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Tsai MH, Bevel MS, Andrzejak SE, Moore JX. Receipt of follow-up care plans on colorectal cancer screening among breast, prostate, and lung cancer survivors. J Cancer Surviv 2024; 18:781-790. [PMID: 36574189 PMCID: PMC10293471 DOI: 10.1007/s11764-022-01309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Our study aimed to examine whether receipt of follow-up care plans is associated with greater guideline-concordant CRC screening stratified by breast, prostate, and lung cancer survivors. METHODS We used data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3339 eligible treatment-utilizing cancer survivors with complete treatment. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS We observed that 83.9% of breast and 88.2% of prostate cancer survivors with follow-care plans received CRC screening (p-value < 0.001). The lowest CRC screening use was observed among lung cancer (70.8%). In multivariable analysis, receipt of follow-up care plans was strongly associated with greater odds of receiving CRC screening in breast (OR, 2.67; 95% CI: 1.71-4.16) and prostate (OR, 3.81; 95% CI: 2.30-6.31) cancer survivors. Regardless of provider type, 84 to 88% reduced likelihood of receipt of CRC screening when they received follow-up care plans among lung cancer survivors. Among those without follow-up care plans, breast (OR, 0.29; 95% CI: 0.09-0.92) and lung (OR, 0.05; 95% CI: 0.01-0.25) cancer survivors who received care from general practices were less likely to receive CRC screening compared to those who received care from non-general practices. CONCLUSIONS Receipt of follow-up care plans was associated with greater CRC screening use in breast and prostate cancers. Lung cancer survivors demonstrated lower screening use despite receipt of follow-up care plans. IMPLICATION FOR CANCER SURVIVORS Patient and provider communication regarding CRC screening recommendation should be included in their follow-up care plans.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA.
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA.
| | - Malcolm S Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Justin X Moore
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Institute of Public and Preventive Health, Augusta University, 1120 15Th Street, Augusta, GA, 30912, USA
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Pratt-Chavez H, Rishel Brakey H, Sanders SG, Patel J, Ozechowski T, Stoffel C, Sussman AL, Marquez J, Smith DR, Kong AS. Evaluating a web-based training curriculum for disseminating best practices for the care of newborns with neonatal opioid withdrawal syndrome in a rural hospital, the NOWS-NM Program. BMC Pediatr 2024; 24:258. [PMID: 38641785 PMCID: PMC11027285 DOI: 10.1186/s12887-024-04710-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/13/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The incidence of neonatal opiate withdrawal syndrome (NOWS) in the US has grown dramatically over the past two decades. Many rural hospitals not equipped to manage these patients transfer them to hospitals in bigger cities. METHODS We created a curriculum, the NOWS-NM Program, a web-based curriculum training in best practices. To evaluate the curriculum, we conducted pre- and post-surveys of NOWS knowledge, attitudes, and care practices, plus post-curriculum interviews and focus groups. RESULTS Fourteen participants completed both pre- and post-curriculum surveys. They indicated an increase in knowledge and care practices. A small number of respondents expressed negative attitudes about parents of infants with NOWS at pre-test, the training curriculum appeared to have no impact on such attitudes at post-test. Sixteen participants participated in focus groups or interviews. Qualitative data reinforced the positive quantitative results and contradicted the negative survey results, respondents reported that the program did reduce stigma and improve provider/staff interactions with patients. CONCLUSIONS This curriculum demonstrated positive impacts on NOWS knowledge and care practices. Incorporating focus on core concepts of trauma-informed care and self-regulation in future iterations of the curriculum may strengthen the opportunity to change attitudes and address the needs expressed by participants and improve care of families and babies with NOWS.
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Affiliation(s)
- Heather Pratt-Chavez
- School of Medicine, Department of Pediatrics, University of New Mexico, MSC10 5590, Albuquerque, NM, 87131, USA.
| | - Heidi Rishel Brakey
- Clinical & Translational Science Center, University of New Mexico, MSC08 4635, Albuquerque, NM, 87131, USA
| | - Sarah G Sanders
- School of Medicine, Department of Pediatrics, University of New Mexico, MSC10 5590, Albuquerque, NM, 87131, USA
| | - Juhee Patel
- University of New Mexico School of Medicine, University of New Mexico, MSC08 4560, Albuquerque, NM, 87131, USA
| | - Tim Ozechowski
- School of Medicine, Department of Pediatrics, University of New Mexico, MSC10 5590, Albuquerque, NM, 87131, USA
| | - Chloe Stoffel
- School of Medicine, Department of Pediatrics, University of New Mexico, MSC10 5590, Albuquerque, NM, 87131, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine and the Comprehensive Cancer Center, University of New Mexico, MSC 09 5040, Albuquerque, NM, 87131, USA
| | - Jessie Marquez
- Influents Innovations, 3800 Sports Way, Springfield, OR, 97477, USA
| | - David R Smith
- Influents Innovations, 3800 Sports Way, Springfield, OR, 97477, USA
| | - Alberta S Kong
- School of Medicine, Department of Pediatrics, University of New Mexico, MSC10 5590, Albuquerque, NM, 87131, USA
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Warnimont J, Bhatia N, Korman AM. Non-specific language to describe physicians is uncommon across dermatology residency websites. Arch Dermatol Res 2024; 316:112. [PMID: 38520568 DOI: 10.1007/s00403-024-02833-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Jenna Warnimont
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, CA, USA
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- , 540 Officenter Place, Suite 240, Columbus, OH, 43230, USA.
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Walker Z, Markert T, Berzansky I, Lanes A, Srouji SS. Social media's impact on patient provider choice. J Assist Reprod Genet 2024; 41:649-659. [PMID: 38231286 PMCID: PMC10957839 DOI: 10.1007/s10815-023-03012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE This study aimed to investigate if social media (SM) impacts a patient's provider choice in the field of reproductive endocrinology and infertility (REI). METHODS This was a survey-based study completed in July 2022. A survey link was distributed using Amazon Mechanical Turk, which directed participants to a Qualtrics-based survey. Participants were 18-50 years old. The primary outcome was to identify the preferred method for finding a REI provider based on time spent on SM (< 1 h, 1-3 h, 3 + h). RESULTS A total of 336 responses were analyzed. Fifty-four percent of respondents used SM < 1 h, 33.33% used 1-3 h, and 12.80% used 3 + h. The majority (69.05%) of respondents stated that they would seek out a REI provider/clinic if they had difficulty conceiving. Most respondents identified asking their primary care physician (44.64%) as the primary means for finding an REI provider/clinic and did not prefer to use SM. Although Facebook (< 1 h: 30.94%, 1-3 h: 31.25%, 3 + h: 27.91%) was the most utilized SM platform among respondents, YouTube was the preferred SM platform if respondents were to follow a REI clinic with a preference for posts focusing on education (< 1 h: 55.68%, 1-3 h: 43.12%, 3 + h: 58.14%) or stress management (< 1 h: 17.61%, 1-3 h: 29.36%, 3 + h: 20.94%). CONCLUSION Most respondents utilize traditional methods when choosing their REI provider or clinic and would not utilize SM. However, SM, primarily through YouTube, may be helpful for educating infertility patients and providing support and stress relief while they undergo treatment.
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Affiliation(s)
- Zachary Walker
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA.
| | | | - Isa Berzansky
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Andrea Lanes
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Serene S Srouji
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA
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Warnimont J, Bhatia N, Korman AM. Non-specific language to describe physicians is common across dermatology organization websites. Arch Dermatol Res 2024; 316:72. [PMID: 38217748 DOI: 10.1007/s00403-023-02791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Jenna Warnimont
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, CA, USA
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, 540 Officenter Place, Suite 240, Columbus, OH, 43230, USA.
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Tindyebwa T, Ssempala R, Ssennyonjo A, Mayora C, Muhoozi M, Tusabe J, Mukama P, Freddie S. Expectations of clients, insurers, and providers: a qualitative responsiveness assessment among private health insurance sector in Kampala-Uganda. BMC Health Serv Res 2023; 23:1358. [PMID: 38053178 DOI: 10.1186/s12913-023-10386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND There is less attention to assessing how health services meet the expectations of private health insurance (PHI) actors, clients, insurers, and providers in developing countries. Interdependently, the expectations of each actor are stipulated during contract negotiations (duties, obligations, and privileges) in a PHI arrangement. Complementary service roles performed by each actor significantly contribute to achieving their expectations. This study assessed the role of PHI in meeting the expectations of clients, insurers, and providers in Kampala. Lessons from this study may inform possible reviews and improvements in Uganda's proposed National Health Insurance Scheme (NHIS) to ensure NHIS service responsiveness. METHODS This study employed a qualitative case-study design. Eight (8) focus group discussions (FGDs) with insured clients and nine (9) key informant interviews (KIIs) with insurer and provider liaison officers between October 2020 and February 2021 were conducted. Participants were purposively selected from eligible institutions. Thematic analysis was employed, and findings were presented using themes with corresponding anonymized narratives and quotes. RESULTS Client-Provider, Client-Insurer, and Provider-Insurer expectations were generally not met. Client-provider expectations: Although most facilities were clean with a conducive care environment, clients experienced low service care responsiveness characterized by long waiting times. Both clients and providers received inadequate feedback about services they received and delivered respectively, in addition to prompt care being received by a few clients. For client-insurer expectations, under unclear service packages, clients received low-quality medicines. Lastly, for provider-insurer expectations, delayed payments, selective periodic assessments, and inadequate orientation of clients on insurance plans were most reported. Weak coordination between the client-provider and insurer did not support delivery processes for responsive service. CONCLUSION Health care service responsiveness was generally low. There is a need to commit resources to support the setting up of clearer service package orientation programs, and efficient monitoring and feedback platforms. Uganda's proposed National Health Insurance Act may use these findings to: Inform its design initiatives focusing on operating under realistic expectations, investment in quality improvement systems and coordination, and efficient and accountable client care relationships.
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Affiliation(s)
- Tonny Tindyebwa
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
| | - Richard Ssempala
- Department of Economic Theory and Analysis, School of Economics, Makerere University, Kampala, Uganda
| | - Aloysius Ssennyonjo
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Chrispus Mayora
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Micheal Muhoozi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Joan Tusabe
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Paul Mukama
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Ssengooba Freddie
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
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Stark S, Lehmann Y. ["Ensuring patient safety is one of our primary responsibilities." - Results of a qualitative study on maintaining safety in ventilation-associated technical aid supply]. Z Evid Fortbild Qual Gesundhwes 2023; 182-183:53-62. [PMID: 37926622 DOI: 10.1016/j.zefq.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Maintaining safety is critical in home mechanical ventilation (HMV). It is co-determined by the availability of reliable technical aids and their correct application. Ensuring safe aid supply is part of the aid providers'́ legal mandate. However, whether and how this is achieved is largely unknown. Therefore, the tasks of technical aid providers, associated requirements and challenges with special regards to educational and safety aspects were investigated. METHODS For this purpose, episodic interviews were conducted between July and December 2020 with a purposive sample of field representatives of eleven technical aid providers. Between one and six persons participated in each of the interviews, resulting in a total sample of 25 persons (14 field representatives without management function, ten with management function, one director). Given the conditions during the COVID-19 pandemic, six interviews took place face-to-face and five as web meetings. Interviews were analysed using qualitative content analysis. RESULTS From the interviewees'́ perspective, the most important safety-related measure is the legally required and individually tailored initial instruction in a safe aid application. Additional safety-related tasks comprise counselling, e. g. for prescribing physicians and users (patients, relatives, nursing service employees), regular home visits, and the provision of a technical emergency service. Interviewees indicate that safety risks emerge primarily from a lack of skills and a high staff turnover among professional caregivers. This, they state, challenges building up and maintaining competencies among nursing staff. Other safety risks arise from healthcare fragmentation, lacking coordination, cooperation, and accountability of the professionals involved. Respondents address these challenges pragmatically by providing additional services, like ongoing caregiver training, care coordination and support roles. DISCUSSION Maintaining safety in ventilation-associated technical aid supply must be considered a crucial component of the overall HMV care processes, in which safety currently cannot be taken for granted. Field representatives of technical aid providers address the existing challenges with selective and intuitive strategies, some of which exceed their legal mandate. CONCLUSION Improving safety in home care can be supported by establishing Advanced Nursing Practice roles in nursing services. The systematic further development of roles and tasks of staff of technical aid providers should be clarified within an overarching discourse on viable approaches to cross-sectoral and interprofessional HMV care.
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Affiliation(s)
- Susanne Stark
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, QUEST Center for Responsible Research, Berlin, Deutschland; Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Deutschland.
| | - Yvonne Lehmann
- BBG Berliner Bildungscampus für Gesundheitsberufe gGmbH, Berlin, Deutschland; Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Deutschland
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Aziz MM, El-Gazzar AF. Provider bias and family planning in Upper Egypt: a simulated client approach. J Egypt Public Health Assoc 2023; 98:19. [PMID: 37777657 PMCID: PMC10542042 DOI: 10.1186/s42506-023-00144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/17/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Provider bias is a main barrier that extensively violates the right of free family planning method choice. Egypt is one of the countries that shows skewness in its method mix. Provider bias and insufficiency of alternative methods are identified as potential factors underlying this phenomenon which contributes to high unmet needs and discontinuation rates. Provider bias may be influenced by cultural beliefs and societal trends and is usually overlooked as a possible cause of this skewed method mix. This study aims to explore the presence of provider bias in rural Upper Egypt and its potential causes, a community with conservative cultural beliefs and least contraceptive prevalence rates. METHODS This is a qualitative study using the "simulated client's approach." The study was conducted in 16 villages in Assiut and Sohag governorates in Egypt. The simulated clients visited 30 clinics, 15 in each governorate, including primary healthcare units and private clinics. Three scenarios were used to explore the physicians-imposed restrictions for contraceptive use with different clients' eligibility criteria. Data was analyzed using the grounded theory methodology. RESULTS Recommending a contraceptive method for the mystery clients was not based on informed choice. Most providers had method or client bias. Copper IUD was the most favorable contraceptive method recommended by providers, with negative attitude towards using hormonal contraception. Nulliparous and young clients were discouraged to use contraception before proving fertility or offered temporary methods as emergency contraception or condoms. Providers have shown misconceptions related to infertility-associated complications of contraceptive use, especially for the young and nulliparous women. CONCLUSION In this study, providers had a clear bias towards recommending IUD rather than all other contraceptive methods, which was hindered in some cases by the lack of insertion skills. Interventions to reduce provider bias should go beyond technical training. Moreover, training on reproductive rights should be a main component of routine training. Providers should regularly receive research results and be oriented toward recent medical eligibility criteria of contraceptive methods use. Moreover, the sociocultural beliefs of providers that may affect their practice should be explored and addressed.
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Affiliation(s)
- Mirette M Aziz
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt
| | - Amira F El-Gazzar
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt.
- Department of Public Health and Community Medicine, Badr University in Cairo, Badr City, Egypt.
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Klee D, Pyne D, Kroll J, James W, Hirko KA. Rural patient and provider perceptions of telehealth implemented during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:981. [PMID: 37700286 PMCID: PMC10496200 DOI: 10.1186/s12913-023-09994-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Understanding perceptions of telehealth implementation from patients and providers can improve the utility and sustainability of these programs, particularly in under-resourced rural settings. The purpose of this study was to evaluate both patient and provider perceptions of telehealth visits in a large rural healthcare system during the COVID-19 pandemic. To promote sustainability of telehealth approaches, we also assessed whether the percentage of missed appointments differed between in-person and telehealth visits. METHODS Using anonymous surveys, we evaluated patient preferences and satisfaction with telehealth visits from November 2020 -March 2021 and assessed perceptions of telehealth efficiency and value among rural providers from September-October 2020. We examined whether telehealth perceptions differed according to patients' age, educational attainment, insurance status, and distance to clinical site and providers' age and length of time practicing medicine using ANOVA test. We also examined whether the percentage of missed appointments differed between in-person and telehealth visits at a family practice clinic within the rural healthcare system from April to September 2020 using a Chi-square test. RESULTS Over 73% of rural patients had favorable perceptions of telehealth visits, and satisfaction was generally higher among younger patients. Patients reported difficulty with scheduling follow-up appointments, lack of personal contact and technology challenges as common barriers. Over 80% of the 219 providers responding to the survey reported that telehealth added value to their practice, while 36.6% agreed that telehealth visits are more efficient than in-person visits. Perception of telehealth value and efficiency did not differ by provider age (p = 0.67 and p = 0.67, respectively) or time in practice (p = 0.53 and p = 0.44, respectively). Technology challenges for the patient (91.3%) and provider (45.1%) were commonly reported. The percentage of missed appointments was slightly higher for telehealth visits compared to in-person visits, but the difference was not statistically significant (8.7% vs. 8.0%; p = 0.39). CONCLUSIONS Telehealth perceptions were generally favorable among rural patients and providers, although satisfaction was lower among older patients and providers. Our findings suggest that telehealth approaches may add value and efficiency to rural clinical practice. However, technology issues for both patients and providers and gaps in care coordination need to be addressed to promote sustainability of telehealth approaches in rural practice.
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Affiliation(s)
- David Klee
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA.
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
- , 1400 Medical Campus Drive, Traverse City, MI, 49684, USA.
| | - Derek Pyne
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - Joshua Kroll
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - William James
- Munson Medical Center, Munson Healthcare, Traverse City, MI, USA
| | - Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Hastert TA, Nair M, Eggly S. Providers' communication-related concerns in helping patients address the financial impact of cancer. Patient Educ Couns 2023; 114:107860. [PMID: 37421848 DOI: 10.1016/j.pec.2023.107860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES This study describes the communication-related concerns of oncology providers in addressing financial issues with patients. METHODS We conducted semi-structured interviews with 17 providers (9 clinicians, 5 social workers/navigators, 3 attorneys) who addressed financial concerns with cancer patients and analyzed resulting transcripts using qualitative thematic analysis. Interview topics included cost-related concerns of patients, resources providers used, and unmet needs related to addressing financial issues. Here we present codes and content related to a cross-cutting cost communication, stratified by provider discipline. RESULTS Communication-related issues varied by provider type. Clinicians identified lack of information, lack of time, and the need for additional support as major barriers to effective cost discussions. Social workers/navigators expressed the importance of establishing a relationship before discussing costs and on the need to revisit cost concerns over time to meet patients' changing needs. The attorneys endorsed the need for more and earlier cost communication to prevent financial hardship. CONCLUSION Communication concerns and strategies were central to providers' experiences of addressing cancer patient cost concerns. PRACTICE IMPLICATIONS Understanding the experiences of diverse oncology providers can inform the development and implementation of interventions to prevent and mitigate financial hardship in people with cancer.
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Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.
| | - Mrudula Nair
- Department of Public Health Sciences, Henry Ford Medical Group, Detroit, MI, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
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Beauchamp G, Donnell D, Hosek S, Anderson PL, Chan KCG, Dye BJ, Mgodi N, Bekker LG, Delany-Moretlwe S, Celum C. Trust in the provider and accurate self-reported PrEP adherence among adolescent girls and young women in South Africa and Zimbabwe: HPTN 082 study. BMC Womens Health 2023; 23:276. [PMID: 37208687 PMCID: PMC10199602 DOI: 10.1186/s12905-023-02418-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Trust is an important cornerstone of patient-provider communication. Accurate reporting of pre-exposure prophylaxis (PrEP) adherence is vital for providers to determine who needs adherence support, especially adolescent girls and young women (AGYW) disproportionately affected by newly diagnosed HIV. METHODS This is a secondary analysis of the HPTN 082 open-label PrEP demonstration trial. From 2016-2018, 451 AGYW aged 16-25 years were enrolled in South Africa (Cape Town and Johannesburg) and Zimbabwe (Harare). PrEP was initiated by 427, and 354 (83%) had month three patient-reported adherence responses and intracellular tenofovir diphosphate (TFV-DP) measurements. The patient-reported adherence response to 'In the past month, how often did you take the tablet?' was dichotomized as 'high' if the response was every day or most days, and 'low' if some days or not many days or never. The biomarker marker evidence of adherence in dried blood spots was defined as 'high' if TFV-DP ≥ 700, and 'low' if < 350 fmol/punch. We used multinomial logistic regression to examine if trust in the PrEP provider was associated with concordance between patient-reported adherence and intracellular tenofovir-diphosphate (TFV-DP). RESULTS AGYW who reported trust in their providers were almost four-fold (aOR 3.72, 95% CI 1.20-11.51) more likely to have concordant adherence (high self-reported adherence and high TFV-DP concentrations) compared to discordant non-adherence (high self-reported adherence and low TFV-DP concentrations). CONCLUSION Education and training of providers to build trusting relationships with AGYW may lead to more accurate reporting of PrEP adherence. With accurate reporting, adequate support can be provided to bolster adherence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02732730.
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Affiliation(s)
- Geetha Beauchamp
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, WA, 98109, Seattle, USA.
| | - Deborah Donnell
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, WA, 98109, Seattle, USA
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Kwun C G Chan
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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12
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Yule AM, Basaraba C, Mail V, Bereznicka A, Cates-Wessel K, Levin FR. A cross sectional survey of provider experiences with patient drug overdose death. J Subst Use Addict Treat 2023; 148:209008. [PMID: 36921768 PMCID: PMC10423649 DOI: 10.1016/j.josat.2023.209008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION A record number of drug overdose (OD) deaths occurred in the United States in 2021. We know little regarding the impact of patient drug OD deaths on providers within health care settings. The aim of this study was to assess provider preparedness and experience with patient drug OD death. METHODS The study distributed an email invitation to individuals in the Provider Clinical Support System database in December 2020 to complete an anonymous web-based survey. We used multiple choice questions to assess provider demographics, preparedness to cope with patient OD death, and experience with patient OD death. The study evaluated stress associated with patient OD death using the Impact of Event Scale-Revised. We summarized responses using descriptive statistics. Associations between high stress after patient OD death and the impact of the death on clinical practice and the helpfulness of individuals and processes were assessed using Chi-square and Fisher's Exact tests. RESULTS Among the 12,204 individuals who read the email invitation, 1064 opened the survey link, and 523 completed the survey. Participants were predominantly physicians (40.2 %) and counselors (25 %), 70 % female, 78.4 % white, with a mean age of 52 years. Among the participants 26.4 % felt at least very well prepared to cope with an OD death, and 27.7 % felt at least very well prepared to support a colleague with a patient OD death. Most respondents (55.1 %) had a history of a patient OD death. Many patient OD deaths were not discussed by providers with other colleagues, but when providers did discuss these deaths providers identified colleagues as being very helpful. Compared to providers with low stress after patient OD death, those with high levels of stress were more likely to refer patients to a higher level of care (p = 0.035). CONCLUSIONS Many providers did not feel prepared themselves to cope with a patient OD death or support a colleague following this type of event. Patient OD deaths were a common experience, and providers did not frequently discuss their patient's deaths with others. A patient OD death can change clinical decision-making for providers experiencing high levels of stress related to the OD death.
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Affiliation(s)
- Amy M Yule
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Boston, MA 02118, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.
| | - Cale Basaraba
- Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Victoria Mail
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Boston, MA 02118, USA
| | - Agata Bereznicka
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Boston, MA 02118, USA; Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Kathryn Cates-Wessel
- American Academy of Addiction Psychiatry, 400 Massasoit Ave #307, East Providence, RI 02914, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
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13
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Williamson TJ, Walsh LE, Rawl SM, Carter-Bawa L. Slipping through the cracks: Who is eligible but does not receive a healthcare provider recommendation for lung cancer screening? Lung Cancer 2023; 179:107185. [PMID: 37023535 PMCID: PMC10219439 DOI: 10.1016/j.lungcan.2023.107185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Receiving a healthcare provider recommendation to screen is an important predictor for whether individuals at high risk for lung cancer undergo lung cancer screening. Although sociodemographic and socioeconomic characteristics are associated with differential screening participation, it is unknown whether those characteristics are associated with receiving a healthcare provider recommendation for lung cancer screening. METHODS This cross-sectional study used Facebook-targeted advertising to recruit a national sample of lung cancer screening-eligible adults (N = 515) who completed questionnaires on sociodemographic information (age, gender, race, marital status), socioeconomic characteristics (income, insurance status, education, rurality of residence), smoking status, and receiving a healthcare provider recommendation to screen. Pearson's chi-square tests and independent samples t-tests evaluated whether sociodemographic, socioeconomic, and smoking-related characteristics were associated significantly with receiving a healthcare provider recommendation to screen. RESULTS Higher household income, having insurance coverage, and being married were associated significantly with receiving a healthcare provider recommendation to screen (all p <.05). Age, gender, race, education, rurality of residence, and smoking status were not associated significantly with receiving a recommendation to screen. DISCUSSION Particular subgroups of individuals at high risk for lung cancer-including those with lower income, without insurance coverage, and who are not married-are less likely to receive a recommendation to screen from their healthcare provider, despite being at high risk for lung cancer and eligible for screening. Future research should test whether differential screening participation and low screening uptake could be addressed by clinician-focused interventions that encourage ubiquitous discussion and recommendation to undergo screening for people at high risk for lung cancer.
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Affiliation(s)
- Timothy J Williamson
- Department of Psychological Science, Loyola Marymount University, Los Angeles, CA, USA; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Leah E Walsh
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Psychology, Fordham University, Bronx, NY, USA
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis, IN, USA; Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Lisa Carter-Bawa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Cancer Prevention Precision Control Institute, Center for Discovery & Innovation at Hackensack Meridian Health, Nutley, NJ, USA
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14
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Morales-Campos DY, Zimet GD, Kahn JA. Human Papillomavirus Vaccine Hesitancy in the United States. Pediatr Clin North Am 2023; 70:211-226. [PMID: 36841591 DOI: 10.1016/j.pcl.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Although the US Advisory Committee on Immunization Practices recommends vaccinating adolescents against the human papillomavirus (HPV) to prevent HPV-associated cancers, vaccine initiation and completion rates are suboptimal. Parental and provider hesitancy contributes significantly to low HPV vaccine uptake. This review describes sources of HPV vaccine hesitancy using a World Health Organization framework that categorizes determinants of vaccine hesitancy as follows: contextual factors (historical, sociocultural, environmental, or political factors), individual and group factors (personal perception or influences of the social/peer environment), and vaccine/vaccination-specific issues (directly related to vaccine or vaccination).
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Affiliation(s)
- Daisy Y Morales-Campos
- Department of Mexican American and Latino/a Studies, Latino Research Institute, The University of Texas at Austin, 210 West 24th Street, GWB 1.102, F9200, Austin, TX 78712, USA.
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, USA
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15
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Ferrucci KA, McPhillips E, Lapane KL, Jesdale BM, Dubé CE. Provider perceptions of barriers and facilitators to care in eating disorder treatment for transgender and gender diverse patients: a qualitative study. J Eat Disord 2023; 11:36. [PMID: 36890569 PMCID: PMC9993680 DOI: 10.1186/s40337-023-00760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The prevalence of eating disorders is higher in transgender and non-binary compared to cisgender people. Gender diverse people who seek eating disorder treatment often report struggling to find affirming and inclusive treatment from healthcare clinicians. We sought to understand eating disorder care clinicians' perceptions of facilitators of and barriers to effective eating disorder treatment for transgender and gender diverse patients. METHODS In 2022, nineteen US-based licensed mental health clinicians who specialized in eating disorder treatment participated in semi-structured interviews. We used inductive thematic analysis to identify themes around perceptions and knowledge of facilitators and barriers to care for transgender and gender diverse patients diagnosed with eating disorders. RESULTS Two broad themes were identified: (1) factors affecting access to care; and (2) factors affecting care while in treatment. Within the first theme, the following subthemes were found: stigmatization, family support, financial factors, gendered clinics, scarcity of gender-competent care, and religious communities. Within the second theme, prominent subthemes included discrimination and microaggressions, provider lived experience and education, other patients and parents, institutions of higher education, family-centered care, gendered-centered care, and traditional therapeutic techniques. CONCLUSION Many barriers and facilitators have potential to be improved upon, especially those caused by clinicians' lack of knowledge or attitudes towards gender minority patients in treatment. Future research is needed to identify how provider-driven barriers manifest and how they can be improved upon to better patient care experiences.
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Affiliation(s)
- Katarina A Ferrucci
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Emily McPhillips
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Catherine E Dubé
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
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16
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Vasudevan L, Bruening R, Hung A, Woolson S, Brown A, Hastings SN, Linton T, Embree G, Hostler CJ, Mahanna E, Okeke NL, Bosworth H, Sperber NR. COVID-19 vaccination intention and activation among health care system employees: A mixed methods study. Vaccine 2022; 40:5141-5152. [PMID: 35902277 PMCID: PMC9276645 DOI: 10.1016/j.vaccine.2022.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Achieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees. METHODS The study was conducted from December 2020 - May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4-6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion. RESULTS Prior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as "immunization advocates", 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention. CONCLUSION The findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population.
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Affiliation(s)
- Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Duke Human Vaccine Institute, Durham, NC, USA.
| | - Rebecca Bruening
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Woolson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Adrian Brown
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Geriatrics Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Tammy Linton
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Office of Public Health and Epidemiology, Durham VA Health Care System, Durham, NC, USA
| | - Genevieve Embree
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Office of Public Health and Epidemiology, Durham VA Health Care System, Durham, NC, USA
| | - Christopher J Hostler
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Office of Public Health and Epidemiology, Durham VA Health Care System, Durham, NC, USA
| | - Elizabeth Mahanna
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Nwora Lance Okeke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Hayden Bosworth
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke-Margolis Center for Health Policy, Durham, NC, USA
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17
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Ahmed FZ, Andraka-Christou B, Clark MH, Totaram R, Atkins DN, Del Pozo B. Barriers to medications for opioid use disorder in the court system: provider availability, provider "trustworthiness," and cost. Health Justice 2022; 10:24. [PMID: 35895179 PMCID: PMC9327334 DOI: 10.1186/s40352-022-00188-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) significantly decrease mortality but courts rarely refer participants with opioid use disorder to MOUD providers. Previous qualitative work suggests routine court referrals to MOUD providers are more likely if court team members perceive providers as "trustworthy." Court team members may also be less likely to refer participants to MOUD if they consider MOUD unaffordable, particularly in Florida, which has not expanded Medicaid. Our aims were to explore court team members' 1) perceptions of availability of local trustworthy MOUD providers, 2) characteristics associated with perceptions of availability of local trustworthy MOUD providers, including beliefs about MOUD efficacy, and 3) perceptions of MOUD affordability. METHODS An online survey was distributed to all criminal problem-solving court and dependency court team members in Florida in 2019 and 2020. Likert scale questions assessed respondent agreement with statements about the availability of any MOUD providers, the availability of trustworthy MOUD providers, and the affordability of MOUD for court participants. An open-ended question explored MOUD barriers. Spearman's rho, Friedman, Kruskal Wallis, and Mann-Whitney U tests were used for analyzing quantitative data and iterative categorization for qualitative data. RESULTS One hundred fifty-one respondents completed quantitative questions (26% response rate), and 42 completed the qualitative question. Respondents were more likely to agree that local MOUD providers are more available than trustworthy MOUD providers. Perceptions of trustworthy provider availability differed significantly by MOUD type and were associated with MOUD efficacy beliefs. Qualitative results suggest that MOUD providers offering counseling and individualized treatment are more trustworthy. CONCLUSIONS Court team MOUD beliefs may influence their perceptions of providers, or negative experiences with providers may influence court team MOUD beliefs. Improving court team perceptions of local MOUD providers may be critical for facilitating court participant treatment access.
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Affiliation(s)
- Fatema Z Ahmed
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA.
| | - Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA
- Department of Internal Medicine (Joint Secondary Appointment), University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - M H Clark
- Department of Learning Sciences & Educational Research, University of Central Florida, 12494 University Blvd, Orlando, FL, 32816, USA
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA
| | - Danielle N Atkins
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA
| | - Brandon Del Pozo
- Warren Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, 02903, USA
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18
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Huang Q, Gilkey MB, Thompson P, Grabert BK, Dailey SA, Brewer NT. Explaining higher Covid-19 vaccination among some US primary care professionals. Soc Sci Med 2022; 301:114935. [PMID: 35334260 PMCID: PMC8933282 DOI: 10.1016/j.socscimed.2022.114935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Background and objective Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference. Methods In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11–17. The national sample included physicians (71%) as well as nurses and advanced practice providers. The survey assessed the three domains of the Increasing Vaccination Model: thinking and feeling, social processes, and direct behavior change. Results Covid-19 vaccine uptake was higher among physicians than among nurses and advanced practice providers (91% vs. 76%, p < .05). Overall, in the thinking and feeling domain, higher confidence in Covid-19 vaccination, higher perceived susceptibility to the disease, and stronger anticipated regret were associated with higher vaccine uptake (all p < .05). In the social processes domain, perceiving more positive social norms for Covid-19 vaccination, receiving recommendations to get the vaccine, and wanting to help others were associated with higher vaccine uptake (all p < .05). In the direct behavior change domain, receiving an invitation to get the vaccine and better access to vaccination were associated with higher uptake (both p < .05). Of these variables, most of the thinking and feeling and social processes variables mediated the association of training with vaccine uptake. Conclusions Physicians had higher Covid-19 vaccine uptake than nurses and advanced practice providers, corresponding with their more supportive vaccine beliefs and social experiences. Efforts to reach the remaining unvaccinated cohort can build on these findings.
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Affiliation(s)
- Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, School of Medicine, University of North Carolina, USA
| | - Brigid K Grabert
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA.
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Stawiarski K, Priyadharshini Jeyashanmugaraja G, Edwards K, Bindelglass G, Lancaster G. Improved Physician Understanding of Patient End-of-Life Preferences: A Quality Improvement Project. J Pain Symptom Manage 2021; 62:1289-1294. [PMID: 34118369 DOI: 10.1016/j.jpainsymman.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Code status (CS) orders lack a universal definition. We aimed to improve provider understanding of order options. MEASURES Provider's knowledge of CS terminology, ease of understanding CS orders and ease of starting CS discussions. INTERVENTION A multifaceted intervention including 1) altered CS order language in the electronic medical record (EMR) from "Full Interventions," "Limited Interventions," and "Comfort Measures Only" to "Full advanced cardiovascular life support (ACLS)," "Partial ACLS," and "No ACLS" 2) clinical tools for CS identification 3) provider education. OUTCOMES Correct provider response rate for "Partial ACLS" and "No ACLS" terms increased from 43.5 to 60% and 20 to 71% (odds ratio 1.95; 95% confidence interval 0.99-3.83; P = 0.03, OR 9.8; CI 4.48-21.49; P < 0.001). The proportion of providers who felt understanding CS orders and starting conversations about CS was "very easy" (a score of 1-3 on a scale of 1 to 10) improved from 26.1 to 45.7% (P = 0.01) and 49.3 to 65.7% (P = 0.03). CONCLUSIONS/LESSONS LEARNED Provider understanding of CS options can be improved with a combined QI intervention.
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Affiliation(s)
- Kristin Stawiarski
- Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT.
| | | | - Kristin Edwards
- Section of Geriatrics and Palliative Care, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT
| | - Gloria Bindelglass
- Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT
| | - Gilead Lancaster
- Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT
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Lacombe-Duncan A, Logie CH, Persad Y, Leblanc G, Nation K, Kia H, Scheim AI, Lyons T, Horemans C, Olawale R, Loutfy M. Implementation and evaluation of the 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)' provider education pilot. BMC Med Educ 2021; 21:561. [PMID: 34732178 PMCID: PMC8566115 DOI: 10.1186/s12909-021-02991-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/21/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)'. This theoretically-informed community-developed intervention aimed to increase providers' gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV. METHODS Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons. RESULTS The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12-10.86, p < 0.001, possible score range: 16-96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD = 3.21; 95% CI of MD: 1.90-4.90, p < 0.001, possible score range: 9-63). Greater change in outcome measures from pre- to post-intervention was experienced by those with fewer trans and transfeminine clients served in the past year, in indirect service roles, and having received less prior training. CONCLUSIONS This brief healthcare and social service provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases, particularly among those with less trans and HIV experience. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care, increase healthcare access, and reduce HIV disparities among trans women. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04096053 ).
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA.
- Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI, 48109-5482, USA.
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada.
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, M5S 1V4, Canada
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
| | - Gabrielle Leblanc
- Action Santé Travesti(e)s & Transsexuel(le)s du Québec (ASTT(E)Q), 1300 Sanguinet, Montréal, H2X 3E7, Canada
| | - Kelendria Nation
- Prism Education Series, Vancouver Coastal Health, 1128 Hornby Street, Vancouver, V6Z 2L4, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, V6T 1Z2, Canada
| | - Ayden I Scheim
- Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Tara Lyons
- Center for Gender & Sexual Health Equity (CGSHE), 1190 Hornby Street, Vancouver, V6Z 2K5, Canada
- Department of Criminology, Kwantlen Polytechnic University, 12666 72 Avenue, Surrey, V3W 2M8, Canada
| | - Chavisa Horemans
- CIHR Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
| | - Ronke Olawale
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109-1106, USA
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario, M5G 1N8, Canada
- Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
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21
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Lee RE, Parker NH, Hallett AM, Kao D, Modelska MJ, Rifai HS, Soltero EG, O'Connor DP. Stakeholder perspectives and sustainability of an integrated care model for the prevention and management of obesity: the Childhood Obesity Research Demonstration (CORD) project. Transl Behav Med 2021; 11:393-407. [PMID: 32667038 DOI: 10.1093/tbm/ibaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability of implemented programming, the importance of intervening in multiple settings, and ongoing implementation and evaluation strategies. Replicability of complex childhood obesity interventions is possible when there are strong partnerships. Benefits can continue to be conferred from programming, particularly when evidence-based strategies are used that employ best practices. Implementation is facilitated by institutionalization and policies that buffer challenges, such as staffing or leadership changes. Community capacity both enhances the sustainability of interventions and develops as a result of strengthening partnerships and policies that support childhood obesity programming.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Nathan H Parker
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allen M Hallett
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, USA
| | - Dennis Kao
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Maria J Modelska
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Hanadi S Rifai
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Erica G Soltero
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
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22
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Abstract
Identifying reforms that minimize US healthcare costs is imperative. This commentary explores one intervention with potential cost-saving implications that has received comparably minimal consideration: spiritual care provision. It highlights the staff and patient costing benefits of spiritual care in addressing spiritual distress and urges practical policy and research initiatives to maximize its impact.
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Affiliation(s)
- Eric J. Hall
- HealthCare Chaplaincy Network and Spiritual Care Association, 505 8th Ave, 9th floor, New York, NY 10016 USA
| | - Richard A. Powell
- Department of Primary Care & Public Health, Imperial College London, NIHR Applied Research Center Northwest London, Charing Cross Campus, The Reynolds Building, St Dunstan’s Road, London, England
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23
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Milford C, Beksinska M, Greener R, Pienaar J, Rambally Greener L, Mabude Z, Smit J. Fertility desires of people living with HIV: does the implementation of a sexual and reproductive health and HIV integration model change healthcare providers' attitudes and clients' desires? BMC Health Serv Res 2021; 21:509. [PMID: 34039312 PMCID: PMC8157636 DOI: 10.1186/s12913-021-06487-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background There is a need for information and healthcare support for the fertility desires and contraceptive needs of people living with HIV (PLHIV) in order to provide safer conception support for sero-discordant couples wanting to safely conceive. A model to integrate sexual and reproductive health and HIV services was developed and implemented in a district hospital and six clinics in the eThekwini District, South Africa. Methods To evaluate the model’s success, a cross-sectional survey was conducted before and after implementation of the model. As part of this evaluation, fertility desires of PLHIV (both male and female), and providers’ perspectives thereof were explored. Changes in desires and attitudes after integration of services were investigated. Results Forty-six healthcare providers and 269 clients (48 male, 221 female) were surveyed at baseline, and 44 providers and 300 clients (70 male, 230 female) at endline. Various factors including relationship status, parity and antiretroviral treatment (ART) access influenced PLHIVs’ desires for children. Concerns for their own and their child’s health negatively impacted on PLHIV’s fertility desires. These concerns declined after integration of services. Similarly, providers’ concerns about PLHIV having children decreased after the implementation of the model. Conclusions Integrated services are important to facilitate provision of information on contraceptive options as well as safer conception information for PLHIV who want to have children. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06487-0.
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Affiliation(s)
- Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa.
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa
| | - Ross Greener
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa
| | - Jacqueline Pienaar
- The Aurum Institute, Johannesburg, South Africa.,The Centre for HIV-AIDS Prevention Studies, Johannesburg, South Africa
| | - Letitia Rambally Greener
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa
| | - Zonke Mabude
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa
| | - Jennifer Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Commercial City Building, 40 Dr AB Xuma Street, Durban, 4001, South Africa
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24
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Pitts MA, Sashidhar S, Hudak P, Blood-Siegfried J. Early Peanut Protein Introduction in Clinical Practice. J Pediatr Nurs 2020; 55:95-99. [PMID: 32721769 DOI: 10.1016/j.pedn.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE New multiple agency recommendations have encouraged the early introduction of peanut protein (PP) in high-risk children to decrease peanut allergies. However, many providers are hesitant to use these recommendations. Our objective was to increase the recommendation of new guidelines by providers during routine infant care and evaluate caregiver acceptance of early PP introduction. DESIGN AND METHODS This QI project focused on changing providers' knowledge and attitudes as a means to change practice using the "Plan-Do-Study-Act" model. Following provider educational sessions in 4 clinical sites providers and caregivers were questioned about instruction on the introduction of PP. Pre and post educational intervention data were collected from providers using chart audit and caregivers' report through the modified Promoting Healthy Development Survey (PHDS). RESULTS The educational intervention was effective in increasing provider knowledge (p < .05), providers' dissemination of knowledge to caregivers through provider report (p < .001) and caregiver report (p < .05). CONCLUSIONS Education increased providers' knowledge about the safety and importance of early introductions of PP, and allayed fears about initiating an allergic reaction. The increased provider recommendation to caregivers was validated by both provider and caregiver report. Caregivers felt comfortable initiating peanut protein. PRACTICE IMPLICATIONS Provider education led to increased recommendation to caregivers on early introduction of PP and increased caregiver comfort introducing PP.
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Affiliation(s)
- Melanie Ann Pitts
- Kids First Pediatrics of Fayetteville, NC, United States of America; Kids First Pediatrics of Fayetteville at Village One, NC, United States of America; Kids First Pediatrics of Raeford, NC, United States of America; Legacy Pediatrics, NC, United States of America; Duke University School of Nursing, NC, United States of America.
| | - Sreelekha Sashidhar
- Kids First Pediatrics of Fayetteville, NC, United States of America; Kids First Pediatrics of Fayetteville at Village One, NC, United States of America; Kids First Pediatrics of Raeford, NC, United States of America; Legacy Pediatrics, NC, United States of America
| | - Priscilla Hudak
- Kids First Pediatrics of Fayetteville, NC, United States of America; Kids First Pediatrics of Fayetteville at Village One, NC, United States of America; Kids First Pediatrics of Raeford, NC, United States of America; Legacy Pediatrics, NC, United States of America
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25
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Bingemann T, Sharma H, Nanda A, Khan DA, Markovics S, Sussman J, Murphy A, Kalman D, Mosnaim G. AAAAI Work Group Report: Physician Wellness in Allergy and Immunology. J Allergy Clin Immunol Pract 2020; 8:1224-1229. [PMID: 32067926 DOI: 10.1016/j.jaip.2020.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Physician health and wellness can be negatively impacted by burnout, which, in turn, can lead to medical errors and early retirement. Burnout issues can start in medical school and progress during residency, fellowship, and throughout a physician's career. Previous studies have reported burnout rates between 45% and 54% for US physicians in general. However, there is currently little data regarding health and wellness specifically in the field of allergy and immunology. OBJECTIVE This workgroup report was developed to assess health and wellness in our specialty. METHODS The American Academy of Allergy, Asthma, and Immunology (AAAAI) electronically distributed an anonymous questionnaire using the validated mini-Z survey to a random sample of 1035 fellows and members. In addition to the mini-Z items, the survey queried personal and professional demographic characteristics, and included open-ended wellness questions. RESULTS A total of 138 fellows and members of the AAAAI completed the survey, yielding a 13% response rate. The burnout rate was 35%, which is lower than the national average among US physicians, and is overall encouraging. However, there is room for improvement. Limitations of the study include a small sample size as well as evolving definitions of burnout. CONCLUSIONS Our results identify specialty specific concerns and can be used to inform the development of tailored interventions to improve wellness and minimize burnout. However, future surveys with a larger sample size are needed to obtain a more robust data set on allergy and immunology specific wellness challenges.
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Affiliation(s)
- Theresa Bingemann
- Division of Allergy and Immunology, Rochester General Hospital, and University of Rochester School of Medicine, Rochester, NY
| | - Hemant Sharma
- Division of Allergy and Immunology, Children's National Medical Center, Washington, DC
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - David A Khan
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - James Sussman
- Allergy Partners of New Mexico, Santa Fe, NM; University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Denise Kalman
- Division of Allergy and Immunology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Del
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Northshore University Health System, Evanston, Ill
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26
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Malik AT, Baek J, Alexander JH, Khan SN, Scharschmidt TJ. Orthopaedic vs. Neurosurgery - Does a surgeon's specialty have an influence on 90-day complications following surgical intervention of spinal metastases? Clin Neurol Neurosurg 2020; 192:105735. [PMID: 32078956 DOI: 10.1016/j.clineuro.2020.105735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/02/2020] [Accepted: 02/09/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Spinal metastases are routinely managed and/or operated on by both orthopaedic surgeons and neurological surgeons. However, controversy still exists as to whether the operating surgeon's specialty has an impact on post-operative complication rates. PATIENTS AND METHODS The 2007-2017 Humana Administrative Claims database was queried using Current Procedural Terminology codes to identify patients undergoing fusions, laminectomies or osteotomy/corpectomy for spinal metastases. Physician taxonomy codes were used to identify the operating surgeon's specialty (orthopaedic vs. neurosurgery). Multivariate logistic regression analyses were used to assess difference in 90-day complications, readmissions and mortality between the two specialties while controlling for age, gender, race, co-morbidity burden, procedural characteristics (fusion, laminectomy and/or osteotomy/corpectomy) and type of primary cancer. RESULTS A total of 887 patients undergoing surgical intervention for spinal metastases were included - out of which 204 (23.0 %) patients were operated on by orthopaedic surgeons and 683 (77.0 %) by neurosurgeons. Following adjustment for difference in patient demographics and baseline clinical characteristics, no statistically significant differences were noted between the two specialties with regards to wound complications (p = 0.992), pulmonary complications (p = 0.461), cardiac complications (p = 0.631), thrombotic complications (p = 0.177), sepsis (p = 0.463), pneumonia (p = 0.767), urinary tract infection (p = 0.916), acute renal failure (p = 0.934), hardware complications (p = 0.892), emergency department visits (p = 0.934), 90-day readmissions (p = 0.277) and 90-day mortality (p = 0.786). CONCLUSIONS Based off our findings, it appears that a surgeon's specialty has no influence on intermediate-term complications following surgical intervention for spinal metastases. The findings of the study should support the need for maintaining access of patients to both specialties for appropriate surgical consultation.
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Affiliation(s)
- Azeem Tariq Malik
- Division of Spine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States; Division of Musculoskeletal Oncology, Department of Orthopaedics, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States
| | - Jae Baek
- Division of Spine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States; Division of Musculoskeletal Oncology, Department of Orthopaedics, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States
| | - John H Alexander
- Division of Musculoskeletal Oncology, Department of Orthopaedics, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States
| | - Safdar N Khan
- Division of Spine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States
| | - Thomas J Scharschmidt
- Division of Musculoskeletal Oncology, Department of Orthopaedics, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States.
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27
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Ohuabunwa U, Shah S, Jordan Q, Johnson K, Avent E, Flacker J. Towards Patient Safety: Evaluation of Care Transitions Training Needs Among Key Providers Involved in Patient Care Transitions. Med Sci Educ 2019; 29:1017-1022. [PMID: 34457579 PMCID: PMC8368098 DOI: 10.1007/s40670-019-00798-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Significant morbidity, mortality, and increased healthcare costs of up to 20.1 billion dollars annually occur as a result of poorly executed patient care transitions. The critical role of providers in ensuring patient safety at discharge requires provider knowledge of required care transitions processes to ensure optimal execution of transitions of care. The present study was designed to determine provider perception of their care transitions training, curriculum content, and self-identified care transitions knowledge gaps. A cross-sectional survey was conducted among key healthcare providers at the Grady Memorial Hospital, a 953 bed urban safety net hospital. Of these, 131 participants completed the surveys including 73 internal medicine residents, 51 nurses, and 7 social workers. Among participants, 13% reported that they had never had any formal training on care transitions. Of these, 88.2% were medical residents, while 11.8% were bedside nurses. Among participants who had received care transitions training, only 40% received their training prior to graduation. Healthcare providers across disciplines were least exposed to training on discharge settings of care, determining the most appropriate next level of care for patients at discharge, and communication and coordination with post-acute care facilities. Providers made recommendations regarding topics they considered important to be included in care transitions training. Defining the full discharge process and responsibilities of various healthcare providers were topics recommended by most providers as important to be included in care transitions training. This study has highlighted the extent of exposure to formal care transitions training among providers from multiple disciplines involved in various aspects of discharge care. It has demonstrated a paucity of formal care transitions training at the health professional school level. It has also highlighted self-identified care transitions training needs and will form a foundation for design of care transitions curricula for a broad range of healthcare professionals.
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Affiliation(s)
- Ugochi Ohuabunwa
- Division of General Medicine and Geriatrics, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303 USA
| | - Seema Shah
- Institute for Family Health, New York, NY USA
| | - Queenie Jordan
- Senior Services Division, Grady Hospital, Atlanta, GA USA
| | | | | | - Jonathan Flacker
- Division of General Medicine and Geriatrics, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, GA 30303 USA
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28
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Martin S, Warner EL, Kirchhoff AC, Mooney R, Martel L, Kepka D. An Electronic Medical Record Alert Intervention to Improve HPV Vaccination Among Eligible Male College Students at a University Student Health Center. J Community Health 2019; 43:756-760. [PMID: 29453619 DOI: 10.1007/s10900-018-0480-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This pilot study aims to improve HPV vaccination for college aged males at a student health center. The first part of the study consisted of a focus group that assessed the barriers and facilitators of HPV vaccination among healthcare providers and clinic staff (N = 16). Providers reported missed opportunities for HPV vaccination. For the second part of the study, providers and staff reviewed medical records of patients ages 18-26 with student health insurance and with < 3 doses of the HPV vaccine at baseline (12/1/2014 to 7/31/2015) and follow-up (12/1/2015 to 7/31/2016). A computer-automated EMR alert was generated in the medical record of eligible male patients (N = 386). Z-scores were estimated for two-sample proportions to measure change in HPV vaccine rates at baseline and follow-up for males and females. HPV vaccine initiation rates increased among males (baseline: 5.2% follow-up: 25.1%, p < 0.001). This study shows that EMR alerts improved HPV vaccine initiation rates among insured college-aged males.
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Affiliation(s)
- Suzanne Martin
- University of Utah College of Nursing, Salt Lake City, UT, USA.,University of Utah Student Health Center, Salt Lake City, UT, USA
| | - Echo L Warner
- University of Utah College of Nursing, Salt Lake City, UT, USA.,Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA
| | - Anne C Kirchhoff
- University of Utah College of Nursing, Salt Lake City, UT, USA.,University of Utah Department of Pediatrics, Salt Lake City, UT, USA
| | - Ryan Mooney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA
| | - Laura Martel
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA
| | - Deanna Kepka
- University of Utah College of Nursing, Salt Lake City, UT, USA. .,Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Office 4707, Salt Lake City, UT, 84112, USA.
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29
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Lakoh S, Firima E, Jiba DF, Sesay M, Conteh MM, Deen GF. Low partner testing in high HIV prevalence setting in Freetown, Sierra Leone: a retrospective study. BMC Res Notes 2019; 12:629. [PMID: 31551091 PMCID: PMC6760048 DOI: 10.1186/s13104-019-4662-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/18/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Despite a 1.5% National HIV prevalence, less than 40% of people living with HIV in Sierra Leone know their status. Limited activities on testing partners of HIV patients could be contributory to this substantial unawareness of HIV status. We carried out a retrospective study aimed at assessing partner testing and HIV prevalence among adults (≥ 15 years) tested using Determine™ and SD Bioline as recorded in the HIV testing registers from January to December 2017 at Connaught Hospital, an urban tertiary hospital in Sierra Leone. RESULTS Of the 3808 clients tested for HIV, 2048 (53.8%) were females. The median age was 31 (IQR 24-42) years and 2104 (55.3%) were single. While 3014 (79.1%) had Provider-Initiated Testing and Counseling (PITC), 794 (20.9%) had Client-Initiated Testing and Counseling (CITC). HIV test was positive in 925 (24.3%) {CI 22.9-25.6, P < 0.001} clients. Of the 17 (0.4%) partners tested for HIV, 9 (52.9%) were positive. PITC yielded more HIV positive cases (760, 25.2%) than CITC (165, 20.8%). Partner testing (P = 0.007), female sex (P < 0.001) and PITC (P = 0.006) were associated with a positive HIV diagnosis. With high HIV prevalence and low partner testing, activities on partner testing are needed to improve the response to the epidemic.
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Affiliation(s)
- Sulaiman Lakoh
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone. .,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone.
| | | | - Darlinda F Jiba
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Momodu Sesay
- National HIV/AIDS Secretariat, Freetown, Sierra Leone
| | | | - Gibrilla Fadlu Deen
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
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30
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Gardner T, Vazquez SR, Kim K, Jones AE, Witt DM. Providers' utilization and perceptions of warfarin dosing algorithms. Thromb Res 2019; 183:4-12. [PMID: 31505378 DOI: 10.1016/j.thromres.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/15/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Warfarin dosing algorithms have proven beneficial in increasing time within therapeutic range (TTR) and decreasing adverse events associated with out-of-range international normalized ratios (INRs). Despite widespread availability, providers' utilization and perceptions of warfarin algorithms in real-world practice are unclear. Identifying perceptions and barriers to algorithm use may help attempts to improve warfarin therapy management. METHODS Anticoagulation providers' utilization and perceptions of warfarin dosing algorithms were assessed via a nationwide electronic survey. RESULTS Of the 246 providers who completed the survey, 82% were pharmacists, and 69% had over five years' experience dosing warfarin. Warfarin dosing algorithms were deemed beneficial by 84% of respondents and 72% currently use a warfarin dosing algorithm in their practice at least occasionally. Pharmacists were least likely of anticoagulation providers to use algorithms, although this was not statistically significant (p = 0.12). Algorithm utilization also decreased as years of warfarin dosing experience increased, with the highest rate of usage noted in the first year of dosing warfarin. The most common reason providers gave for discontinuing algorithm use was that they no longer felt it was needed. In this study, clinic patient volume did not appear to be associated with algorithm utilization. CONCLUSION Warfarin dosing algorithms are frequently used among anticoagulation providers, especially those new to dosing warfarin, but use is frequently not sustained over the long-term. Education on the continued benefits of warfarin dosing algorithms could increase long-term utilization, potentially improving patient outcomes.
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Affiliation(s)
- Trevor Gardner
- University of Utah College of Pharmacy, Department of Pharmacotherapy, University of Utah, 30 South 2000 East Salt, Lake City, UT 84112, United States of America
| | - Sara R Vazquez
- University of Utah Health Thrombosis Center, 50 N Medical Drive Room 1R211, Salt Lake City, UT 84132, United States of America.
| | - Kibum Kim
- University of Utah College of Pharmacy, Department of Pharmacotherapy, University of Utah, 30 South 2000 East Salt, Lake City, UT 84112, United States of America
| | - Aubrey E Jones
- University of Utah College of Pharmacy, Department of Pharmacotherapy, University of Utah, 30 South 2000 East Salt, Lake City, UT 84112, United States of America; University of Utah Health Thrombosis Center, 50 N Medical Drive Room 1R211, Salt Lake City, UT 84132, United States of America
| | - Daniel M Witt
- University of Utah College of Pharmacy, Department of Pharmacotherapy, University of Utah, 30 South 2000 East Salt, Lake City, UT 84112, United States of America; University of Utah Health Thrombosis Center, 50 N Medical Drive Room 1R211, Salt Lake City, UT 84132, United States of America
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31
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Mohiuddin AK. The New Era of Pharmacists in Ambulatory Patient Care. Innov Pharm 2019; 10:10.24926/iip.v10i1.1622. [PMID: 34007527 PMCID: PMC7643699 DOI: 10.24926/iip.v10i1.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pharmacy is evolving from a product-oriented to a patient-oriented profession. This role modification is extremely healthy for the patient, the pharmacist, and other members of the health-care team. However, the evolution will present pharmacists with a number of new challenges. Now, more than in the past, pharmacists must make the acquisition of contemporary practice knowledge and skills a high priority, to render the level of service embodied in the concept of pharmaceutical care. Pharmacy educators' organizations and regulatory bodies must all work together to support pharmacists as they assume expanded health-care roles. Pharmacy and the healthcare industry must work to ensure that the pharmacist is compensated justly for all services. But before this can happen it will be necessary for pharmacy to demonstrate value-added to the cost of the prescription. Marketing of the purpose of pharmacy in the health-care morass and of the services provided by the pharmacist is needed to generate an appropriate perceived value among purchasers and users of health-care services. Pharmacists should view themselves as dispensers of therapy and drug effect interpretations as well as of drugs themselves. Service components of pharmacy should be identified clearly to third party payers and be visible to consumers, so that they know what is available at what cost and how it may be accessed. In the future, pharmacy services must be evaluated on patient outcome (i.e., pharmaceutical care) rather than the number of prescriptions dispensed, and pharmacy must evolve toward interpretation and patient consultation, related to the use of medication technologies.
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Affiliation(s)
- AK Mohiuddin
- Department of Pharmacy, World University of Bangladesh
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Colvin C, De Silva G, Garfin C, Alva S, Cloutier S, Gaviola D, Oyediran K, Rodrigo T, Chauffour J. Quality of TB services assessment: The unique contribution of patient and provider perspectives in identifying and addressing gaps in the quality of TB services. J Clin Tuberc Other Mycobact Dis 2019; 17:100117. [PMID: 31788559 PMCID: PMC6880011 DOI: 10.1016/j.jctube.2019.100117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ambitious efforts to detect and treat tuberculosis (TB) are required to reduce the burden of disease in low resource settings, and the provision of high quality TB services is critical to reaching global TB targets. The quality of TB services assessment (QTSA) is a facility-based approach aimed at identifying gaps in TB services and prioritizing interventions to improve care across multiple countries with high TB burden. Randomly sampled facilities are assessed with standardized instruments to collect data on structures, processes, and outcomes of TB care, with adaption for local diagnostic and treatment algorithms. The sampling strategy is modified to ensure representation of all levels of the health system where TB services are provided, as well as inclusion of private sector or other facility types relevant to the context. Instruments include a facility audit, provider and patient interviews, and a review of TB registers. A recent QTSA in the Philippines generated important data on provider and patient perspectives on quality of care, showing that providers are more likely to report that they counseled current TB patients on key aspects of TB diagnosis and treatment than patients are to report having received the information. These comparisons highlight areas where refresher training or interpersonal communication and counseling skills may be needed.
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Affiliation(s)
- Charlotte Colvin
- United States Agency for International Development (USAID), Global Health Bureau, 2100 Crystal Drive, Arlington, VA 22202, USA
| | - Gretchen De Silva
- United States Agency for International Development (USAID), Global Health Bureau, 2100 Crystal Drive, Arlington, VA 22202, USA
| | - Celine Garfin
- National Tuberculosis Program, Room 103, Building 12, Department of Health, San Lazaro Compound, Rizal Ave, Santa Cruz, Manila 1003, Philippines
| | - Soumya Alva
- John Snow, Inc. (JSI), 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, USA
| | - Suzanne Cloutier
- John Snow, Inc. (JSI), 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, USA
| | - Donna Gaviola
- National Tuberculosis Program, Room 103, Building 12, Department of Health, San Lazaro Compound, Rizal Ave, Santa Cruz, Manila 1003, Philippines
| | - Kola Oyediran
- John Snow, Inc. (JSI), 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, USA
| | - Tito Rodrigo
- USAID/Philippines, Annex 2 Building, US Embassy, 1201 Roxas Boulevard, 1000 Ermita, Manila Philippines
| | - Jeanne Chauffour
- John Snow, Inc. (JSI), 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, USA
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Koenig AF, Borrero S, Zhao X, Callegari L, Mor MK, Sonalkar S. Factors associated with long-acting reversible contraception use among women Veterans in the ECUUN study. Contraception 2019; 100:234-240. [PMID: 31152697 DOI: 10.1016/j.contraception.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this study is to understand patient-, provider- and system-level factors associated with long-acting reversible contraception (LARC) use among women Veterans and with receipt of LARC methods within the Veterans Affairs (VA) system. STUDY DESIGN We analyzed data from a national telephone-based survey of 2302 women ages 18-44 receiving primary care in VA. Multivariable regression was used to examine adjusted associations of participant-reported patient-, provider- and facility-level factors with LARC use and within-VA receipt of LARC among women Veterans. RESULTS Among 987 women Veterans at risk of unintended pregnancy, 294 (30%) reported using LARC, 65% of whom had received their method within VA. Higher LARC use was observed among women who were multiparous vs. nulliparous [adjusted odds ratio (aOR)=1.52; 95% confidence interval (CI)=1.04-2.22] and did not desire future pregnancies (aOR=1.88; 95% CI=1.31-2.68). Although overall LARC uptake was not associated with any provider- or facility-level factors, receipt of these methods within VA was associated with receiving both general and gender-specific health care by a single provider (aOR=2.81; 95% CI=1.20-6.61) and with receiving care within a women's health clinic (aOR=2.54; 95% CI=1.17-5.50). CONCLUSIONS While patient-level factors were more strongly correlated with use of LARC, provider- and system-level factors influence whether women received these methods within VA. IMPLICATIONS This study of patient-, provider- and system-level correlates of LARC use in VA, the country's largest integrated healthcare system, highlights that women Veterans share similar patient-level factors associated with LARC use as the general population and that continuity with providers and comprehensive women's health services can facilitate LARC access.
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Affiliation(s)
- Angela F Koenig
- Department of Obstetrics and Gynecology, The Hospital of the University of Pennsylvania.
| | - Sonya Borrero
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; Center for Research on Health Care, University of Pittsburgh School of Medicine
| | - Xinhua Zhao
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Lisa Callegari
- VA Health Services Research and Development Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Healthcare System; Department of Obstetrics and Gynecology, University of Washington School of Medicine
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Sarita Sonalkar
- Department of Obstetrics and Gynecology, The Hospital of the University of Pennsylvania
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Affiliation(s)
- Amy M Yule
- The Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, and the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Yule); New York State Psychiatric Institute, Division of Substance Abuse, and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (Levin)
| | - Frances R Levin
- The Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, and the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Yule); New York State Psychiatric Institute, Division of Substance Abuse, and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (Levin)
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Hermann RM, Long E, Trotta RL. Improving Patients' Experiences Communicating With Nurses and Providers in the Emergency Department. J Emerg Nurs 2019; 45:523-530. [PMID: 30655007 DOI: 10.1016/j.jen.2018.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/05/2018] [Accepted: 12/02/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION As health care becomes increasingly patient centered, organizations strive to improve patients' ratings of satisfaction with care. Communication with nurses and providers drives overall satisfaction, yet little evidence exists to guide them in ensuring effective communication in the emergency department. METHODS A semistructured interview guide based on the Hospital Consumer Assessment of Healthcare Providers survey was used to elicit qualitative data from 30 patients seen in the emergency department and fast track regarding communication with nurses and providers. Data were analyzed using content analysis methodology. RESULTS Two types of overarching themes emerged. Foundational themes include behaviors that convey courtesy and respect and are required for participants to view their interactions with nurses and providers as positive. Interactive themes describe humanistic ways in which nurses and providers conveyed courtesy and respect, reassurance through careful listening, attentiveness, and explaining things in an understandable way. DISCUSSION The findings underscore existing evidence regarding patients' perceptions of being treated with courtesy and respect via nurses' and providers' use of positive verbal phrasing and nonverbal body language. They reveal new insights into the importance of specific communication behaviors used by nurses and providers during interactions. Treating patients as individuals amidst a fast-paced care environment, proactively recognizing and responding to patients' fears and concerns, and explaining information clearly to ensure understanding were critical.
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Kaihula WT, Sawe HR, Runyon MS, Murray BL. Assessment of cardiopulmonary resuscitation knowledge and skills among healthcare providers at an urban tertiary referral hospital in Tanzania. BMC Health Serv Res 2018; 18:935. [PMID: 30514275 PMCID: PMC6278030 DOI: 10.1186/s12913-018-3725-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 11/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background Early and effective CPR increases both survival rate and post-arrest quality of life. In limited resource countries like Tanzania, there is scarce data describing the basic knowledge of CPR among Healthcare providers (HCP). This study aimed to determine the current level of knowledge on, and ability to perform, CPR among HCP at Muhimbili National Hospital (MNH). Methods This was a descriptive cross sectional study of a random sample of 350 HCP from all cadres and departments at MNH from October 2015 to March 2016. Each participant completed a with 25 question multiple choice and fill-in-the-blank CPR test and a practical test using a CPR manikin where the participant was videotaped for 1–2 min. Two expert observers independently viewed the videos and rated participant performance on a structured data form. The primary outcome of interest was staff member overall performance on the written and practical CPR testing. Results We enrolled 350 HCPs from all 12 MNH clinical departments. The median participant age was 35 (IQR 29–43) years, 225 (64%) were female and 138 (39%) had clinical experience of less than 5 years. Only 57 (16%) and 88 (25%) scored above 50% in written and practical tests, respectively according to local minimum passing test score and 13(4%) and 30 (9%) scored above 75% in written and practical tests, respectively according to international minimum passing test score on CPR. The 233(67%) HCP who reported prior experience performing CPR on an adult patient scored higher on testing than those without; 40% (IQR 28–54) versus 26% (IQR 16–42) respectively, but both groups had median scores <50%. Conclusion The level of CPR knowledge and skills displayed by all cadres and in all departments was poor despite the fact that most providers reported having performed CPR in the past. Since MNH is a tertiary referral hospital, it may reflect the performance of resuscitation status of other local health centers in Tanzania and other low-income countries to employ a formal system of training every HCP in CPR. Staff should be certified and assessed regularly to ensure retention of resuscitation knowledge and skills. Electronic supplementary material The online version of this article (10.1186/s12913-018-3725-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Winfrida T Kaihula
- Emergency Medicine Department, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania. .,Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania.
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili National Hospital, P.O. Box 65001, Dar es Salaam, Tanzania.,Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Brittany L Murray
- Division of Paediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Sun ZX, Shi JF, Lan L, Mao AY, Huang HY, Lei HK, Qiu WQ, Dong P, Zhu J, Wang DB, Liu GX, Bai YN, Sun XJ, Liao XZ, Ren JS, Guo LW, Zhou Q, Yang L, Song BB, Du LB, Zhu L, Gong JY, Liu YQ, Ren Y, Mai L, Qin MF, Zhang YZ, Zhou JY, Sun XH, Wu SL, Qi X, Lou PA, Cai B, Zhang K, He J, Dai M. [Constituent and workload of service providers engaged in cancer screening: findings and suggestions from a multi-center survey in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2018; 39:295-301. [PMID: 29609242 DOI: 10.3760/cma.j.issn.0254-6450.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To understand the constituent and workload of service providers engaged in cancer screening in China and provide evidence for the assessment of the sustainability of national cancer screening project. Methods: Using either questionnaire or online approach, the survey was conducted in 16 provinces, where Cancer Screening Program in Urban China (CanSPUC) was conducted, from 2014 to 2015. The medical institutes surveyed included hospitals [71.1% were class Ⅲ(A) hospitals], centers for disease control and prevention (CDCs) and community centers where cancer screening was undertaken during 2013-2015. The questionnaire survey was conducted among the staffs responsible for the overall coordination, management and implementation of the screening project to collect the information about the allocation, workload and compensation of the service providers from different specialties. Results: A total of 4 626 staffs were surveyed in this study, their average age was (37.7±9.5) years, and males accounted for 31.0%. Human resources allocated differed with province. The number of senior staff ranged from 6 (Chongqing) to 43 (Beijing) among the 8 comparable provinces. Among the staffs surveyed, 2 192 were from hospitals, 431 were from CDCs and 1 990 were from community centers, and the staffs who complained heavy workload accounted for 19.9%, 24.6% and 34.1% respectively (P<0.001). Among 227 staffs for overall coordination, 376 management staffs and 3 908 staffs for implementation, those who complained heavy workload accounted for 23.6%, 22.3% and 28.2% respectively (P<0.001). A total of 3 244 staffs (73.8%) got compensations for heavy workload. The compensation types were manly labor fee linked with workload (67.5%) and labor fee regardless workload (26.6%). Conclusion: The province specific differences in human resources allocation indicated the differences in screening project's organizing pattern and capability. It is suggested to conduct routine cancer screening (using specialized staffs), reduce the workload of the first line and community staffs and increase the compensation for the service providers for the sustainability of cancer screening project in China.
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Affiliation(s)
- Z X Sun
- Harbin Center for Disease Control and Prevention, Harbin 150056, China
| | - J F Shi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - L Lan
- Harbin Center for Disease Control and Prevention, Harbin 150056, China
| | - A Y Mao
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China
| | - H Y Huang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - H K Lei
- Chongqing Cancer Institute, Chongqing 400030, China
| | - W Q Qiu
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China
| | - P Dong
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China
| | - J Zhu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - D B Wang
- Anhui Medical University, Hefei 230032, China
| | - G X Liu
- Harbin Medical University, Harbin 150056, China
| | - Y N Bai
- Institute of Epidemiology and Health Statistics, Lanzhou University, Lanzhou 730000, China
| | - X J Sun
- Center for Health Management and Policy Research, Shandong University, Jinan 250012, China
| | - X Z Liao
- Hunan Provincial Cancer Hospital, Changsha 410006, China
| | - J S Ren
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - L W Guo
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Q Zhou
- Chongqing Cancer Institute, Chongqing 400030, China
| | - L Yang
- Guangxi Medical University, Nanning 530021, China
| | - B B Song
- Affiliated Cancer Hospital of Harbin Medical University, Harbin 150081, China
| | - L B Du
- Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - L Zhu
- Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - J Y Gong
- Shandong Tumor Hospital, Jinan 250117, China
| | - Y Q Liu
- Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Y Ren
- Tieling Central Hospital, Tieling 112000, China
| | - L Mai
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - M F Qin
- Yunnan Cancer Hospital, Kunming 650018, China
| | - Y Z Zhang
- Shanxi Provincial Cancer Hospital, Taiyuan 030013, China
| | - J Y Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - X H Sun
- Ningbo No.2 Hospital, Ningbo 315010, China
| | - S L Wu
- Kailuan General Hospital, Tangshan 063000, China
| | - X Qi
- Tangshan People's Hospital, Tangshan 063001, China
| | - P A Lou
- Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, China
| | - B Cai
- Nantong Tumor Hospital, Nantong 226000, China
| | - K Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J He
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - M Dai
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Wong ST, Hogg W, Burge F, Johnston S, French I, Blackman S. Using the CollaboraKTion framework to report on primary care practice recruitment and data collection: costs and successes in a cross-sectional practice-based survey in British Columbia, Ontario, and Nova Scotia, Canada. BMC Fam Pract 2018; 19:87. [PMID: 29898667 PMCID: PMC6001004 DOI: 10.1186/s12875-018-0782-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
Background Across Canada and internationally we have poor infrastructure to regularly collect survey data from primary care practices to supplement data from chart audits and physician billings. The purpose of this work is to: 1) examine the variable costs for carrying out primary care practice-based surveys and 2) share lessons learned about the level of engagement required for recruitment of practices in primary care. Methods This work was part of a larger study, TRANSFORMATION that collected data from three provincial study sites in Canada. We report here on practice-based engagement. Surveys were administered to providers, organizational practice leads, and up to 20 patients from each participating provider. We used the CollaboraKTion framework to report on our recruitment and engagement strategies for the survey work. Data were derived from qualitative sources, including study team meeting minutes, memos/notes from survey administrators regarding their interactions with practice staff, and patients and stakeholder meeting minutes. Quantitative data were derived from spreadsheets tracking numbers for participant eligibility, responses, and completions and from time and cost tracking for patient survey administration. Results A total of 87 practices participated in the study (n = 22 in BC; n = 26 in ON; n = 39 in NS). The first three of five CollaboraKTion activities, Contacting and Connecting, Deepening Understandings, and Adapting and Applying the Knowledge Base, and their associated processes were most pertinent to our recruitment and data collection. Practice participation rates were low but similar, averaging 36% across study sites, and completion rates were high (99%). Patient completion rates were similarly high (99%), though participation rates in BC were substantially lower than the other sites. Recruitment and data collection costs varied with the cost per practice ranging from $1503 to $1792. Conclusions A comprehensive data collection system in primary care is possible to achieve with partnerships that balance researcher, clinical, and policy maker contexts. Engaging practices as valued community members and independent business owners requires significant time, and financial and human resources. An integrated knowledge translation and exchange approach provides a foundation for continued dialogue, exchange of ideas, use of the information produced, and recognises recruitment as part of an ongoing cycle.
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Affiliation(s)
- Sabrina T Wong
- School of Nursing, University of British Columbia, T201 2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada. .,Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - William Hogg
- Department of Family Medicine, University of Ottawa, 201-600 Peter Morand Cresc, Ottawa, ON, K1G 5Z3, Canada.,Montfort Hospital Research Institute, 713 Montreal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Building, Halifax, NS, B3H 2E2, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, 201-600 Peter Morand Cresc, Ottawa, ON, K1G 5Z3, Canada.,Montfort Hospital Research Institute, 713 Montreal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Ilisha French
- Montfort Hospital Research Institute, 713 Montreal Rd, Ottawa, ON, K1K 0T2, Canada
| | - Stephanie Blackman
- Department of Family Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, Abbie J. Lane Building, Halifax, NS, B3H 2E2, Canada
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Buller-Taylor T, McGuinness L, Yan M, Janjua NZ. Reducing patient and provider knowledge gaps: An evaluation of a community informed hepatitis C online course. Patient Educ Couns 2018; 101:1095-1102. [PMID: 29370951 DOI: 10.1016/j.pec.2018.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/20/2017] [Accepted: 01/09/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Hepatitis C (HCV) knowledge gaps are associated with lower levels of engagement in (HCV) care which contributes to HCV-related morbidity and mortality. Knowledge gaps may be exacerbated by rapid changes in HCV care/treatment. Cost-effective, timely and easy-to-implement education is needed to address knowledge gaps and foster HCV engagement. METHODS We developed a free, one-hour, online course for patients and providers. Online and facilitated course events were evaluated. Outcome measures included: pre/post-scores, perceived knowledge gains and increased capacity to educate/encourage engagement in HCV care. RESULTS Total pre-post-test gains were significant (p < .001) across groups. Over 50% of participants reported: perceived knowledge gains of "A lot" or higher; the course increased their capacity to educate and encourage client engagement in care by "A lot" or higher. CONCLUSIONS The evaluation confirmed ongoing patient and provider HCV knowledge gaps, significantly reduced those gaps, and increased provider's capacity to educate and encourage client engagement in HCV care. PRACTICE IMPLICATIONS The course is an effective tool to address knowledge gaps that might lower engagement in care. It is available to patients to use in the privacy of their own home or for providers for their personal use, to use with individuals or patient groups.
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Affiliation(s)
- Terri Buller-Taylor
- British Columbia Centre for Disease Control (BCCDC); School of Nursing, University of British Columbia (UBC), Vancouver, Canada.
| | - Liza McGuinness
- British Columbia Centre for Disease Control (BCCDC); School of Nursing, University of British Columbia (UBC), Vancouver, Canada
| | - Melissa Yan
- School of Population and Public Health, UBC, Vancouver, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control (BCCDC); School of Population and Public Health, UBC, Vancouver, Canada
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Awantang GN, Babalola SO, Koenker H, Fox KA, Toso M, Lewicky N. Malaria-related ideational factors and other correlates associated with intermittent preventive treatment among pregnant women in Madagascar. Malar J 2018; 17:176. [PMID: 29695231 PMCID: PMC5918989 DOI: 10.1186/s12936-018-2308-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background The Malagasy Ministry of Health aimed to achieve 80% coverage of intermittent preventive treatment of malaria among pregnant women (IPTp) in targeted districts by 2015. However, IPTp coverage rates of have remained fairly static over the past few years. Methods During a cross-sectional household survey, mothers of children under the age of 2 years were asked about their most recent pregnancy. The primary outcome of interest was a mother receiving two or more doses of sulfadoxine–pyrimethamine (SP) (IPTp2) during their last pregnancy, at least one of which was obtained from a health provider. Multilevel analysis was used to account for community-level factors. Correlates included exposure to communication messages, the number of antenatal care (ANC) visits made by the woman, her household wealth, and other sociodemographic characteristics. Results Over one-tenth (11.7%) of women received two or more doses of SP, at least one of which was obtained during an ANC visit. Two-thirds (68.3%) of women who consulted a health provider but did not take IPTp attributed this to not being offered the medication by their health provider. The odds of a woman receiving IPTp2 varied with her knowledge, attitudes, and perceived social norms related to IPTp and ANC and exposure to malaria messages. General malaria ideation, specifically the perceived severity of and perceived susceptibility to malaria, however, was not associated with increased odds of receiving IPTp2. A large variation in the odds of receiving IPTp2 was due to community-level factors that the study did not examine. Conclusions Health communication programmes should aim to improve IPTp/ANC-specific ideation, particularly the norms of seeking regular care during pregnancy and taking any prescribed medication. While ANC attendance is necessary, it was not sufficient to meet IPTp2 coverage. Women surveyed in Madagascar rely on health providers to prescribe SP according to national policy. At the same time, stock-outs prevent health providers from prescribing SP. The large observed community-level variation in IPTp2 coverage is likely due to supply-side factors, such as SP availability and health-provider ideation and practices.
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Affiliation(s)
- Grace N Awantang
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - Stella O Babalola
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Hannah Koenker
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Kathleen A Fox
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Nan Lewicky
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
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Kurlander JE, Kolbe M, Rubenstein JH, Richardson CR, Heisler M, Weissman A, De Vries R, Saini SD. Internists' Perceptions of Proton Pump Inhibitor Adverse Effects and Impact on Prescribing Practices: Results of a Nationwide Survey. Gastroenterology Res 2018; 11:11-17. [PMID: 29511400 PMCID: PMC5827896 DOI: 10.14740/gr944w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/27/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Observational studies have linked proton pump inhibitors (PPIs) with serious adverse effects. The study aimed to evaluate internists' perceptions of PPI harms and effects on prescribing. METHODS This was an online survey of a representative sample of the American College of Physicians in 2013. We queried familiarity with and concern about PPI adverse effects (1 - 7 Likert-type scales, anchored by "not at all" and "extremely"). We also asked how frequently (often, sometimes, rarely, or never) participants used any of three "de-escalation" strategies to stop or reduce PPIs because of concern about adverse effects: reducing patients' PPI dose, switching to H2 blocker, or discontinuing PPI. We used multivariable logistic regression to evaluate associations between sometimes/often using any PPI de-escalation strategy and gender, time in practice, familiarity, and concern. RESULTS The response rate was 53% (487/914). Seventy percent were male, median time in practice was 11 - 15 years, and most practiced general medicine (58%). Ninety-nine percent reported at least some familiarity with reported adverse effects (mean 4.9, standard deviation (SD) 1.0), and 98% reported at least some concern (mean 4.6, SD 1.3). Sixty-three percent reported sometimes/often reducing the PPI dose, 52% switching to H2 blocker, and 44% discontinuing PPI. In multivariable analysis, familiarity with adverse effects (OR 1.66 (1.31 - 2.10) for 1-point increase, P < 0.001) and concern (OR 2.14 (1.76 - 2.61) for 1-point increase, P < 0.001) were independently associated with de-escalation. Gender and time in practice had no effects. CONCLUSION Almost all internists report awareness and concern about PPI adverse effects, and most are de-escalating PPIs as a result. Research on which approach is most effective for which patients is critically important.
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Affiliation(s)
- Jacob E. Kurlander
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mark Kolbe
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joel H. Rubenstein
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Caroline R. Richardson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Arlene Weissman
- Research Center, American College of Physicians, Philadelphia, PA, USA
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sameer D. Saini
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
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Barros de Luca G, Zopunyan V, Burke-Shyne N, Papikyan A, Amiryan D. Palliative care and human rights in patient care: an Armenia case study. Public Health Rev 2017; 38:18. [PMID: 29450090 PMCID: PMC5809943 DOI: 10.1186/s40985-017-0062-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
This paper examines palliative care within the human rights in patient care framework, which clarifies state obligations and addresses the rights of both patients and providers. In the context of palliative care, these rights extend beyond the right to health and include patient rights to freedom from torture, cruel and inhuman treatment, non-discrimination and equality, bodily integrity, privacy and confidentiality, information, and right to a remedy. They also encompass provider rights to decent working conditions, freedom of association, and due process. The paper then looks at a case study of Armenia, acknowledging how the government's commitment to palliative care, combined with awareness raising and advocacy by human rights organizations, created an enabling environment for the realization of human rights in patient care in the context of palliative care.
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Affiliation(s)
| | | | | | | | - Davit Amiryan
- Open Society Foundations - Armenia, Yerevan, Armenia
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Nanda A, Wasan A, Sussman J. Provider Health and Wellness. J Allergy Clin Immunol Pract 2017; 5:1543-1548. [PMID: 28734859 DOI: 10.1016/j.jaip.2017.05.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
Provider health and wellness is a significant issue and can impact patient care, including patient satisfaction, quality of care, medical errors, malpractice risk, as well as provider and office staff turnover and early retirement. Health and wellness encompasses various areas including burnout, depression, divorce, and suicide and affects providers of all specialties and at all levels of training. Providers deal with many everyday stresses, including electronic health records, office politics, insurance and billing issues, dissatisfied patients, and their own personal and family issues. Approximately half of all physicians suffer from burnout, and the rate of burnout among physicians of all specialties is increasing. An important first step in dealing with burnout is recognition and then seeking assistance. Strategies to prevent and treat burnout include increasing provider resiliency as well as implementing practical changes in the everyday practice of medicine. There is currently very little data regarding health and wellness specifically in the field of allergy and immunology, and studies are necessary to determine the prevalence of burnout and related issues in this field. Many medical specialties as well as state and national medical associations have health and wellness committees and other resources, which are essential for providers. Health and wellness programs should be introduced early in a provider's training and continued throughout a provider's career.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | - James Sussman
- Allergy Partners of New Mexico, Santa Fe, NM; University of New Mexico School of Medicine, Albuquerque, NM
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Molina Y, Beresford SAA, Hayes Constant T, Thompson B. Conversations about Abnormal Mammograms on Distress and Timely Follow-up Across Ethnicity. J Cancer Educ 2017; 32:320-327. [PMID: 26403889 PMCID: PMC4808511 DOI: 10.1007/s13187-015-0918-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Communication with healthcare providers, family, and friends is associated with increased mammography use. Less is known about the abnormal mammogram experience, especially in terms of the interval between screening and follow-up appointments (time to follow-up) and psychological distress. The impact of communication may vary across ethnicity, depending on cultural emphases placed on interpersonal relationships. The current study's objectives were to (a) explore the role of family/friend and provider communication with regard to time to follow-up and distress and (b) examine if family/friend and provider communication moderates associations between ethnicity and these outcomes. A convenience-based sample of 41 Latina and 41 non-Latina White (NLW) women who had received an abnormal mammogram result was recruited from Washington State. Women who discussed results with providers had a shorter time to follow-up, although this was not significant when including health insurance. A significant interaction between conversations with family/friends and ethnicity was found: Latinas who did not have conversations with family/friends had particularly elevated psychological distress relative to NLW women and slightly more than other Latinas. This exploratory study suggests health communication with providers and family/friends is important for timely receipt of follow-up care and reduced distress among women who receive an abnormal mammogram result, which has implications for cancer education intervention development and adaptation. Larger, population-based research is necessary to confirm these findings.
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Affiliation(s)
| | - Shirley A A Beresford
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Tara Hayes Constant
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Beti Thompson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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Mohammed KA, Geneus CJ, Osazuwa-Peters N, Adjei Boakye E, Tobo BB, Burroughs TE. Disparities in Provider Recommendation of Human Papillomavirus Vaccination for U.S. Adolescents. J Adolesc Health 2016; 59:592-598. [PMID: 27506278 DOI: 10.1016/j.jadohealth.2016.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the prevalence of and examine factors associated with provider recommendation of human papillomavirus vaccination for U.S. adolescents. METHODS Multivariable logistic regression analyses were performed using data from the National Immunization Survey-Teen 2014 on 34,478 adolescents aged 13-17 years. RESULTS Overall prevalence of vaccine recommendation was 72.6% for girls and 51.8% for boys. Lower rates were observed among girls aged 13 years, living below poverty line, adolescents of lesser educated mothers, and those residing in the South. Overall, girls had higher odds of vaccine recommendation (odds ratio [OR] = 2.57; 95% confidence interval [CI] = 2.35-2.82). Correlates of higher vaccine recommendation for girls were: older age-17 versus 13 (OR = 1.51; 95% CI = 1.20-1.89), living above versus below poverty line, and residing in Northeast (OR = 1.45; 95% CI = 1.21-1.73) and Midwest (OR = 1.29; 95% CI = 1.11-1.50) versus South. For boys, correlates of higher vaccine recommendation were: non-Hispanic black (OR = 1.30; 95% CI = 1.07-1.58) and Hispanic (OR = 1.24; 95% CI = 1.03-1.48) versus non-Hispanic white race and residing in Northeast (OR = 1.79; 95% CI = 1.54-2.08) and West (OR = 1.41; 95% CI = 1.17-1.70) versus South. Other factors associated with vaccine recommendation were having a college-educated mother and frequent doctor visits in the past 12 months. CONCLUSIONS This study highlights significant disparities in provider recommendation of human papillomavirus vaccination for U.S. adolescents. Findings suggest possible areas for tailored interventions to bridge the gap in vaccine recommendation and uptake in high-risk populations.
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Affiliation(s)
- Kahee A Mohammed
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri.
| | - Christian J Geneus
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, St Louis University, St Louis, Missouri; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, St Louis University, St Louis, Missouri; St Louis University Cancer Center, St Louis, Missouri
| | - Eric Adjei Boakye
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri
| | - Betelihem B Tobo
- Department of Epidemiology, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
| | - Thomas E Burroughs
- St Louis University Center for Outcomes Research (SLUCOR), St Louis University, St Louis, Missouri
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Vogel M, Nordt C, Dürsteler KM, Lang UE, Seifritz E, Krausz M, Herdener M. Evaluation of medication-assisted treatment of opioid dependence-The physicians' perspective. Drug Alcohol Depend 2016; 164:106-112. [PMID: 27215674 DOI: 10.1016/j.drugalcdep.2016.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/04/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant. METHODS We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors. RESULTS The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for termination (p<0.0001), psychological improvement throughout treatment (p<0.0001), wish for abstinence from the substitute (p<0.0001), social integration index at termination (p<0.0001), and social (p<0.0001) as well as medical (p<0.0001) improvement. The negative association of treatment break off with MAT assessment was more pronounced in semi-rural than urban areas (p<0.0001). CONCLUSION Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use.
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Affiliation(s)
- Marc Vogel
- University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland; University of British Columbia, Institute of Mental Health, David Strangway Building, Room 430, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Carlos Nordt
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland
| | - Kenneth M Dürsteler
- University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland; Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland
| | - Undine E Lang
- University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland
| | - Michael Krausz
- University of British Columbia, Institute of Mental Health, David Strangway Building, Room 430, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Marcus Herdener
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland
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Wu AC, Li L, Fung V, Kharbanda EO, Larkin EK, Butler MG, Galbraith A, Miroshnik I, Davis RL, Horan K, Lieu TA. Mismatching Among Guidelines, Providers, and Parents on Controller Medication Use in Children with Asthma. J Allergy Clin Immunol Pract 2016; 4:910-6. [PMID: 27212379 DOI: 10.1016/j.jaip.2016.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Underuse of controller medicines among children with asthma remains widespread despite national guidelines. OBJECTIVES To (1) assess provider prescribing patterns for asthma controller medications; (2) assess how frequently parents' reports of their child's asthma controller medicine use were mismatched with their provider's recommendations; and (3) evaluate parent attitudes and demographic characteristics associated with these mismatches. METHODS In this cross-sectional study, we conducted linked surveys of parents and providers of children with probable persistent asthma in a Medicaid program and 4 commercial health plans in 2011. Probable persistent asthma was defined as a diagnosis of asthma and 1 or more controller medication dispensing. RESULTS This study included 740 children (mean age, 8.6 years). Providers for 50% of the children reported prescribing controller medications for daily year-round use, 41% for daily use during active asthma months, and 9% for intermittent use for relief. Among parents, 72% knew which class of controller medication the provider prescribed and 49% knew the administration frequency and the medication class. Parents were less likely to report the same controller medication type as the provider, irrespective of dose and frequency, if they were Latino (odds ratio [OR], 0.23; CI, 0.057-0.90), had a household smoker (OR, 2.87; CI, 0.42-19.6), or believed the controller medicine was not helping (OR, 0.15; CI, 0.048-0.45). CONCLUSIONS Mismatches between parent reports and providers intentions regarding how the child was supposed to use inhaled steroids occurred for half of the children. Efforts should focus on ways to reduce mismatches between parent and provider intentions regarding controller medication use.
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Affiliation(s)
- Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Lingling Li
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Vicki Fung
- Harvard Medical School, Boston, Mass; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Mass
| | - Elyse O Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minn
| | - Emma K Larkin
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Melissa G Butler
- Center for Clinical Outcomes & Research - Southeast, Kaiser Permanente Georgia, Atlanta, Ga; The Argus Group, Hamilton, Bermuda
| | - Alison Galbraith
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass
| | - Irina Miroshnik
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Robert L Davis
- Center for Biomedical Informatics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Kelly Horan
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass
| | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, Calif
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Okoro O, Odedina F. HIV Treatment in African American Women-Care That Makes a Difference. J Racial Ethn Health Disparities 2016; 4:376-384. [PMID: 27129853 DOI: 10.1007/s40615-016-0238-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/28/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022]
Abstract
African American women bear a disproportionate burden of HIV disease. Socioeconomic and psycho-social factors while adding to the vulnerability of this population also contribute to non-adherence and consequently poor outcomes. The provider-patient relationship has the potential to enhance HIV medication adherence in this population. Using in-depth interviews, patient and provider perspectives are explored to identify specific elements of the provider-patient interaction that enhance patient satisfaction with care and consequently improve HIV medication adherence. Themes associated with provider attitudes and actions perceived as positively impacting care in this patient group include (1) physical touch, (2) treating (the patient) "as a person", (3) actively listening to the patient, (4) showing empathy, (5) being non-judgmental, and (6) being readily accessible. These findings suggest that the demonstration of care and commitment from the provider as perceived by the patient is important to African American women living with HIV and may significantly influence adherence behavior and enhance treatment outcomes in this population.
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Affiliation(s)
- Olihe Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA.
| | - Folakemi Odedina
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
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Atuahene MD, Afari EO, Adjuik M, Obed S. Health knowledge, attitudes and practices of family planning service providers and clients in Akwapim North District of Ghana. Contracept Reprod Med 2016; 1:5. [PMID: 29201395 PMCID: PMC5675058 DOI: 10.1186/s40834-016-0016-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 02/26/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Family planning services help save lives by reducing women's exposure to risks of child birth and abortion. While family planning services provide measures to prevent unintended pregnancies and time the formation of families, the acceptability and coverage is still very low worldwide. Some of the reasons for this include poor quality of service, unavailability of range of methods, fear of opposition from partners, side effects and health concerns among others.About 40 % of the world's 215,000 annual deaths in childbirth occur in the Sub-Saharan region. In Ghana, urban-rural fertility differences range from two to three children. The acceptability and coverage of family planning are still low and in the study area in particular. METHODS We sought to examine factors that contribute to low acceptability and coverage of family planning services in a sub-urban community with a design of quantitative cross-sectional. Ethical approval was given by the Ghana Health Service. Midwives and community health nurses who provide family planning services were interviewed. Exit-interview was also conducted with women receiving a variety of outpatient services. RESULTS Most of the women in this study (48.7 %) were in the 25-34 age range and were either married (42.8 %) or cohabiting (40.5 %). Majority of these women (67.7 %) have middle/Junior high level of formal education with a modal parity of two. Sixty eight (68) clients were identified as current family planning users. About 6.0 % and 4.5 % were dissatisfied about auditory and visual privacy during counselling respectively. This was confirmed by providers who attributed it to inappropriate facility layout. Most of the clients (79.1 %) were not given educational materials although 88.8 % were talked to about family planning and this could be due to unavailability of these hand-outs.Though clients show satisfaction of services received, providers did not follow standard protocols with as much as 73.7 % faced with challenges in provision of services which were attributed to improper facility layout and lack of furniture. About 77.2 % were willing to provide short term methods, while 91.2 % wanted to provide long term methods. As much as 93.3 % of the women said they would have liked providers give more detailed information on family planning. While most of the women (88.3 %) used injectables, only 6.1 % and 0.9 % used Implants and IUD respectively. CONCLUSIONS Finding ways to improve client privacy through good facility layout will ensure visual and auditory privacy to enhance family planning service provision and uptake. Continuous competency training will assist providers design innovative action plans and meet client satisfaction needs.
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Abstract
OBJECTIVE Investigate determinants of receiving healthcare provider (HCP) recommendations for seasonal and H1N1 influenza vaccinations. METHODS Using a United States national sample of adults 18 + from the National 2009 H1N1 Flu Survey, multivariate regression models estimated the likelihood of receiving a HCP recommendation. Covariates included demographics, socioeconomic status, and Advisory Committee on Immunization Practices (ACIP) priority groups. RESULTS Adults age 55-64 and 65 + were more likely to report a HCP recommendation when compared to adults age 18-34 (OR: 1.483, 95%CI: 1.237-1.778 and OR: 1.738, 95%CI: 1.427-2.116, respectively). Chronically ill adults had 58.0% (95%CI: 1.414-1.765) higher odds of receiving a HCP recommendation than non-chronically ill adults. Patients visiting a doctor once and twice had 28.7% (95%CI: 0.618-0.821) and 17.1% (95%CI: 0.721-0.952) lower odds of receiving a HCP recommendation when compared to adults visiting their doctor at least four times. And, compared to Non-Hispanic Whites, Non-Hispanic Blacks had 28.4% (95%CI: 1.064-1.549) higher odds of receiving a recommendation. CONCLUSIONS ACIP priority groups experienced higher rates of recommendations compared to non-ACIP groups. Racial differences in HCP recommendations cannot explain racial disparities in flu vaccination rates.
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Affiliation(s)
- Reginald Villacorta
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Verna and Peter Dauterive Hall, 635 Downey Way, Los Angeles, CA 90089-3333, USA
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