Developing Community-Level Implementation Networks to Connect Older Adults to Evidence-Based Falls Prevention Programs

Background: Evidence-based falls prevention programs are available in many communities, but participation in such programs remains low. This study aimed to develop community-based referral networks of organizations to facilitate the uptake of evidence-based falls prevention programs through engaging older adults at risk for falls with the RememberingWhen™ program and connecting them to evidence-based programs in Midwestern communities. Methods: Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), referral networks were developed in two Midwestern communities (urban and micropolitan) through a seven-step community engagement plan: establishing and operationalizing the State-level Advisory Board (SAB), identifying falls prevention resources, conducting community assessments, developing Local Advisory Groups (LAG), operationalizing the LAG, developing referral network and protocols, and implementing the network. Semistructured interviews guided by the RE-AIM framework were conducted with members of the SAB, LAG, administrators and staff from organizations that participated in networks, and older adult participants. Results: After participating in the development of referral networks, participants felt they learned important skills that they can use to develop additional collaborations and networks in the future, emphasized the benefits of building community capacity among organizations with common missions. Interview data yielded strategies on enhancing the referral network's reach, impact, adoption, implementation efficiency, and maintenance. Conclusion: Future sustainability studies of such networks should explore identified challenges and strategies to sustain efforts. Results highlight the importance of ongoing funds to support the efforts of organizational networks in communities.

Determinants of Bluetooth-Enabled Self-Measured Blood Pressure Monitoring in Federally Qualified Health Centers

BACKGROUND

In 2021, the Health Resources and Services Administration (HRSA) launched the National Hypertension Control Initiative (HTN Initiative) with the goal to enhance HTN control through Bluetooth-enabled self-measured blood pressure (BT-SMBP) monitoring and use this data to inform clinical decisions in Federally Qualified Health Centers (FQHCs) with a large proportion of their population with uncontrolled blood pressure (BP). We sought to understand the experience of Michigan-based FQHCs in implementing the HTN initiative.

METHODS

Staff from three Michigan-based FQHCs were invited to participate in semi-structured interviews from September to November 2022. Interviews were conducted in-person and were based on the Tailored Implementation in Chronic Diseases framework. Content analysis was performed by three coders.

RESULTS

Ten staff participated in interviews (FQHC 1: n = 6, FQHC 2: n = 1, FQHC 3: n = 3). The FQHCs differed in their stage of implementation and their approach. FQHC 1 created a large-scale, community health worker driven program, FQHC 2 created a small-scale, short term, BP device loan program, and FQHC 3 created a primarily outsourced, large-scale program through a contracted partner. Positive staff attitudes and outcome expectations, previous experience with SMBP grants, supportive clinic leadership, social support, and free BP cuff resources were identified as facilitators to implementation. Patients' high social needs, SMBP-related Technology, and insufficient workforce and staff capacity were identified as barriers.

CONCLUSION

BT-SMBP among FQHC patients is promising but challenges in integrating SMBP data into clinic workflow, workforce capacity to support the high social needs of participants, and to assist in reacting to the more frequent BP data remain to be overcome.

Determinants of Bluetooth-enabled Self Measured Blood Pressure monitoring in Federally Qualified Health Centers

Background

In 2021, the Health Resources and Services Administration (HRSA) launched the National Hypertension Control Initiative (HTN Initiative) with the goal to enhance HTN control through Bluetooth-enabled self-measured blood pressure (BT SMBP) monitoring and use this data to inform clinical decisions in Federally Qualified Health Centers (FQHCs) with large proportion of their population with uncontrolled BP. We sought to understand the experience of Michigan-based FQHCs in implementing the HTN initiative.

Methods

Staff from three Michigan-based FQHCs were invited to participate in semi-structured interviews from September to November 2022. Interviews were conducted in-person and were based on the Tailored Implementation of Chronic Diseases framework. Content analysis was performed by three coders.

Results

Ten staff participated in interviews (FQHC 1: n=6, FQHC 2: n=1, FQHC 3: n=3). The FQHCs differed in their stage of implementation and their approach. FQHC 1 created a large-scale, community health worker driven program, FQHC 2 created a small-scale, short term, BP device loan program, and FQHC 3 created a primarily outsourced, large-scale program through a contracted partner. Positive staff attitudes and outcome expectations, previous experience with SMBP grants, and supportive clinic leadership were identified as facilitators to implementation; Patients high social needs, SMBP-related Technology, and insufficient workforce and staff capacity were identified as barriers.

Conclusion

BT SMBP among FQHC patients is promising but challenges in integrating SMBP data into clinic workflow, workforce capacity to support the high social needs of participants and to assist in reacting to the more frequent BP data remain to be overcome.

The Experiences of Family Caregivers of Community-Dwelling Older Adults with Dementia in Providing Daily Oral Care

Individuals with dementia increasingly rely on caregivers for daily oral care over time. This study explored the experience of family caregivers of community-dwelling individuals with dementia in providing oral care and their interest in caregiver oral education using the concepts of Social Cognitive Theory. Twenty-three caregivers ages 19-80 participated in a semi-structured qualitative interview that also included a structured questionnaire. Majority of caregivers were female (83%) with an average age of 56 years; 29% were spouses. Fifty-four percent of care recipients had natural teeth only, 42% had teeth and dentures, and 4% had dentures only. Caregivers were generally knowledgeable about the importance of oral health, but some expressed a lack of knowledge in how to perform oral care for others. Caregivers reported high levels of outcome expectation, agreeing that providing oral care would improve care recipient’s oral health. Caregivers expressed mixed levels of self-efficacy; many cited reduced self-efficacy due to resistance or refusal of care. Quantitative data showed that higher confidence in knowledge and oral care skills was associated with greater confidence in providing oral care (r=0.726, p<0.001). Intent to participate in a caregiver oral health education program was associated with positive outcome expectations (r=0.73, p=0.007) and desire to learn the signs and symptoms of mouth pain and infection (r=0.72, p=0.009). Increasing family caregiver’s oral health knowledge and skills, outcome expectations, and self-efficacy to provide care may help improve the oral health of persons with dementia. Additional qualitative and quantitative data and implications for practice will be presented.

Lipid Infusions in Man

The soybean lipid emulsion Intralipid was infused during two hours in 13 volunteer individuals. Biochemically, lipid infusions increased the platelet content of triglycerides, but did not cause significant platelet aggregation, and the platelet counts and survival time were unchanged. However, the lipid infusions reduced platelet and erythrocyte electrophoric mobility, reduced the availability of platelet factor 3 by ADP or kaolin and reduced platelet adhesiveness. A coating of parts of the platelet surface by lipid particles or some other changes in the platelet membrane could explain the effects on platelet electrophoretic mobility, platelet factor 3, and adhesiveness.

Acquired Hemorrhagic Diathesis of Unknown Nature

1) A case of a severe, acquired hemorrhagic diathesis, complicating a carcinoma of the stomach, is reported.

2) The only pathological hemostatic finding was a markedly prolonged bleeding time.

3) Platelets were normal; the capillaries seemed to be normal. There was no increased fibrinolysis, and no other defect in his clotting mechanism could be discovered.

4) The prolonged bleeding time was probably caused by a hitherto undescribed mechanism.

Platelet function related to the development and presenting symptoms in coronary artery disease. An epidemiological study in apparently healthy men

Among 2014 apparently healthy men aged 40-59 years platelet function was studied with Hellem's retention method in 488 men. In 55 of these 488 men coronary heart disease (CHD) was strongly suspected and coronary angiography confirmed the diagnosis in 34 of 51 angiographied men. Platelet responsiveness was significantly lower among those who had angina pectoris than among their CHD-suspect counterparts without angina, regardless of coronary angiographic findings. Since angiopositive men without angina and 408 "normals" had similar retention values, it seems as if presenting symptoms, but not the development of CHD are linked to platelet function. During a near maximal bicycle exercise test significantly higher peak exercise blood pressure was found among men with very low retention values than among men with retention values in the middle and upper range. This could not be explained by differences in maximal heart rate or work performance. This indicates that blood pressure regulation during exercise may in part be linked to platelet function related mechanisms.

ABO blood groups and coronary heart disease (CHD). A study in subjects with severe and latent CHD

The view based on epidemiological and laboratory data that blood group A subjects (=A) have clinically significant higher thrombotic potential than blood group 0 subjects (=O), is supported by the present finding of a significantly higher platelet retention in A than 0. The completely normal AB0 distribution found among 71 cases of proven latent CHD, and the disproportionate excess of 0 vs. A in a consecutive series of 191 coronary artery bypass candidates apparently conflict with epidemiological data indicating a higher risk of achieving CHD in A than 0. The conflict may be solved by suggesting a) that the "thrombotic proneness" in A compared with 0 causes a poorer prognosis in CHD among the former, leaving a disproportionate excess of 0 among longterm CHD survivors, and b) that AB0-related factors have had an insignificant, independent impact on the evolution of preclinical coronary artery disease in our 71 men with latent CHD.

Chronic effect of smoking on platelet count and "platelet adhesiveness" in presumably healthy middle-aged men

In 386 men aged 40-49 years the number of platelets was related to differences in smoking habits. "Platelet adhesiveness" (retention) was estimated by a glass bead filter method in 376 of these men. The estimation of "adhesiveness" was performed in native blood without anticoagulants at least 12 hr after the last cigarette smoked. A small but statistically highly significant increase in platelet count, in number of "adhesive platelets" and percentage of "adhesive platelets" was found in smokers as compared with non-smokers, the highest values being found in the heaviest smokers and vice versa. Such smoking-related changes in platelet count and reactiveness might unfavourably influence the tendency towards coronary thrombosis, and might in part explain the deleterious effects of smoking on coronary heart disease morbidity and mortality.