care, and feasibility. Selection criteria included published studies evaluating the feasibility of an addictive disorder screening test in primary care. Data were extracted for each included article, and each analyzed screening test. Of the 4911 articles selected, 20 were included and 16 screening tests were studied. Physician feasibility was evaluated with satisfaction questionnaires or qualitative studies, mainly measuring test administration time. Patient feasibility was measured using criteria including "ease of use", comprehension, or format preference. Self-administered formats were preferred, especially electronic versions. Overall, the TAPS (Tobacco, Alcohol, Prescription medication, and other Substance use) tool provides a good balance between ease of use, brevity of administration and more extensive screening for substance use disorders. Feasibility appears to be a set of heterogeneous criteria relating to users, including comprehension or satisfaction, and practical aspects, including administration time or format preference. The criteria synthesized in this review could serve as a basis for screening test feasibility studies in primary care given the absence of feasibility study guidelines.
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Affiliation(s)
- Maxime Pautrat
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
| | | | - Jean Pierre Lebeau
- Department of General Practice, University of Tours, France
- University of Tours, EA7505 Education Ethique Santé, France
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Howe L, Husband A, Robinson‐Barella A. Prescribing pre- and post-operative physical activity interventions for people undergoing breast cancer surgery: A qualitative systematic review. Cancer Med 2024; 13:e7063. [PMID: 38457236 PMCID: PMC10923032 DOI: 10.1002/cam4.7063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/26/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Undertaking physical activity, pre- and post-operatively, can benefit recovery time and improve post-surgical outcomes. One cohort of patients that have reported these benefits are those undergoing surgery for breast cancer. Yet, what remains unclear is the level to which physical activity interventions are implemented into standard surgical care for patients with breast cancer. AIMS This systematic review aimed to examine existing qualitative evidence focusing on pre- and post-operative physical activity interventions to better understand the benefits and shortcomings of physical activity within the surgical journey. METHODS A systematic literature search was undertaken in November 2022, across five databases: MEDLINE, PsycINFO, Embase, CINAHL, and Scopus. Qualitative studies involving people with breast cancer who had undertaken a physical activity intervention, either pre- and/or post-operatively, were included for analysis. The review was registered on PROSPERO: CRD42022372466 and performed according to PRISMA guidelines. The Critical Appraisal Skills Programme qualitative study checklist was used to assess study quality. RESULTS Fourteen studies were included, comprising the perspectives of 418 people receiving surgery for breast cancer. One study implemented preoperative physical activity interventions; the remaining studies focused on post-operative interventions. A narrative systematic review was undertaken due to heterogeneity in reported results. Four themes were developed by thematic analysis, centring on: (1) factors promoting engagement with physical activity interventions; (2) factors preventing engagement with physical activity interventions; (3) the impact of pre- and post-operative interventions on physical and psychological health; and (4) participant recommendations for pre- and post-operative interventions. CONCLUSION Pre- and post-operative physical activity interventions were well-accepted. Patients recognised factors which promoted or prevented engagement with interventions, as well as pre- and post-operative physical and psychological benefits that arose as a result. Evidence based co-design studies may further inform successful implementation of prescribed physical activity into standard care for surgical breast cancer patients.
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Affiliation(s)
- Lauren Howe
- School of Pharmacy, King George VI BuildingNewcastle UniversityNewcastle upon TyneUK
| | - Andy Husband
- School of Pharmacy, King George VI BuildingNewcastle UniversityNewcastle upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Anna Robinson‐Barella
- School of Pharmacy, King George VI BuildingNewcastle UniversityNewcastle upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
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Smith SL, Francis HW, Witsell DL, Dubno JR, Dolor RJ, Bettger JP, Silberberg M, Pieper CF, Schulz KA, Majumder P, Walker AR, Eifert V, West JS, Singh A, Tucci DL. A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement. Ear Hear 2024; 45:23-34. [PMID: 37599396 PMCID: PMC10841210 DOI: 10.1097/aud.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVES The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no). DESIGN We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider. RESULTS All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups. CONCLUSIONS The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.
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Affiliation(s)
- Sherri L. Smith
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Howard W. Francis
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - David L. Witsell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Judy R. Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rowena J. Dolor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Mina Silberberg
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
| | - Carl F. Pieper
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Kristine A. Schulz
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | | | - Amy R. Walker
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Victoria Eifert
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Jessica S. West
- Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | | | - Debara L. Tucci
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD
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20
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Liss DT, Cooper AJ, Cherupally M, Brown T, Pearson MG. Association of primary care visit length with outpatient utilization, continuity, and care processes. Fam Pract 2023:cmad116. [PMID: 38124495 DOI: 10.1093/fampra/cmad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Little is known about how variation in the scheduled length of primary care visits can impact patients' patterns of health care utilization. OBJECTIVE To evaluate how the scheduled length of in-person visits with primary care physicians (PCPs) was associated with PCP and patient characteristics, outpatient utilization, and preventive care receipt. METHODS This retrospective cohort study examined data from a large American academic health system. PCP visit length template was defined as either 15- and 30-min scheduled appointments (i.e. 15/30), or 20- and 40-min scheduled appointments (i.e. 20/40). RESULTS Of 222 included PCPs, 85 (38.3%) used the 15/30 template and 137 (61.7%) used the 20/40 template. The 15/30 group had higher proportions of male (49.4%, vs. 35.8% in the 20/40 group) and family medicine (37.6% vs. 21.2%) physicians. In adjusted patient-level analysis (N = 238,806), having a 15/30 PCP was associated with 9% more primary care visits (incidence rate ratio [IRR], 1.09; 95% confidence interval [CI], 1.03-1.14), and 8% fewer specialty care visits (IRR, 0.92; 95% CI, 0.86-0.98). PCP visit length template was not associated with significant differences in obstetrics/gynaecology visits, continuity of care, or preventive care receipt. In interaction analyses, having a 15/30 PCP was associated with additional primary care visits among non-Hispanic White patients (IRR, 1.10; 95% CI, 1.04-1.16) but not among non-Hispanic Black patients. CONCLUSION PCPs' choices about the scheduled length of in-person visits may impact their patients' specialty care use, and have varying impacts across different racial/ethnic groups.
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Affiliation(s)
- David T Liss
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew J Cooper
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Manisha Cherupally
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tiffany Brown
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Marilyn G Pearson
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Internal Medicine, Northwestern Medicine, Chicago, IL, United States
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21
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Verdonck C, Van Daele E, Willems R, Borgermans L, Boeckxstaens P. Underlying motivations hampering Flemish primary care physicians from overcoming the barriers in osteoporosis care: an EMR-facilitated clinical reasoning study. BMC Health Serv Res 2023; 23:1428. [PMID: 38104093 PMCID: PMC10725585 DOI: 10.1186/s12913-023-10441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Over half of the European population aged minimum 65 years presents with at least two chronic diseases. Attention towards these diseases exhibits disparities, with limited primary care physician (PCP) attention for osteoporosis. This was confirmed in a previous integrated osteoporosis care (IOC) project in which notable difficulties to enlist PCPs arose. Consequently, this study was initiated in Flemish PCPs for in-depth analysis of underlying mechanisms hampering PCPs to fully commit to osteoporosis care. METHODS A qualitative Electronic Medical Record (EMR)-facilitated clinical reasoning study was conducted. A semi-structured interview guide was employed to guide PCPs from reflections on their own patients to broader views regarding osteoporosis care. An inductive thematic analysis was performed using NVivo 12. RESULTS Thirteen PCPs were interviewed. They stated that osteoporosis patients often had complex (medical) profiles. PCPs emphasised the ongoing necessity for prioritisation within this context. This leads to a competition for PCP attention during consultations at three levels: i. between acute versus preventive care; ii. between primary fracture prevention and other preventive services and iii. between secondary fracture prevention and other preventive services; spanning eight areas of competition: disease significance, perceived impact, PCP awareness, the patient agenda, PCP competence, PCP support, perceived patient burden, and efficiency of care provision. Applicability of these areas of competition differed between levels. CONCLUSION The intricate context in which PCPs operate, creates a competition for PCP attention leading to a lack of attention for fracture prevention. To preserve efforts in fracture prevention, areas of competition should be systematically addressed. TRIAL REGISTRATION Approval for the study has been provided by the Ghent University Hospital Ethics Committee (BC-09797).
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Affiliation(s)
- Caroline Verdonck
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium.
| | - Ellis Van Daele
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
| | - Liesbeth Borgermans
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
| | - Pauline Boeckxstaens
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10 - Entrance 42 - 4thFloor, 9000, Ghent, Belgium
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22
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Brenner AT, Waters AR, Wangen M, Rohweder C, Odebunmi O, Marciniak MW, Ferrari RM, Wheeler SB, Shah PD. Patient preferences for the design of a pharmacy-based colorectal cancer screening program. Cancer Causes Control 2023; 34:99-112. [PMID: 37072526 PMCID: PMC10113122 DOI: 10.1007/s10552-023-01687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To assess preferences for design of a pharmacy-based colorectal cancer (CRC) screening program (PharmFIT™) among screening-eligible adults in the United States (US) and explore the impact of rurality on pharmacy use patterns (e.g., pharmacy type, prescription pick-up preference, service quality rating). METHODS We conducted a national online survey of non-institutionalized US adults through panels managed by Qualtrics, a survey research company. A total of 1,045 adults (response rate 62%) completed the survey between March and April 2021. Sampling quotas matched respondents to the 2010 US Census and oversampled rural residents. We assessed pharmacy use patterns by rurality and design preferences for learning about PharmFIT™; receiving a FIT kit from a pharmacy; and completing and returning the FIT kit. RESULTS Pharmacy use patterns varied, with some notable differences across rurality. Rural respondents used local, independently owned pharmacies more than non-rural respondents (20.4%, 6.3%, p < 0.001) and rated pharmacy service quality higher than non-rural respondents. Non-rural respondents preferred digital communication to learn about PharmFIT™ (36% vs 47%; p < 0.001) as well as digital FIT counseling (41% vs 49%; p = 0.02) more frequently than rural participants. Preferences for receiving and returning FITs were associated with pharmacy use patterns: respondents who pick up prescriptions in-person preferred to get their FIT (OR 7.7; 5.3-11.2) and return it in-person at the pharmacy (OR 1.7; 1.1-2.4). CONCLUSION Pharmacies are highly accessible and could be useful for expanding access to CRC screening services. Local context and pharmacy use patterns should be considered in the design and implementation of PharmFIT™.
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Affiliation(s)
- Alison T Brenner
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Austin R Waters
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olufeyisayo Odebunmi
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Macary Weck Marciniak
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Parth D Shah
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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23
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Hepner KA, Sousa JL, Roth CP, Huilgol SS, Jean C, Schulson LB, Gandhi P, Malika N, Engel CC. Improving Pain Care for Service Members: Administrator, Provider, and Patient Perspectives on Treatment, Policies, and Opportunities for Change. RAND HEALTH QUARTERLY 2023; 11:3. [PMID: 38264313 PMCID: PMC10732241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Acute and chronic pain are common among service members, with musculoskeletal pain and injuries being the leading cause of nondeployability among active-duty service members. Given the significant implications for individual health and force readiness, providing high-quality pain care to service members is a priority of the Military Health System (MHS). Prior RAND research used administrative data to assess the quality and safety of pain care and opioid prescribing in the MHS, generated a set of quality measures that the MHS could adopt going forward, and identified strengths and opportunities for improvement in care provided to service members with pain conditions. In this study, authors document findings from interviews with MHS administrators, providers, and patients, providing valuable detail and context for those findings, along with on-the-ground perspectives on MHS pain care policies and guidance in practice. Staff and patients recommended prioritizing increases in treatment access and availability to improve pain care, and patients emphasized effective treatment and patient-centered care as the most important facilitators of high-quality pain care.
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24
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Saini SD, Lewis CL, Kerr EA, Zikmund-Fisher BJ, Hawley ST, Forman JH, Zauber AG, Lansdorp-Vogelaar I, van Hees F, Saffar D, Myers A, Gauntlett LE, Lipson R, Kim HM, Vijan S. Personalized Multilevel Intervention for Improving Appropriate Use of Colorectal Cancer Screening in Older Adults: A Cluster Randomized Clinical Trial. JAMA Intern Med 2023; 183:1334-1342. [PMID: 37902744 PMCID: PMC10616770 DOI: 10.1001/jamainternmed.2023.5656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023]
Abstract
Importance Despite guideline recommendations, clinicians do not systematically use prior screening or health history to guide colorectal cancer (CRC) screening decisions in older adults. Objective To evaluate the effect of a personalized multilevel intervention on screening orders in older adults due for average-risk CRC screening. Design, Setting, and Participants Interventional 2-group parallel unmasked cluster randomized clinical trial conducted from November 2015 to February 2019 at 2 US Department of Veterans Affairs (VA) facilities: 1 academic VA medical center and 1 of its connected outpatient clinics. Randomization at the primary care physician/clinician (PCP) level, stratified by study site and clinical full-time equivalency. Participants were 431 average-risk, screen-due US veterans aged 70 to 75 years attending a primary care visit. Data analysis was performed from August 2018 to August 2023. Intervention The intervention group received a multilevel intervention including a decision-aid booklet with detailed information on screening benefits and harms, personalized for each participant based on age, sex, prior screening, and comorbidity. The control group received a multilevel intervention including a screening informational booklet. All participants received PCP education and system-level modifications to support personalized screening. Main Outcomes and Measures The primary outcome was whether screening was ordered within 2 weeks of clinic visit. Secondary outcomes were concordance between screening orders and screening benefit and screening utilization within 6 months. Results A total of 436 patients were consented, and 431 were analyzed across 67 PCPs. Patients had a mean (SD) age of 71.5 (1.7) years; 424 were male (98.4%); 374 were White (86.8%); 89 were college graduates (21.5%); and 351 (81.4%) had undergone prior screening. A total of 258 (59.9%) were randomized to intervention, and 173 (40.1%) to control. Screening orders were placed for 162 of 258 intervention patients (62.8%) vs 114 of 173 control patients (65.9%) (adjusted difference, -4.0 percentage points [pp]; 95% CI, -15.4 to 7.4 pp). In a prespecified interaction analysis, the proportion receiving orders was lower in the intervention group than in the control group for those in the lowest benefit quartile (59.4% vs 71.1%). In contrast, the proportion receiving orders was higher in the intervention group than in the control group for those in the highest benefit quartile (67.6% vs 52.2%) (interaction P = .049). Fewer intervention patients (106 of 256 [41.4%]) utilized screening overall at 6 months than controls (96 of 173 [55.9%]) (adjusted difference, -13.4 pp; 95% CI, -25.3 to -1.6 pp). Conclusions and Relevance In this cluster randomized clinical trial, patients who were presented with personalized information about screening benefits and harms in the context of a multilevel intervention were more likely to receive screening orders concordant with benefit and were less likely to utilize screening. Trial Registration ClinicalTrials.gov Identifier: NCT02027545.
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Affiliation(s)
- Sameer D. Saini
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Eve A. Kerr
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Brian J. Zikmund-Fisher
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Sarah T. Hawley
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Jane H. Forman
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Darcy Saffar
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Aimee Myers
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Lauren E. Gauntlett
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Rachel Lipson
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - H. Myra Kim
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor
| | - Sandeep Vijan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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25
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Le A, Rohweder C, Wheeler SB, Lafata JE, Teal R, Giannone K, Zaffino M, Smith JS. Self-Collection for Primary HPV Testing: Perspectives on Implementation From Federally Qualified Health Centers. Prev Chronic Dis 2023; 20:E93. [PMID: 37857461 PMCID: PMC10599328 DOI: 10.5888/pcd20.230056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Primary testing for high-risk human papillomavirus (HPV) by self-collection could result in higher rates of cervical cancer screening. Federally qualified health centers (FQHCs) in the US serve a large proportion of women who have low income and no health insurance and are medically underserved - risk factors for being insufficiently screened for cervical cancer. Although the implementation of self-collection for HPV testing is not yet widespread, health care entities need to prepare for its eventual approval by the US Food and Drug Administration. We conducted focus groups and interviews among clinical and administrative staff and leadership to gather data on key logistical concerns that must be addressed before implementing self-collection for HPV testing in FQHCs. METHODS We identified focus group and interview participants from 6 FQHCs in North Carolina. We conducted focus groups with clinical and administrative staff (N = 45) and semistructured interviews with chief executive officers, senior-level administrators, chief medical officers, and clinical data managers (N = 24). Transcripts were coded by using codebooks derived from research questions and notes taken during data collection. Themes emerged on implementation of self-collection for HPV testing. We applied the constructs from the Consolidated Framework for Implementation Research (CFIR) to themes to identify domains of potential barriers and facilitators to implementation. RESULTS Clinical personnel reported that offering self-collection for HPV testing is acceptable and feasible and can increase cervical cancer screening rates. Uncertainties emerged about accuracy of results, workflow disruptions, financial implications, and effects on clinic quality measures. CONCLUSION Implementing self-collection for HPV testing was considered feasible and acceptable by participants. However, important health service delivery considerations, including financial implications, must be addressed before integrating self-collection for HPV testing into the standard of care.
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Affiliation(s)
- Amanda Le
- Department of Public Health Leadership, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Connected Health Applications and Interventions, University of North Carolina at Chapel Hill
| | - Kara Giannone
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Connected Health Applications and Interventions, University of North Carolina at Chapel Hill
| | | | - Jennifer S Smith
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill, 2103 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435
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26
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Boston D, Larson AE, Sheppler CR, O'Connor PJ, Sperl-Hillen JM, Hauschildt J, Gold R. Does Clinical Decision Support Increase Appropriate Medication Prescribing for Cardiovascular Risk Reduction? J Am Board Fam Med 2023; 36:777-788. [PMID: 37704387 PMCID: PMC10680997 DOI: 10.3122/jabfm.2022.220391r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/30/2023] [Accepted: 05/25/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE To assess the impact of a clinical decision support (CDS) system's recommendations on prescribing patterns targeting cardiovascular disease (CVD) when the recommendations are prioritized in order from greatest to least benefit toward overall CVD risk reduction. METHODS Secondary analysis of trial data from September 20, 2018, to March 15, 2020, where 70 community health center clinics were cluster-randomized to the CDS intervention (42 clinics; 8 organizations) or control group (28 clinics; 7 organizations). Included patients were medication-naïve and aged 40 to 75 years with ≥1 uncontrolled cardiovascular disease risk factor, with known diabetes or cardiovascular disease, or ≥10% 10-year reversible CVD risk. RESULTS Among eligible encounters with 29,771 patients, the probability of prescribing a medication targeting hypertension was greater at intervention clinic encounters when CDS was used (34.9% [95% CI, 31.5 to 38.3]) versus dismissed (29.6% [95% CI, 26.7 to 32.6]; P < .001), but not when compared with control clinic encounters (34.9% [95% CI, 31.1 to 38.7]; P = .998). Prescribing for dyslipidemia was significantly higher at intervention encounters where the CDS system was used (11.3% [95% CI, 9.3 to 13.3]) compared with dismissed (7.7% [95% CI, 6.1 to 9.3]; P = .003) and to control encounters (8.7% [95% CI, 7.0 to 10.4]; P = .044); smoking cessation medication showed a similar pattern. Except for dyslipidemia, prescribing rates increased according to their prioritization. CONCLUSIONS Use of this CDS system was associated with significantly higher prescribing targeting most cardiovascular risk factors. These results highlight how displaying prioritized actions to reduce reversible CVD risk could improve risk management. TRIAL REGISTRATION ClinicalTrials.gov, NCT03001713, https://clinicaltrials.gov/.
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Affiliation(s)
- David Boston
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH).
| | - Annie E Larson
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Christina R Sheppler
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Patrick J O'Connor
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - JoAnn M Sperl-Hillen
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Jennifer Hauschildt
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
| | - Rachel Gold
- From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH)
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Carris NW, Bunnell BE, Mhaskar R, DuCoin CG, Stern M. A Systematic Approach to Treating Early Metabolic Disease and Prediabetes. Diabetes Ther 2023; 14:1595-1607. [PMID: 37543535 PMCID: PMC10499776 DOI: 10.1007/s13300-023-01455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 08/07/2023] Open
Abstract
At least 70% of US adults have metabolic disease. However, less is done to address early disease (e.g., overweight, obesity, prediabetes) versus advanced disease (e.g., type 2 diabetes mellitus, coronary artery disease). Given the burden of advanced metabolic disease and the burgeoning pandemics of obesity and prediabetes a systematic response is required. To accomplish this, we offer several recommendations: (A) Patients with overweight, obesity, and/or prediabetes must be consistently diagnosed with these conditions in medical records to enable population health initiatives. (B) Patients with early metabolic disease should be offered in-person or virtual lifestyle interventions commensurate with the findings of the Diabetes Prevention Program. (C) Patients unable to participate in or otherwise failing lifestyle intervention must be screened to assess if they require pharmacotherapy. (D) Patients not indicated for, refusing, or failing pharmacotherapy must be screened to assess if they need bariatric surgery. (E) Regardless of treatment approach or lack of treatment, patients must be consistently screened for the progression of early metabolic disease to advanced disease to enable early control. Progression of metabolic disease from an overweight yet otherwise healthy person includes the development of prediabetes, obesity ± prediabetes, dyslipidemia, hypertension, type 2 diabetes, chronic kidney disease, coronary artery disease, and heart failure. Systematic approaches in health systems must be deployed with clear protocols and supported by streamlined technologies to manage their population's metabolic health from early through advanced metabolic disease. Additional research is needed to identify and validate optimal system-level interventions. Future research needs to identify strategies to roll out systematic interventions for the treatment of early metabolic disease and to improve the metabolic health among the progressively younger patients being impacted by obesity and diabetes.
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Affiliation(s)
- Nicholas W Carris
- Department of Pharmacotherapeutics and Clinical Research, Taneja College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd MDC 30, Tampa, FL, 33612, USA.
| | - Brian E Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Christopher G DuCoin
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Marilyn Stern
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Manca DP, Fernandes C, Lofters A, Aubrey-Bassler K, Shea-Budgell M, Campbell-Scherer D, Sopcak N, Meaney C, Moineddin R, McBrien K, Krueger P, Wong T, Grunfeld E. Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic. BMC PRIMARY CARE 2023; 24:200. [PMID: 37770854 PMCID: PMC10537846 DOI: 10.1186/s12875-023-02159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Cancer and chronic diseases are a major cost to the healthcare system and multidisciplinary models with access to prevention and screening resources have demonstrated improvements in chronic disease management and prevention. Research demonstrated that a trained Prevention Practitioner (PP) in multidisciplinary team settings can improve achievement of patient level prevention and screening actions seven months after the intervention. METHODS We tested the effectiveness of the PP intervention in a pragmatic two-arm cluster randomized controlled trial. Patients aged 40-65 were randomized at the physician level to an intervention group or to a wait-list control group. The intervention consisted of a patient visit with a PP. The PP received training in prevention and screening and use of the BETTER WISE tool kit. The effectiveness of the intervention was assessed using a composite outcome of the proportion of the eligible prevention and screening actions achieved between intervention and control groups at 12-months. RESULTS Fifty-nine physicians were recruited in Alberta, Ontario, and Newfoundland and Labrador. Of the 1,005 patients enrolled, 733 (72.9%) completed the 12-month analysis. The COVID-19 pandemic occurred during the study time frame at which time nonessential prevention and screening services were not available and in-person visits with the PP were not allowed. Many patients and sites did not receive the intervention as planned. The mean composite score was not significantly higher in patients receiving the PP intervention as compared to the control group. To understand the impact of COVID on the project, we also considered a subset of patients who had received the intervention and who attended the 12-month follow-up visit before COVID-19. This assessment demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies. CONCLUSIONS We did not observe an improvement in cancer and chronic disease prevention and screening (CCDPS) outcomes at 12 months after a BETTER WISE prevention visit: due to the COVID-19 pandemic, the study was not implemented as planned. Though benefits were described in those who received the intervention before COVID-19, the sample size was too small to make conclusions. This study may be a harbinger of a substantial decrease and delay in CCDPS activities under COVID restrictions. TRIAL REGISTRATION ISRCTN21333761. Registered on 19/12/2016. http://www.isrctn.com/ISRCTN21333761 .
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Affiliation(s)
- Donna Patricia Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
- Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, AB, T6L 5X8, Canada.
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada
| | - Melissa Shea-Budgell
- Charbonneau Cancer Institute and Department of Oncology, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Paul Krueger
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Tracy Wong
- Patient Advisor, Alberta Health Services, Strategic Clinical Networks, Calgary, AB, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, ON, M5G 0A3, Canada
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Zhang C, Mathur AK. Breaking Barriers and Bridging Gaps: Advancing Diversity, Equity, and Inclusion in Kidney Transplant Care for Black and Hispanic Patients in the United States. Transpl Int 2023; 36:11455. [PMID: 37829616 PMCID: PMC10565005 DOI: 10.3389/ti.2023.11455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
Kidney transplantation offers better mortality and quality of life outcomes to patients with end-stage renal failure compared to dialysis. Specifically, living donor kidney transplantation is the best treatment for end-stage renal disease, since it offers the greatest survival benefit compared to deceased donor kidney transplant or dialysis. However, not all patients from all racial/ethnic backgrounds enjoy these benefits. While black and Hispanic patients bear the predominant disease burden within the United States, they represent less than half of all kidney transplants in the country. Other factors such as cultural barriers that proliferate myths about transplant, financial costs that impede altruistic donation, and even biological predispositions create a complex maze and can also perpetuate care inaccessibility. Therefore, blanket efforts to increase the overall donation pool may not extend access to vulnerable populations, who may require more targeted attention and interventions. This review uses US kidney transplantation data to substantiate accessibility differences amongst racial minorities as well as provides examples of successful institutional and national systemic level changes that have improved transplantation outcomes for all.
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Affiliation(s)
- Chi Zhang
- Mayo Clinic Arizona, Phoenix, AZ, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Ferrari RM, Leeman J, Brenner AT, Correa SY, Malo TL, Moore AA, O'Leary MC, Randolph CM, Ratner S, Frerichs L, Farr D, Crockett SD, Wheeler SB, Lich KH, Beasley E, Hogsed M, Bland A, Richardson C, Newcomer M, Reuland DS. Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers. Implement Sci Commun 2023; 4:118. [PMID: 37730659 PMCID: PMC10512568 DOI: 10.1186/s43058-023-00485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Adoption of colorectal cancer (CRC) screening has lagged in community health center (CHC) populations in the USA. To address this implementation gap, we developed a multilevel intervention to improve screening in CHCs in our region. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide this effort. Here, we describe the use of implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) compilation in both the Exploration and Preparation phases of this project. During these two EPIS phases, we aimed to answer three primary questions: (1) What factors in the inner and outer contexts may support or hinder colorectal cancer screening in North Carolina CHCs?; (2) What evidence-based practices (EBPs) best fit the needs of North Carolina CHCs?; and (3) How can we best integrate the selected EBPs into North Carolina CHC systems? METHODS During the Exploration phase, we conducted local needs assessments, built a coalition, and conducted local consensus discussions. In the Preparation phase, we formed workgroups corresponding to the intervention's core functional components. Workgroups used cyclical small tests of change and process mapping to identify implementation barriers and facilitators and to adapt intervention components to fit inner and outer contexts. RESULTS Exploration activities yielded a coalition of stakeholders, including two rural CHCs, who identified barriers and facilitators and reached consensus on two EBPs: mailed FIT and navigation to colonoscopy. Stakeholders further agreed that the delivery of those two EBPs should be centralized to an outreach center. During Preparation, workgroups developed and refined protocols for the following centrally-delivered intervention components: a registry to identify and track eligible patients, a centralized system for mailing at-home stool tests, and a process to navigate patients to colonoscopy after an abnormal stool test. CONCLUSIONS This description may be useful both to implementation scientists, who can draw lessons from applied implementation studies such as this to refine their implementation strategy typologies and frameworks, as well as to implementation practitioners seeking exemplars for operationalizing strategies in early phases of implementation in healthcare.
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Affiliation(s)
- Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Nursing, University of North Carolina at Chapel Hill, 120 North Medical Drive, Chapel Hill, NC, 27599, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
| | - Sara Y Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Meghan C O'Leary
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Connor M Randolph
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Shana Ratner
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- UNC Institute for Healthcare Quality Improvement, CB #8005, Chapel Hill, NC, 27599, USA
| | - Leah Frerichs
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Deeonna Farr
- College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Greenville, NC, 27858, USA
| | - Seth D Crockett
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- Division of Gastroenterology & Hepatology, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR, 97239, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Evan Beasley
- Blue Ridge Health, UNC Health, 2579 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Michelle Hogsed
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Ashley Bland
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Claudia Richardson
- Ahoskie Comprehensive Care, Roanoke Chowan Community Health Center, 120 Health Center Drive, Ahoskie, NC, 27910, USA
| | - Mike Newcomer
- Digestive Health Partners, 191 Biltmore Avenue, Asheville, NC, 28801, USA
- Western Carolina Medical Society, 304 Summit Street, Asheville, NC, 28803, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
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Ozkardes C, Harman PhD J. Association of a Patient's Type of Insurance With Preventive Service Delivery. Cureus 2023; 15:e44927. [PMID: 37818517 PMCID: PMC10560607 DOI: 10.7759/cureus.44927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Chronic disease or death associated with chronic disease is often avoidable with proper interventions, including preventive services in healthcare settings. However, preventive service delivery rates by physicians are low. This study examined the association between preventive services and the type of patient insurance, as well as the association between the duration of an office visit and the type of patient insurance. Methods A retrospective observational cohort study was conducted using multivariate logistic regression. Pooled data on physician office-based visits from the 2011-2016 and 2018 National Ambulatory Medical Care Survey (NAMCS) were used in this analysis. The main measures observed were the odds of providing preventive services as they related to the type of patient insurance. Preventive measures assessed were those recommended by the United States Preventive Services Task Force with an A or B grade, applicable to most adults 18-64. Additionally, the mean office visit duration was analyzed based on the type of insurance. Results The odds of receiving cervical cancer screenings and tobacco smoking cessation screenings were 47% (p <0.01) and 31% (p =0.10) lower with Medicaid than private insurance, respectively. The odds of receiving blood pressure screenings and cervical cancer screenings were 43% (p =0.01) and 62% (p <0.01) lower in uninsured office visits compared to private insurance, respectively. Compared to private insurance, Medicaid and uninsured visits were 2.68 minutes and 1.97 minutes shorter in duration, respectively (p <0.05). Conclusions An association was found between the type of patient's insurance and the odds of providing preventive services. If the aim of healthcare is to improve the incidence of chronic disease or death associated with chronic disease, preventive services should be provided regardless of insurance type.
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Affiliation(s)
- Cuneyt Ozkardes
- Research, Florida State University College of Medicine, Tallahassee, USA
| | - Jeffrey Harman PhD
- Behavioral Health, Florida State University College of Medicine, Tallahassee, USA
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Park Y, Dang EP, Board A, Gilboa SM, Ondersma SJ, Smid MC, Shakib JH, Mitchell KT, England LJ, Broussard CS, Meaney-Delman D, Iskander J, Kim SY. Polysubstance Use in Pregnancy: Surveillance, Interventions, and Next Steps. J Womens Health (Larchmt) 2023; 32:899-904. [PMID: 37552850 PMCID: PMC10558011 DOI: 10.1089/jwh.2023.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Substance use during pregnancy increases risk for a wide range of adverse maternal and neonatal health outcomes. Polysubstance use is common among people who use substances during pregnancy; however, the risks of combined substance exposures during pregnancy are poorly understood. In this report, we provide an overview of the activities of the Centers for Disease Control and Prevention (CDC) and partners and identified gaps related to (1) surveillance, (2) routine screening, and (3) prevention of polysubstance use during pregnancy. Efforts by CDC and other partners to reduce polysubstance use during pregnancy can improve the health of pregnant people and their infants and children.
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Affiliation(s)
- Youngjoo Park
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA
| | - Elizabeth P. Dang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy Board
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven J. Ondersma
- Department of Public Health, Michigan State University, East Lansing, Michigan, USA
| | - Marcela C. Smid
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
| | - Julie H. Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | | | - Lucinda J. England
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheryl S. Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dana Meaney-Delman
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Iskander
- Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shin Y. Kim
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Link E, Memenga P. [Digital personalized health information services from physicians: survey results of patients' and physicians' acceptance and expectations]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:982-989. [PMID: 37582885 PMCID: PMC10465679 DOI: 10.1007/s00103-023-03750-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND The acquisition of health information is fundamental for patient empowerment. In order to support this, new ways of providing information must be found. In this article, the digital personalized provision of health information by physicians as well as the intended use and requirements of patients and physicians are examined. METHODS An online survey of a sample of patients stratified for the German population (N = 1,000) and an online survey of physicians (N = 364) on the subject of digital personalized health information services were conducted. The type of information provision in the medical setting, the intention to use it, and the requirements for digital information services were assessed. RESULTS Digital personalized information services are still rare. However, patients would support such a service, while physicians are more skeptical. Patients value usability and information quality. With regard to the form of presentation, texts tend to be rated more important than videos. For physicians, on the other hand, it is important that the service comes from a trustworthy provider, complies with guidelines, and is free of charge. DISCUSSION The potential of the digital transformation of information provision has so far only been utilized to a limited extent. While the basis for successful implementation seems to be given among patients, physicians still need to overcome their reservations, the benefits of such services need to be communicated, and systemic incentives must be created.
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Affiliation(s)
- Elena Link
- Institut für Publizistik, Johannes Gutenberg-Universität Mainz, Jakob-Welder-Weg 12, 55128, Mainz, Deutschland.
| | - Paula Memenga
- Institut für Journalistik und Kommunikationsforschung, Hochschule für Musik, Theater und Medien Hannover, Hannover, Deutschland
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Jia-Richards M, Williams EC, Rosland AM, Boudreaux-Kelly MY, Luther JF, Mikolic J, Chinman MJ, Daniels K, Bachrach RL. Unhealthy alcohol use and brief intervention rates among high and low complexity veterans seeking primary care services in the Veterans Health Administration. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209117. [PMID: 37355154 PMCID: PMC10527472 DOI: 10.1016/j.josat.2023.209117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/31/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Brief intervention (BI) is recommended for all primary care (PC) patients who screen positive for unhealthy alcohol use; however, patients with multiple chronic health conditions who are at high-risk of hospitalization (i.e., "high complexity" patients) may face disparities in receiving BIs in PC. The current study investigated whether high complexity and low complexity patients in the Veterans Health Administration (VHA) differed regarding screening positive for unhealthy alcohol use, alcohol-use severity, and receipt of BI for those with unhealthy alcohol use. METHODS Patients were veterans receiving PC services at the VHA in a mid-Atlantic region of the United States. The study extracted VHA administrative and clinical data for a total of 282,242 patients who had ≥1 PC visits between 1/1/2014 and 12/31/2014, during which they were screened for unhealthy alcohol use by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). The study defined high complexity patients as those within and above the 90th percentile of risk for hospitalization per the VHA's Care Assessment Need Score. Logistic regression models assessed if being a high complexity patient was associated with screening positive for unhealthy alcohol use (AUDIT-C ≥ 5), severity of unhealthy alcohol use in those who screened positive (AUDIT-C score range 5-12), and receipt of BI in those who screened positive. RESULTS Our sample was 94.5% male, 83% White, 13% Black, 4% other race, and 1.7% Hispanic. A total of 10,813 (3.8%) patients screened positive for unhealthy alcohol use from which we identified 569 (5.3%) high complexity and 10,128 (93.6%) low complexity patients (n = 116 removed due to missing complexity data). Relative to low complexity patients, high complexity patients were less likely to screen positive for unhealthy alcohol use (3.3% vs. 4.1%, AOR = 0.59, p < .001); however, in patients who screened positive, high complexity patients had higher AUDIT-C scores (Mean AUDIT-C = 7.75 vs. 6.87, AOR = 1.46, p < .001) and were less likely to receive a BI (78.0% vs. 92.6%, AOR = 0.42, p < .001). CONCLUSIONS Disparities in BI exist for highly complex patients despite having more severe unhealthy alcohol use. Future research should examine the specific patient- and/or clinic-level factors impeding BI delivery for complex patients.
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Affiliation(s)
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington, School of Public Health, Seattle, WA, USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Ann-Marie Rosland
- Center for Health Equity and Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - James F Luther
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA; Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Joseph Mikolic
- StatCore, Veterans Affairs Pittsburgh Healthcare System Research Office, Pittsburgh, PA, USA
| | - Matthew J Chinman
- Center for Health Equity and Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; The RAND Corporation, Pittsburgh, PA, USA
| | - Karin Daniels
- Center for Health Equity and Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Rachel L Bachrach
- Center for Health Equity and Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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Harper PG, Van Riper K, Ramer T, Slattengren A, Adam P, Smithson A, Wicks C, Martin C, Wootten M, Carlson S, Miller E, Fallert C. Team-based care: an expanded medical assistant role - enhanced rooming and visit assistance. J Interprof Care 2023; 37:S95-S101. [PMID: 30388911 DOI: 10.1080/13561820.2018.1538107] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/16/2018] [Accepted: 10/08/2018] [Indexed: 01/17/2023]
Abstract
Primary care practices face significant challenges as they pursue the Quadruple Aim. Redistributing care across the interprofessional primary care team by expanding the role of the medical assistant (MA) is a potential strategy to address these challenges. Two sequential, linked processes to expand the role of the MA, called Enhanced Rooming and Visit Assistance, were implemented in four family medicine residency clinics in Minnesota. In Enhanced Rooming, MAs addressed preventive services, obtained a preliminary visit agenda, and completed a warm hand-off to the provider. In Visit Assistance, MAs stayed in the room the entire visit to assist with the visit workflow. Enhanced Rooming and Visit Assistance processes were successfully implemented and sustained for over one year. MAs and providers were satisfied with both processes, and patients accepted the expanded MA roles. Mammogram ordering rates increased from 10% to 25% (p < 0.0001). After Visit Summary (AVS) print rates increased by 12% (p < 0.0001). Visit Turn-Around-Time (TAT) decreased 3.1 minutes per visit (p = 0.0001). Expanding the MA role in a primary care interprofessional team is feasible and a potentially useful tool to address the Quadruple Aim.
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Affiliation(s)
- Peter G Harper
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Timothy Ramer
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Slattengren
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Adam
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Angela Smithson
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Cherilyn Wicks
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Casey Martin
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Michael Wootten
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Samantha Carlson
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Christopher Fallert
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN, USA
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36
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Wangler J, Jansky M. Promotion of Exercise and Health for Older People in Primary Care: A Qualitative Study on the Potential, Experiences and Strategies of General Practitioners in Germany. JOURNAL OF PREVENTION (2022) 2023; 44:477-490. [PMID: 36997796 PMCID: PMC10423120 DOI: 10.1007/s10935-023-00730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
In advanced age, physical activity becomes an important element in maintaining one's individual health. GPs are considered to be well suited for advising and attending to older patients according to the principles of (preventive) healthcare. The subject was examined in the context of a study that determined options for action, experiences and strategies relating to the physical activation of older patients by GPs. Between 2021 and 2022, 76 semi-standardised interviews amongst GPs were conducted in all federal states of Germany. The data were evaluated by qualitative content analysis. The category system includes: importance of promoting physical activity; focus of exercise counselling; procedure of counselling; overview of exercise offers and cooperation with healthcare stakeholders; challenges and optimisation approaches. Many interviewees were aware of the significance of promoting health and exercise among older persons. Some physicians paid attention to identifying suitable activities for patients and motivating them to participate on a long-term basis. Cooperations with local health stakeholders have been identified. The interviewees recognised various challenges, which were mainly attributable to the lack of structures for health promotion. Several of the GPs lacked an overview of the physical activity programmes. GPs should assume an active role in exercise and health promotion for older patients. For them to be able to refer their patients effectively to exercise opportunities offered, it will be of importance to integrate the GP setting into a community-based network of prevention. Training measures could support the GP team to refer to the value of physical activity and address need-based recommendations.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131 Mainz, Germany
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131 Mainz, Germany
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Ackermann RT, Cameron KA, Liss DT, Dolan N, Aikman C, Carson A, Harris SA, Doyle K, Cooper AJ, Hitsman B. Primary care delivery of behavioral weight loss services for adults with cardiovascular risk factors: development of pragmatic practice components and results of a randomized feasibility trial. RESEARCH SQUARE 2023:rs.3.rs-3074046. [PMID: 37547026 PMCID: PMC10402202 DOI: 10.21203/rs.3.rs-3074046/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Intensive lifestyle interventions (ILI) improve weight loss and cardiovascular risk factors, but health systems face challenges implementing them. We engaged stakeholders to cocreate and evaluate feasibility of primary care implementation strategies and of a pragmatic randomization procedure to be used for a future effectiveness trial. Methods The study setting was a single, urban primary care office. Patients with BMI ≥ 27 and ≥ 1 cardiovascular risk factor were sent a single electronic health record (EHR) message between December 2019 and January 2020 offering services to support an initial weight loss goal of about 10 pounds in 10 weeks. All patients who affirmed weight loss interest were pragmatically enrolled in the trial and offered "Basic Lifestyle Services" (BLS), including a scale that transmits weight data to the EHR using cellular networks, a coupon to enroll in lifestyle coaching resources through a partnering fitness organization, and periodic EHR messages encouraging use of these resources. About half (n = 42) of participants were randomized by an automated EHR algorithm to also receive "Customized Lifestyle Services" (CLS), including weekly email messages adapted to individual weight loss progress and telephonic coaching by a nurse for those facing challenges. Interventions and assessments spanned January to July 2020, with interference by the coronavirus pandemic. Weight measures were collected from administrative sources. Qualitative analysis of stakeholder recommendations and patient interviews assessed acceptability, appropriateness, and sustainability of intervention components. Results Over 6 weeks, 426 patients were sent the EHR invitation message and 80 (18.8%) affirmed interest in the weight loss goal and were included for analysis. EHR data were available to ascertain a 6-month weight value for 77 (96%) patients. Overall, 62% of participants lost weight; 15.0% exhibited weight loss ≥ 5%, with no statistically significant difference between CLS or BLS arms (p = 0.85). CLS assignment increased participation in daily self-weighing (43% versus 21% of patients through 12 weeks) and enrollment in referral-based lifestyle support resources (52% versus 37%). Conclusions This preliminary study demonstrates feasibility of implementation strategies for primary care offices to offer and coordinate ILI core components, as well as a pragmatic randomization procedure for use in a future randomized comparative trial.
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Riise HKR, Graue M, Igland J, Birkeland KI, Kolltveit BCH. Prevalence of increased risk of type 2 diabetes in general practice: a cross-sectional study in Norway. BMC PRIMARY CARE 2023; 24:151. [PMID: 37468831 PMCID: PMC10357693 DOI: 10.1186/s12875-023-02100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is a global public health problem, but the onset can be delayed or prevented with adequate intervention in individuals with increased risk. Therefore, a major challenge in general practice is to identify individuals at risk of diabetes. However, limited knowledge is available about the prevalence of high diabetes risk individuals in a primary care population. In a cohort of consecutive patients in general practice we examined the prevalence of known diabetes and estimated risk of diabetes using The Finnish Diabetes Risk Score (FINDRISC) calculator, by sociodemographic and clinical characteristics. METHODS This study was a cross-sectional study conducted in four general practices in Western and Eastern Norway. A total of 1682 individuals, 20-80 years of age, were assessed for eligibility from May to December 2019. We excluded patients who actively declined participation (n = 112), were lost because of various organization challenges (n = 103) and patients who did not fulfil the inclusions criteria (n = 63). Diabetes prevalence and prevalence of individuals at risk of T2D with 95% confidence intervals (CI) were estimated for the total sample, by age group and for men and women separately. We tested for differences between groups using t-test for continuous variables and chi-square test (Pearson Chi-Square) for categorical variables. RESULTS Of 1404 individuals, 132 reported known diabetes, yielding a prevalence of 9.9% (95% CI 8.4-11.6). Among participants without a known diagnosis of diabetes, the following estimates of elevated risk assessment scores were found: FINDRISC score ≥ 11 32.8% (95% CI 30.3-35.4) and FINDRISC ≥ 15 10.0% (95% CI 8.6-11.9). Comparable results were found between the sexes. CONCLUSIONS Detection of unknown diabetes and individuals with increased risk, is of high public health relevance for early implementation of preventive measures aimed to reduce the risk of diabetes and its complications through lifestyle modification. A simple, non-expensive questionnaire, such as FINDRISC, may be valuable as an initial screening method in general practice to identify those in need for preventive measures.
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Affiliation(s)
- Hilde Kristin Refvik Riise
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway.
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kåre I Birkeland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
- Vossevangen Medical Center, Voss, Norway
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Everett C, Christy J, Batchelder H, Morgan PA, Docherty S, Smith VA, Anderson JB, Viera A, Jackson GL. Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study. BMJ Open Qual 2023; 12:e002229. [PMID: 37311623 DOI: 10.1136/bmjoq-2022-002229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Interprofessional primary care (PC) teams are key to the provision of high-quality care. PC providers often 'share' patients (eg, a patient may see multiple providers in the same clinic), resulting in between-visit interdependence between providers. However, concern remains that PC provider interdependence will reduce quality of care, causing some organisations to hesitate in creating multiple provider teams. If PC provider teams are formalised, the PC usual provider of care (UPC) type (physician, nurse practitioner (NP) or physician assistant/associate (PA)) should be determined for patients with varying levels of medical complexity. OBJECTIVE To evaluate the impact of PC provider interdependence, UPC type and patient complexity on diabetes-specific outcomes for adult patients with diabetes. DESIGN Cohort study using electronic health record data from 26 PC practices in central North Carolina, USA. PARTICIPANTS Adult patients with diabetes (N=10 498) who received PC in 2016 and 2017. OUTCOME Testing for diabetes control, testing for lipid levels, mean glycated haemoglobin (HbA1c) values and mean low-density lipoprotein (LDL) values in 2017. RESULTS Receipt of guideline recommended testing was high (72% for HbA1c and 66% for LDL testing), HbA1c values were 7.5% and LDL values were 88.5 mg/dL. When controlling for a range of patient and panel level variables, increases in PC provider interdependence were not significantly associated with diabetes-specific outcomes. Similarly, there were no significant differences in the diabetes outcomes for patients with NP/PA UPCs when compared with physicians. The number and type of a patient's chronic conditions did impact the receipt of testing, but not average values for HbA1c and LDL. CONCLUSIONS A range of UPC types on PC multiple provider teams can deliver guideline-recommended diabetes care. However, the number and type of a patient's chronic conditions alone impacted the receipt of testing, but not average values for HbA1c and LDL.
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Affiliation(s)
- Christine Everett
- Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacob Christy
- Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Heather Batchelder
- Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Perri A Morgan
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Valerie A Smith
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - John B Anderson
- Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Primary Care, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anthony Viera
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - George L Jackson
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Petter O'Donnel Jr. School of Public Health, Unitersity of Texas Southwestern Medical Center, Dallas, TX, USA
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Fanaki C, Fortin J, Sirois MJ, Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A. Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults. Can Geriatr J 2023; 26:227-238. [PMID: 37265986 PMCID: PMC10198677 DOI: 10.5770/cgj.26.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Introduction To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. Methods In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the Consolidated Framework for Implementation Research and then adding emergent subthemes. Results We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. Conclusions These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
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Affiliation(s)
- Chaimaa Fanaki
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
| | - Julie Fortin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| | - Marie-Josée Sirois
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Research Centre of the CHU de Québec, Quebec, QC
- Department of Readaptation, Université Laval, Quebec, QC
| | - Edeltraut Kröger
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Faculty of Pharmacy, Université Laval, Quebec, QC
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington Dufferin, Waterloo, ON
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anik Giguere
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
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Ackermann RT, Cameron K, Liss D, Dolan N, Aikman C, Carson A, Harris S, Doyle K, Cooper A, Hitsman B. Primary care delivery of behavioral weight loss services for adults with cardiovascular risk factors: development of pragmatic implementation strategies and results of a randomized feasibility trial. RESEARCH SQUARE 2023:rs.3.rs-2806196. [PMID: 37292808 PMCID: PMC10246232 DOI: 10.21203/rs.3.rs-2806196/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Intensive lifestyle interventions (ILI) improve weight loss and cardiovascular risk factors, but health systems face challenges implementing them. We engaged stakeholders to cocreate and evaluate feasibility of primary care implementation strategies and of a pragmatic randomization procedure to be used for a future effectiveness trial. Methods The study setting was a single, urban primary care office. Patients with BMI ≥ 27 and ≥ 1 cardiovascular risk factor were sent a single electronic health record (EHR) message between December 2019 and January 2020 offering services to support an initial weight loss goal of about "10 pounds in 10 weeks." All patients who affirmed weight loss interest were pragmatically enrolled in the trial and offered "Basic Lifestyle Services" (BLS), including a scale that transmits weight data to the EHR using cellular networks, a coupon to enroll in lifestyle coaching resources through a partnering fitness organization, and periodic EHR messages encouraging use of these resources. About half (n = 42) of participants were randomized by an automated EHR algorithm to also receive "Customized Lifestyle Services" (CLS), including weekly email messages adapted to individual weight loss progress and telephonic coaching by a nurse for those facing challenges. Interventions and assessments spanned January to July 2020, with interference by the coronavirus pandemic. Weight measures were collected from administrative sources. Qualitative analysis of stakeholder recommendations and patient interviews assessed acceptability, appropriateness, and sustainability of intervention components. Results Over 6 weeks, 426 patients were sent the EHR invitation message and 80 (18.8%) affirmed interest in the weight loss goal and were included for analysis. EHR data were available to ascertain a 6-month weight value for 77 (96%) patients. Overall, 62% of participants lost weight; 15.0% exhibited weight loss ≥ 5%, with no statistically significant difference between CLS or BLS arms (p = 0.85). CLS assignment increased participation in daily self-weighing (43% versus 21% of patients through 12 weeks) and enrollment in referral-based lifestyle support resources (52% versus 37%). Conclusions This preliminary study demonstrates feasibility of implementation strategies for primary care offices to offer and coordinate ILI core components, as well as a pragmatic randomization procedure for use in a future randomized comparative trial.
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Affiliation(s)
| | | | - David Liss
- Northwestern University Feinberg School of Medicine
| | - Nancy Dolan
- Northwestern University Feinberg School of Medicine
| | | | | | | | - Kathryn Doyle
- Northwestern Medicine: Northwestern Memorial HealthCare Corp
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Snavely AC, Foley K, Dharod A, Dignan M, Brower H, Wright E, Miller DP. Effectiveness and implementation of mPATH™-CRC: a mobile health system for colorectal cancer screening. Trials 2023; 24:274. [PMID: 37060023 PMCID: PMC10103028 DOI: 10.1186/s13063-023-07273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Screening for colorectal cancer (CRC) is widely recommended but underused, even though CRC is the third most diagnosed cancer and the second leading cause of cancer death in the USA. The mPATH™ program is an iPad-based application designed to identify patients due for CRC screening, educate them on the commonly used screening tests, and help them select their best option, with the goal of increasing CRC screening rates. METHODS The mPATH™ program consists of questions asked of all adult patients at check-in (mPATH™-CheckIn), as well as a module specific for patients due for CRC screening (mPATH™-CRC). In this study, the mPATH™ program is evaluated through a Type III hybrid implementation-effectiveness design. Specifically, the study consists of three parts: (1) a cluster-randomized controlled trial of primary care clinics comparing a "high touch" evidence-based implementation strategy with a "low touch" implementation strategy; (2) a nested pragmatic study evaluating the effectiveness of mPATH-CRC™ on completion of CRC screening; and (3) a mixed-methods study evaluating factors that facilitate or impede the maintenance of interventions like mPATH-CRC™. The primary objective is to compare the proportion of patients aged 50-74 who are eligible for CRC screening who complete mPATH™-CRC in the 6th month following implementation between the "high touch" and "low touch" implementation strategies. Effectiveness of mPATH™-CRC is evaluated by comparing the proportion who complete CRC screening within 16 weeks of their visit to the clinic between a pre-implementation cohort (8 months before implementation) and a post-implementation cohort (8 months after implementation). DISCUSSION This study will provide data on both the implementation of the mPATH™ program and its effectiveness in improving screening rates for CRC. In addition, this work has the potential to have an even broader impact by identifying strategies to support the sustained use of other similar technology-based primary care interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03843957. Registered on 18 February 2019.
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Affiliation(s)
- Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ajay Dharod
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Holly Brower
- Wake Forest University School of Business, Winston-Salem, NC, USA
| | - Elena Wright
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David P Miller
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Gupta A, Hu J, Huang S, Diaz L, Gore R, Levy N, Bergman M, Tanner M, Sherman SE, Islam N, Schwartz MD. Implementation fidelity to a behavioral diabetes prevention intervention in two New York City safety net primary care practices. BMC Public Health 2023; 23:575. [PMID: 36978071 PMCID: PMC10045092 DOI: 10.1186/s12889-023-15477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND It is critical to assess implementation fidelity of evidence-based interventions and factors moderating fidelity, to understand the reasons for their success or failure. However, fidelity and fidelity moderators are seldom systematically reported. The study objective was to conduct a concurrent implementation fidelity evaluation and examine fidelity moderators of CHORD (Community Health Outreach to Reduce Diabetes), a pragmatic, cluster-randomized, controlled trial to test the impact of a Community Health Workers (CHW)-led health coaching intervention to prevent incident type 2 Diabetes Mellitus in New York (NY). METHODS We applied the Conceptual Framework for Implementation Fidelity to assess implementation fidelity and factors moderating it across the four core intervention components: patient goal setting, education topic coaching, primary care (PC) visits, and referrals to address social determinants of health (SDH), using descriptive statistics and regression models. PC patients with prediabetes receiving care from safety-net patient-centered medical homes (PCMHs) at either, VA NY Harbor or at Bellevue Hospital (BH) were eligible to be randomized into the CHW-led CHORD intervention or usual care. Among 559 patients randomized and enrolled in the intervention group, 79.4% completed the intake survey and were included in the analytic sample for fidelity assessment. Fidelity was measured as coverage, content adherence and frequency of each core component, and the moderators assessed were implementation site and patient activation measure. RESULTS Content adherence was high for three components with nearly 80.0% of patients setting ≥ 1 goal, having ≥ 1 PC visit and receiving ≥ 1 education session. Only 45.0% patients received ≥ 1 SDH referral. After adjusting for patient gender, language, race, ethnicity, and age, the implementation site moderated adherence to goal setting (77.4% BH vs. 87.7% VA), educational coaching (78.9% BH vs. 88.3% VA), number of successful CHW-patient encounters (6 BH vs 4 VA) and percent of patients receiving all four components (41.1% BH vs. 25.7% VA). CONCLUSIONS The fidelity to the four CHORD intervention components differed between the two implementation sites, demonstrating the challenges in implementing complex evidence-based interventions in different settings. Our findings underscore the importance of measuring implementation fidelity in contextualizing the outcomes of randomized trials of complex multi-site behavioral interventions. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov on 30/12/2016 and the registration number is NCT03006666 .
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Affiliation(s)
- Avni Gupta
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Jiyuan Hu
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave 2F Rm 222, New York, NY, 10016, USA
| | - Shengnan Huang
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 2Nd Floor, New York, NY, 10016, USA
| | - Laura Diaz
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 9-43A, New York, NY, 10016, USA
| | - Radhika Gore
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Natalie Levy
- Department of Medicine, NYU Grossman School of Medicine, 462 First Avenue, Area 2d, New York, NY, 10016, USA
| | - Michael Bergman
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 2Nd Floor, New York, NY, 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, 423 East 23Rd Street, Room 16049C, New York, NY, 10010, USA
- VA New York Harbor Healthcare System, 423 East 23Rd Street, Room 16049C, New York, NY, 10010, USA
| | - Michael Tanner
- Department of Medicine, NYU Grossman School of Medicine, 462 1St Ave, New York, NY, 10016, USA
| | - Scott E Sherman
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
- VA New York Harbor Healthcare System, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Mark D Schwartz
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, Suite 955, New York, NY, 10016, USA
- VA New York Harbor Healthcare System, 180 Madison Avenue, Suite 955, New York, NY, 10016, USA
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Depression screening in pregnancy and postpartum: Just do something? Gen Hosp Psychiatry 2023; 82:14-18. [PMID: 36893651 DOI: 10.1016/j.genhosppsych.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
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45
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DeFosset AR, Barragan NC, Green G, Morrison JL, Kuo T. Building bi-directional referral and communication pathways across the community-clinic divide: Experiences from a systems-informed innovation project in Los Angeles. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100671. [PMID: 36508993 DOI: 10.1016/j.hjdsi.2022.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Bi-directional communication and referral pathways (BCRPs) between clinics and community-based organizations could promote well-being among vulnerable populations with complex and overlapping health and social needs. While BCRPs are promising, establishing them is complex, involving system and process changes across diverse organizational settings. To date, few models have been implemented or empirically tested. This article describes an innovation and planning project to build a BCRP, linking patients in safety net primary care clinics to a comprehensive suite of community-based health and wellness supports in Los Angeles. During a year-long process, a multi-sector team iteratively engaged data to facilitate learning and improvement. The project proceeded through three distinct, but overlapping, phases: (1) Discovery, (2) Systems Mapping, and (3) BCRP Re-design and Testing, which were coordinated through frequent collaborative meetings. By using a stepwise systems-informed approach to collect and examine data, the team was able to generate new change ideas, dispel assumptions, and make transparent and informed decisions. It was critical to have engagement from both internal partners with knowledge of "on-the-ground" practice realities, and external stakeholders with the fresh perspective needed to identify opportunities and define an improvement agenda. These efforts represent first steps towards implementing sustainable BCRPs and realizing their full potential to dynamically bridge the community-clinic divide and improve population health. Other jurisdictions can learn from and adapt the practical data-driven approach used in Los Angeles to build BCRPs that will be thoroughly operationalized, consistently implemented, and optimized within their own unique contexts.
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Affiliation(s)
- Amelia R DeFosset
- Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina-Chapel Hill, 333 S. Columbia Street, Chapel Hill, NC, 27516, USA.
| | - Noel C Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA
| | - Gabrielle Green
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA
| | - Janina L Morrison
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA; The Wellness Center at the Historic General Hospital, 1200 N. State Street, Los Angeles, CA, 90033, USA; LAC+USC Medical Center, Los Angeles County Department of Health Services, Outpatient Department (Building B), 2010 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA, 90010, USA; Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90024, USA; Department of Epidemiology, UCLA Fielding School of Public Health, P.O. Box 951772, Los Angeles, CA, 90095, USA; Population Health Program, UCLA Clinical and Translational Science Institute, BE-144 Center of Health Sciences, Los Angeles, CA, 90095, USA
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Trant AA, Espinal M, Kisanga EP, Vash-Margita A, Lundsberg L, Sheth SS, Fan L. Optimizing menstrual health and hygiene management in the U.S.: A mixed-methods study of the barriers and the role of healthcare professionals. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100808. [PMID: 36563412 DOI: 10.1016/j.srhc.2022.100808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Menstrual health (MH) practices have been understudied in the U.S. This study aimed to assess patient and medical staff views of MH. METHODS The mixed-methods approach included medical staff and patient surveys, and patient interviews on MH experiences. Quantitative survey data generated descriptive statistics. Thematic content analysis (TCA) evaluated qualitative interviews. Convergent Parallel Triangulation Analysis (CPTA) evaluated both datasets in tandem. RESULTS The medical staff survey's response rate was 72% (54 participants/75 invited staff). Only 7% (4/54) of staff consistently asked patients about menstrual products (MP), while 54% (29/54) were concerned about patients affording MP. The patient survey's response rate was 90% (186/207); 22% (40/186) of respondents showed MH insecurity, which was associated with annual income <$30,000 (p < 0.01); 45% (85/186) missed commitments during menses; 53% (98/186) never discussed MP with healthcare providers. To reach thematic saturation 10/17 invited patients were interviewed. Five themes were identified through TCA: menstruation as a social barrier; menstrual education comes from a variety of sources; MP choice is a balance of comfort, cost, and convenience; patients value relationships with their providers; adolescence is the window for establishing MH. Three threads were identified through CPTA: MH insecurity is common; MH screening and education are limited; menstruation impacts patients' ability to engage in daily activities. CONCLUSION A holistic approach toward MH is needed; education and screening are inconsistent. Comprehensive MH can enhance a patient's understanding of and capacity to advocate for their health. These findings are specific to this population and may not be generalizable.
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Affiliation(s)
| | - Mariana Espinal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | | | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Lisbet Lundsberg
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Sangini S Sheth
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States
| | - Linda Fan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, United States.
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Sinsky CA, Morrow J. High cost of broken relationships. BMJ Qual Saf 2023:bmjqs-2023-015930. [PMID: 36806467 DOI: 10.1136/bmjqs-2023-015930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Christine A Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois, USA
| | - James Morrow
- Granta Medical Group Shelford Medical Practice, Cambridge, UK
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Pautrat M, Renard C, Riffault V, Ciolfi D, Edeline A, Breton H, Brunault P, Lebeau JP. Cross-analyzing addiction specialist and patient opinions and experiences about addictive disorder screening in primary care to identify interaction-related obstacles: a qualitative study. Subst Abuse Treat Prev Policy 2023; 18:12. [PMID: 36803797 PMCID: PMC9938560 DOI: 10.1186/s13011-023-00522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/04/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Promptly identifying individuals with addictive disorders reduces mortality and morbidity and improves quality of life. Although screening in primary care with the Screening, Brief Intervention and Referral Treatment strategy has been recommended since 2008, it remains underutilized. This may be due to barriers including lack of time, patient reluctance or perhaps the timing and approach for discussing addiction with their patients. OBJECTIVE This study aims to explore and cross-analyze patient and addiction specialist experiences and opinions about early addictive disorder screening in primary care to identify interaction-related screening obstacles. DESIGN AND PARTICIPANTS Qualitative study with purposive maximum variation sampling among nine addiction specialists and eight individuals with addiction disorders conducted between April 2017 and November 2019 in Val-de-Loire, France. MAIN MEASURES Using a grounded theory approach, verbatim data was collected from face-to-face interviews with addiction specialists and individuals with addiction disorders. These interviews explored their opinions and experiences with addiction screening in primary care. Initially, two independent investigators analyzed the coded verbatim according to the data triangulation principle. Secondly, convergences and divergences between addiction specialist and addict verbatim categories were identified, analyzed, and conceptualized. KEY RESULTS Four main interaction-related obstacles to early addictive disorder screening in primary care were identified and conceptualized: the new concepts of shared self-censorship and the patient's personal red line, issues not addressed during consultations, and opposition between how physicians and patients would like to approach addictive disorder screening. CONCLUSIONS To continue analysis of addictive disorder screening dynamics, further studies to examine the perspectives of all those involved in primary care are required. The information revealed from these studies will provide ideas to help patients and caregivers start discussing addiction and to help implement a collaborative team-based care approach. TRIAL REGISTRATION This study is registered with the Commission Nationale de l'Informatique et des Libertés (CNIL) under No. 2017-093.
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Affiliation(s)
- Maxime Pautrat
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France.
- Department of General Practice, Tours Regional University Hospital, Tours, France.
| | - Caroline Renard
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Vincent Riffault
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - David Ciolfi
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Agathe Edeline
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Hervé Breton
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- Department of General Practice, Tours Regional University Hospital, Tours, France
| | - Paul Brunault
- Department of General Practice, Tours Regional University Hospital, Tours, France
- UMR 1253, iBrain, University of Tours, Inserm, Tours, France
- Qualipsy EE 1901, University of Tours, Tours, France
- Équipe de Liaison et de Soins en Addictologie, CHRU de Tours, Service d'Addictologie Universitaire, Tours, France
| | - Jean Pierre Lebeau
- Faculty of Medicine, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- Department of General Practice, Tours Regional University Hospital, Tours, France
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Martinez-Lopez N, Makarov DV, Thomas J, Ciprut S, Hickman T, Cole H, Fenstermaker M, Gold H, Loeb S, Ravenell JE. A Study to Compare a CHW-Led Versus Physician-Led Intervention for Prostate Cancer Screening Decision-Making among Black Men. Ethn Dis 2023; 33:26-32. [PMID: 38846259 PMCID: PMC11152150 DOI: 10.18865/1722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Introduction Prostate cancer is the second leading cause of cancer deaths among men in the United States and harms Black men disproportionately. Most US men are uninformed about many key facts important to make an informed decision about prostate cancer. Most experts agree that it is important for men to learn about these problems as early as possible in their lifetime. Objectives To compare the effect of a community health worker (CHW)-led educational session with a physician-led educational session that counsels Black men about the risks and benefits of prostate-specific antigen (PSA) screening. Methods One hundred eighteen Black men recruited in 8 community-based settings attended a prostate cancer screening education session led by either a CHW or a physician. Participants completed surveys before and after the session to assess knowledge, decisional conflict, and perceptions about the intervention. Both arms used a decision aid that explains the benefits, risks, and controversies of PSA screening and decision coaching. Results There was no significant difference in decisional conflict change by group: 24.31 physician led versus 30.64 CHW led (P=.31). The CHW-led group showed significantly greater improvement on knowledge after intervention, change (SD): 2.6 (2.81) versus 5.1 (3.19), P<.001). However, those in the physician-led group were more likely to agree that the speaker knew a lot about PSA testing (P<.001) and were more likely to trust the speaker (P<.001). Conclusions CHW-led interventions can effectively assist Black men with complex health decision-making in community-based settings. This approach may improve prostate cancer knowledge and equally minimize decisional conflict compared with a physician-led intervention.
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Affiliation(s)
| | - Danil V. Makarov
- Department of Population Health, NYU Langone Health, New York, NY
- Department of Urology, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
| | - Jerry Thomas
- Department of Population Health, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
| | - Shannon Ciprut
- Department of Population Health, NYU Langone Health, New York, NY
- Department of Urology, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
| | - Theodore Hickman
- Department of Population Health, NYU Langone Health, New York, NY
| | - Helen Cole
- Department of Population Health, NYU Langone Health, New York, NY
| | | | - Heather Gold
- Department of Population Health, NYU Langone Health, New York, NY
| | - Stacy Loeb
- Department of Population Health, NYU Langone Health, New York, NY
- Department of Urology, NYU Langone Health, New York, NY
- VA New York Harbor Healthcare System, New York, NY
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Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the Time Needed to Provide Adult Primary Care. J Gen Intern Med 2023; 38:147-155. [PMID: 35776372 PMCID: PMC9848034 DOI: 10.1007/s11606-022-07707-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/16/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Many patients do not receive guideline-recommended preventive, chronic disease, and acute care. One potential explanation is insufficient time for primary care providers (PCPs) to provide care. OBJECTIVE To quantify the time needed to provide 2020 preventive care, chronic disease care, and acute care for a nationally representative adult patient panel by a PCP alone, and by a PCP as part of a team-based care model. DESIGN Simulation study applying preventive and chronic disease care guidelines to hypothetical patient panels. PARTICIPANTS Hypothetical panels of 2500 patients, representative of the adult US population based on the 2017-2018 National Health and Nutrition Examination Survey. MAIN MEASURES The mean time required for a PCP to provide guideline-recommended preventive, chronic disease and acute care to the hypothetical patient panels. Estimates were also calculated for visit documentation time and electronic inbox management time. Times were re-estimated in the setting of team-based care. KEY RESULTS PCPs were estimated to require 26.7 h/day, comprising of 14.1 h/day for preventive care, 7.2 h/day for chronic disease care, 2.2 h/day for acute care, and 3.2 h/day for documentation and inbox management. With team-based care, PCPs were estimated to require 9.3 h per day (2.0 h/day for preventive care and 3.6 h/day for chronic disease care, 1.1 h/day for acute care, and 2.6 h/day for documentation and inbox management). CONCLUSIONS PCPs do not have enough time to provide the guideline-recommended primary care. With team-based care the time requirements would decrease by over half, but still be excessive.
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Affiliation(s)
- Justin Porter
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Cynthia Boyd
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M Reza Skandari
- Imperial College Business School, Centre for Health Economics & Policy Innovation, Imperial College London, London, UK
| | - Neda Laiteerapong
- Departments of Medicine & Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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