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Barry MJ, Tseng CW. Moving to More Evidence-Based Primary Care Encounters: A Farewell to the Review of Systems. JAMA 2022; 328:1495-1496. [PMID: 36178699 DOI: 10.1001/jama.2022.18346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This Viewpoint discusses ways in which free time during patient visits, resulting from removal of tradition- and reimbursement-driven care in favor of more evidence-based care, could be used to achieve better health outcomes based on recommendations from the US Preventive Services Task Force evidence-based preventive care.
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Affiliation(s)
- Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Chien-Wen Tseng
- Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu
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2
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Colorectal Cancer Screening During the COVID-19 Pandemic. J Gen Intern Med 2022; 37:3525-3528. [PMID: 35941493 PMCID: PMC9360678 DOI: 10.1007/s11606-022-07642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Shared decision-making (SDM) can help patients make good decisions about preventive health interventions such as cancer screening. We illustrate the use of SDM in the case of a 53-year-old man who had a new patient visit with a primary care physician and had never been screened for colorectal cancer (CRC). The patient had recently recovered from a serious COVID-19 infection requiring weeks of mechanical ventilation. When the primary care physician initially offered a screening colonoscopy, the man expressed great reluctance to return to the hospital for the exam. The PCP then offered a stool test, which could be completed at home, but emphasized that if it were positive, a colonoscopy would be required. He agreed to complete the stool test, and unfortunately, it was positive. He then agreed to undergo colonoscopy, which uncovered a large rectal cancer. The carcinoma had invaded the mesorectal fat but there were no metastases. After undergoing neoadjuvant chemotherapy followed by a low anterior resection of the tumor, he has no evidence of recurrence so far. Many clinicians favor colonoscopy for CRC screening, but evidence suggests that patients who are offered more than one reasonable option are more likely to undergo screening. If screening had been delayed in this patient until he was willing to accept a screening colonoscopy, there was the potential the cancer may have been more advanced when diagnosed, with a worse outcome. Shared decision-making was a key approach to understanding the patient's feelings related to this screening decision and making a decision consistent with his preferences.
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3
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Luu T. Reduced Cancer Screening Due to Lockdowns of the COVID-19 Pandemic: Reviewing Impacts and Ways to Counteract the Impacts. Front Oncol 2022; 12:955377. [PMID: 35965514 PMCID: PMC9372444 DOI: 10.3389/fonc.2022.955377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has created disruptions in health services in general and cancer screening and diagnostic services in particular, leading to diminished cancer screening participation rates. This paper aims to seek insights into impacts that the pandemic has had on cancer screening, impacts that reduced cancer screening may have in the long run, and how to address such impacts. The paper demonstrates that reduced cancer screening in the pandemic is likely to result in enhanced demands for cancer screening in the new normal, enhanced demands for resources to address such demands, and poor prognosis due to stage migration of cancer diseases. Some measures are recommended for counteracting these impacts.
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4
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Concepcion J, Yeager M, Alfaro S, Newsome K, Ibrahim J, Bilski T, Elkbuli A. Trends of Cancer Screenings, Diagnoses, and Mortalities During the COVID-19 Pandemic: Implications and Future Recommendations. Am Surg 2022:31348221091948. [PMID: 35420510 PMCID: PMC9014329 DOI: 10.1177/00031348221091948] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction The impact of the COVID-19 pandemic on cancer screenings and care has yet to
be determined. This study aims to investigate the screening, diagnosis, and
mortality rates of the top five leading causes of cancer mortality in the
United States from 2019 to 2021 to determine the potential impact of the
COVID-19 pandemic on cancer care. Methods A retrospective cohort study investigating the impact of the COVID-19
pandemic on screening, diagnoses, and mortality rates of the top five
leading causes of cancer death (lung/bronchus, colon/rectum, pancreas,
breast, and prostate), as determined by the National Institute of Health
(NIH) utilizing The United States Healthcare Cost Institute and American
Cancer Society databases from 2019 to 2021. Results Screenings decreased by 24.98% for colorectal cancer and 16.01% for breast
cancer from 2019 to 2020. Compared to 2019, there was a .29% increase in
lung/bronchus, 19.72% increase in colorectal, 1.46% increase in pancreatic,
2.89% increase in breast, and 144.50% increase in prostate cancer diagnoses
in 2020 (all P < .01). There was an increase in the total number of
deaths from colorectal, pancreatic, breast, and prostate cancers from 2019
to 2021. Conclusion There was a decrease in the screening rates for breast and colorectal cancer,
along with an increase in the estimated incidence and mortality rate among
the five leading causes of cancer deaths from 2019 to 2021. The findings
suggest that the COVID-19 pandemic is associated with impaired cancer
screening, diagnosis, and care, and further emphasizes the need for
proactive screening and follow-up to prevent subsequent cancer morbidity and
mortality.
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Affiliation(s)
| | - Matthew Yeager
- 158263Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Sophie Alfaro
- 390414A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Kevin Newsome
- 158263Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Joseph Ibrahim
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 390414Orlando Regional Medical Center, Orlando, FL, USA
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5
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Davidson KW, Mangione CM, Barry MJ, Nicholson WK, Cabana MD, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Collaboration and Shared Decision-Making Between Patients and Clinicians in Preventive Health Care Decisions and US Preventive Services Task Force Recommendations. JAMA 2022; 327:1171-1176. [PMID: 35315879 DOI: 10.1001/jama.2022.3267] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The US Preventive Services Task Force (USPSTF) works to improve the health of people nationwide by making evidence-based recommendations for preventive services. Patient-centered care is a core value in US health care. Shared decision-making (SDM), in which patients and clinicians make health decisions together, ensures patients' rights to be informed and involved in preventive care decisions and that these decisions are patient-centered. SDM has a role across the spectrum of USPSTF recommendations. For A or B recommendations (judged by the USPSTF to have high or moderate certainty of a moderate or substantial net benefit at the population level), SDM allows individual patients to decide whether to accept such services based on their personal values and preferences. For C recommendations (indicating at least moderate certainty of a small net benefit at the population level), SDM is critical for individual patients to decide whether the net benefit for them is worthwhile. For D recommendations (reflecting at least moderate certainty of a zero or negative net benefit) or I statements (low certainty of net benefit), clinicians should be prepared to discuss these services if patients ask. More evidence is needed to determine if, in addition to promoting patient-centeredness, SDM reduces inequities in preventive care, as well as to define new strategies to find time for discussion of preventive services in primary care.
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, New York, New York
| | | | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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6
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Kua KP. A multifactorial strategy for dengue prevention and control: A public health situation analysis. Trop Doct 2022; 52:367-371. [DOI: 10.1177/00494755221076910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kok Pim Kua
- Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, Puchong, Petaling, Selangor, Malaysia
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7
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The Impact of COVID-19 on Sexual Behavior and Psychosocial Functioning in a Clinical Sample of Men who have Sex with Men Using HIV Pre-exposure Prophylaxis. AIDS Behav 2022; 26:69-75. [PMID: 34114165 PMCID: PMC8191709 DOI: 10.1007/s10461-021-03334-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on sexual behavior, mental health, and substance use among men who have sex with men (MSM) engaged in pre-exposure prophylaxis (PrEP) care. Generalized linear mixed models and logistic mixed-effect models examined change over time for number of sexual partners, mood, and alcohol consumption. From February 29, 2020 to July 31, 2020, 177 MSM actively engaged in PrEP care were evaluated. The median age was 37 [interquartile range (IQR 30, 51]. Patients in the sample were largely representative of the clinic population and identified as White (73.0%), Black/African American (9.2%), and other race (17.2%), and 11.8% identified as Hispanic/Latino ethnicity. Men reported an average of 2.60 fewer sexual partners (95% CI −4.04, −1.40) during the pandemic compared to pre-COVID-19. Rates of depressive symptoms and alcohol use remained stable and few patients reported substance use. The reduced number of sexual partners may be explained by patients’ efforts to reduce risk of exposure to COVID-19 and low rates of psychosocial symptoms may be indicative of only the highest functioning patients continuing to engage in care. Reductions in sexual partners may offset reduced engagement in care and help mitigate risk of HIV and other sexually transmitted infections (STIs).
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8
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Bradshaw RL, Kawamoto K, Kaphingst KA, Kohlmann WK, Hess R, Flynn MC, Nanjo CJ, Warner PB, Shi J, Morgan K, Kimball K, Ranade-Kharkar P, Ginsburg O, Goodman M, Chambers R, Mann D, Narus SP, Gonzalez J, Loomis S, Chan P, Monahan R, Borsato EP, Shields DE, Martin DK, Kessler CM, Del Fiol G. OUP accepted manuscript. J Am Med Inform Assoc 2022; 29:928-936. [PMID: 35224632 PMCID: PMC9006693 DOI: 10.1093/jamia/ocac028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Population health management (PHM) is an important approach to promote wellness and deliver health care to targeted individuals who meet criteria for preventive measures or treatment. A critical component for any PHM program is a data analytics platform that can target those eligible individuals. Objective The aim of this study was to design and implement a scalable standards-based clinical decision support (CDS) approach to identify patient cohorts for PHM and maximize opportunities for multi-site dissemination. Materials and Methods An architecture was established to support bidirectional data exchanges between heterogeneous electronic health record (EHR) data sources, PHM systems, and CDS components. HL7 Fast Healthcare Interoperability Resources and CDS Hooks were used to facilitate interoperability and dissemination. The approach was validated by deploying the platform at multiple sites to identify patients who meet the criteria for genetic evaluation of familial cancer. Results The Genetic Cancer Risk Detector (GARDE) platform was created and is comprised of four components: (1) an open-source CDS Hooks server for computing patient eligibility for PHM cohorts, (2) an open-source Population Coordinator that processes GARDE requests and communicates results to a PHM system, (3) an EHR Patient Data Repository, and (4) EHR PHM Tools to manage patients and perform outreach functions. Site-specific deployments were performed on onsite virtual machines and cloud-based Amazon Web Services. Discussion GARDE’s component architecture establishes generalizable standards-based methods for computing PHM cohorts. Replicating deployments using one of the established deployment methods requires minimal local customization. Most of the deployment effort was related to obtaining site-specific information technology governance approvals.
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Affiliation(s)
- Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
- Corresponding Author: Richard L. Bradshaw, MS, PhD, Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT 84108-3514, USA;
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Wendy K Kohlmann
- University of Utah Health, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Departments of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- University of Utah Health, Salt Lake City, Utah, USA
- Departments of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Michael C Flynn
- University of Utah Health, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Community Physicians Group, University of Utah, Salt Lake City, Utah, USA
| | - Claude J Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
| | - Phillip B Warner
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
| | - Jianlin Shi
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Keaton Morgan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kadyn Kimball
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Pallavi Ranade-Kharkar
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ophira Ginsburg
- New York University Langone Health, New York City, New York, USA
| | - Melody Goodman
- School of Global and Public Health, New York University, New York City, New York, USA
| | | | - Devin Mann
- New York University Langone Health, New York City, New York, USA
| | - Scott P Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Javier Gonzalez
- New York University Langone Health, New York City, New York, USA
| | - Shane Loomis
- New York University Langone Health, New York City, New York, USA
- Epic Systems Corporation, Madison, Wisconsin, USA
| | - Priscilla Chan
- New York University Langone Health, New York City, New York, USA
| | - Rachel Monahan
- New York University Langone Health, New York City, New York, USA
| | - Emerson P Borsato
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - David E Shields
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
| | - Douglas K Martin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
| | - Cecilia M Kessler
- University of Utah Health, Salt Lake City, Utah, USA
- Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
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O'Malley DM, Alfano CM, Doose M, Kinney AY, Lee SJC, Nekhlyudov L, Duberstein P, Hudson SV. Cancer prevention, risk reduction, and control: opportunities for the next decade of health care delivery research. Transl Behav Med 2021; 11:1989-1997. [PMID: 34850934 PMCID: PMC8634312 DOI: 10.1093/tbm/ibab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this commentary, we discuss opportunities to optimize cancer care delivery in the next decade building from evidence and advancements in the conceptualization and implementation of multi-level translational behavioral interventions. We summarize critical issues and discoveries describing new directions for translational behavioral research in the coming decade based on the promise of the accelerated application of this evidence within learning health systems. To illustrate these advances, we discuss cancer prevention, risk reduction (particularly precision prevention and early detection), and cancer treatment and survivorship (particularly risk- and need-stratified comprehensive care) and propose opportunities to equitably improve outcomes while addressing clinician shortages and cross-system coordination. We also discuss the impacts of COVID-19 and potential advances of scientific knowledge in the context of existing evidence, the need for adaptation, and potential areas of innovation to meet the needs of converging crises (e.g., fragmented care, workforce shortages, ongoing pandemic) in cancer health care delivery. Finally, we discuss new areas for exploration by applying key lessons gleaned from implementation efforts guided by advances in behavioral health.
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Affiliation(s)
- Denalee M O'Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Northwell Health Cancer Institute, New Hyde Park, NY, USA
| | - Catherine M Alfano
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michelle Doose
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anita Y Kinney
- Department of Epidemiology and Biostatistics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Simon J Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Department of Population and Data Sciences, UT-Southwestern, Dallas, TX, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Brigham & Womens' Primary Care Medical Associates, Boston, MA, USA
| | - Paul Duberstein
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Northwell Health Cancer Institute, New Hyde Park, NY, USA.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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10
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Duffy E, Chilazi M, Cainzos-Achirica M, Michos ED. Cardiovascular Disease Prevention During the COVID-19 Pandemic: Lessons Learned and Future Opportunities. Methodist Debakey Cardiovasc J 2021; 17:68-78. [PMID: 34824683 PMCID: PMC8588760 DOI: 10.14797/mdcvj.210] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/12/2021] [Indexed: 01/04/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been the defining healthcare issue since its outbreak, consuming healthcare systems and disrupting all aspects of human life throughout 2020 and continuing through 2021. When reviewing cardiovascular disease (CVD) prevention throughout the COVID-19 pandemic, the first tendency may be to focus on the negative disruption. Months of quarantine, isolation, and missed healthcare visits or delayed care may have exacerbated the epidemic of CVD in the United States. Looking back, however, perhaps it wasn't a lost year as much as a health crisis that better prepared us for the battle to improve cardiovascular health. The pandemic brought new platforms for interacting with patients eager to engage, presenting a unique opportunity to reset how we approach preventive care. In this review, we discuss what the pandemic has taught us about caring for those vulnerable patients who were most afflicted-older adults, persons of color, and people facing adverse socioeconomic circumstances-and who continue to be impacted by CVD. We also identify opportunities for enhanced CVD prevention now boosted by the overnight adoption of telemedicine and other innovative cardiac care models. Lastly, we discuss how the COVID-19 pandemic has motivated physicians and patients alike to prioritize our health above all else, if only transiently, and how we can leverage this increased health awareness and investment into long-term, meaningful disease prevention.
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Affiliation(s)
- Eamon Duffy
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
| | - Michael Chilazi
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
| | - Miguel Cainzos-Achirica
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US.,Center for Outcomes Research, Houston Methodist, Houston, Texas, US
| | - Erin D Michos
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, US
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11
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Population Health Rounds: A Novel Vehicle for Training in Population Medicine and Clinical Preventive Medicine. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:S139-S145. [PMID: 33785685 DOI: 10.1097/phh.0000000000001326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Preventive medicine residents must train in population medicine (including analytics and population health) and clinical preventive medicine (including screening, behavioral counseling, and chemoprophylaxis). Yet, opportunities to perform both functions concurrently for the same population are scarce. Residents must also master the art of preventive medicine, but they often lack an established community of practice that provides a continuous forum to do so. This project explored Population Health Rounds as a novel vehicle to optimize preventive medicine residency training. PROGRAM DESCRIPTION Modeled after traditional medical rounds, Population Health Rounds consist of a 1-hour weekly meeting engaging preventive medicine residents and supervising attendings at Stony Brook Medicine in both population medicine and clinical preventive medicine concurrently, including patient case discussions and targeted population health analytics. EVALUATION AND RESULTS Because of the pandemic, the rounds have predominantly focused on COVID-19 and its effects on the hospital employee population. In addition to providing direct patient care to COVID-19-positive and exposed employees, residents have analyzed data on this population and made recommendations to hospital leadership based on COVID-19's institutional epidemiology, including incidence, prevalence, and predictive factors. A formative qualitative survey of resident perceptions offers insights on the value and learning outcomes of this new model. DISCUSSION AND CONCLUSION Factors that may impact the implementation, sustainability, and feasibility of this model are discussed. The preventive medicine residency program is commissioned to address gaps in clinical preventive services for the patient-centered medical home tied to the sponsoring institution's family medicine practice. Additional plans are underway to expand the rounds to other clinical contexts, such as lifestyle medicine in the occupational setting, and for targeted populations, such as the underserved. Replication of the Population Health Rounds model is recommended to determine its effectiveness.
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12
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Abbate M, Fresneda S, Yañez A, Ricci-Cabello I, Galmes-Panades AM, Aguilo A, Bennasar-Veny M. Nurse-led telephone intervention for lifestyle changes on glycaemic control in people with prediabetes: Study protocol for a randomized controlled trial. J Adv Nurs 2021; 77:3204-3217. [PMID: 33769603 DOI: 10.1111/jan.14842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023]
Abstract
AIM To evaluate the effectiveness of a nurse-led personalized telephone lifestyle intervention versus automated SMSs in the reduction of fasting plasma glucose in adults with prediabetes. DESIGN The PREDIPHONE is a randomized controlled, parallel, two arms, superiority trial with 15 months of follow-up. Participants will be randomized to either the intervention group (teleconsultations) or the active control group (SMSs). METHODS A total of 428 participants will be randomized in a 1:1 ratio to one of the two arms and followed up during 9 months. The teleconsultations group will receive nurse-led personalized advice, while the SMSs group will receive 4-5 brief SMSs a week. Participants in both groups will receive evidence-based recommendations for diet and physical activity (PA). Outcome measures will be collected at baseline, months 4 and 9 and at month 15, to evaluate post-intervention effects. DISCUSSION Prevention of diabetes through the implementation of lifestyle interventions remains an important priority. The current pandemic situation has magnified its urgency as it heavily affected the functionality of the healthcare system. Moreover, it created the need of remotely delivering preventative interventions. This study will provide insights on the effectiveness and feasibility of a telephone-based intervention led by nurses in the amelioration of risk factors associated with diabetes. IMPACT Findings from this study will offer health services decision-makers sound evidence regarding an alternative method to face-to-face consultations that could be practical, acceptable and inexpensive, and that concretely answers the need for easily implementable prevention strategies. TRIAL REGISTRATION NCT04735640 (ClinicalTrials.gov identifier). PROTOCOL VERSION V1.0, 18/02/2021.
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Affiliation(s)
- Manuela Abbate
- Research group on Global Health and Human Development, University of the Balearic Islands (UIB), Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Sergio Fresneda
- Research group on Global Health and Human Development, University of the Balearic Islands (UIB), Palma, Spain.,Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Group on Global Health & Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Aina Yañez
- Research group on Global Health and Human Development, University of the Balearic Islands (UIB), Palma, Spain.,Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Group on Global Health & Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Balearic Islands Health Service, Primary Care Research Unit of Mallorca, Palma, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Aina M Galmes-Panades
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.,Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Antoni Aguilo
- Research group on Global Health and Human Development, University of the Balearic Islands (UIB), Palma, Spain.,Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Group on Global Health & Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Miquel Bennasar-Veny
- Research group on Global Health and Human Development, University of the Balearic Islands (UIB), Palma, Spain.,Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain.,Research Group on Global Health & Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
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