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Brooks EM, Fugate-Laus K, Webel B, Naavaal S. Perceptions of a State-Level HPV Vaccine Mandate and Exemption Option in Rural Virginia: A Qualitative Study. Vaccines (Basel) 2024; 12:401. [PMID: 38675783 PMCID: PMC11054131 DOI: 10.3390/vaccines12040401] [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: 02/15/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; yet, despite the availability of safe and effective HPV vaccines, only half of eligible adolescents have completed the vaccine series. School-entry requirements are one proven strategy to increase vaccination rates among children and youth and reduce the burden of HPV-related cancer. This study investigated community perceptions of an HPV vaccine school-entry mandate in Virginia and the consequences of a low threshold exemption option included in the legislation. We conducted 40 interviews with community members including 15 interviews with parents, 19 with healthcare providers, and 6 with community leaders. Interviews asked about knowledge, beliefs, and attitudes concerning the HPV vaccine and mandate. Interviews were recorded, transcribed, and thematically analyzed. Despite healthcare provider support for the mandate, there was widespread confusion over the school-entry policy and concern that the exemption option undermined vaccination efforts. Understanding variations in community-level perceptions and response to school-based vaccination mandates is crucial for designing effective public health strategies. Findings suggest statewide vaccination initiatives should preemptively identify low uptake areas and provide targeted information to communities. Future mandates should avoid the use of ambiguous and contradictory language in vaccine-related legislation.
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Affiliation(s)
- E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kendall Fugate-Laus
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Shillpa Naavaal
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
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Webel B, Villalobos G, Rockwell MS, Huffstetler A, Britz JB, Brooks EM, Krist AH. Considering the Environmental Impact of Practice-Based Research. J Am Board Fam Med 2024; 37:22-24. [PMID: 38448235 PMCID: PMC11044959 DOI: 10.3122/jabfm.2023.230202r1] [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: 05/25/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Practice-based research networks (PBRNs) improve primary care by addressing issues that matter to clinicians. Building trust between researchers and care teams is essential to this process, which often requires visiting practices to cultivate relationships and perform research activities. However, in a recent study using practice facilitation to improve the delivery of a preventive service, the COVID-19 pandemic prompted us to convert all planned facilitation from an in-person to virtual format. This eliminated the need to commute by automobile to and from practices across the state, greatly reducing the carbon footprint of the study. METHODS From practice facilitator field notes that detailed practice locations and number of sessions, we calculated the total number of driving miles averted by virtual facilitation. We then determined metric tons of carbon dioxide we avoided producing using the Environmental Protection Agency Greenhouse Gases Equivalencies Calculator. During post-intervention interviews, we assessed practices' perspectives and experiences with the virtual format. RESULTS Three practice facilitators provided an average of 3.4 sessions for 64 practices. Virtual facilitation averted 32,574.8 drive miles and prevented the release of 12.7 metric tons of carbon dioxide, an offset equivalent to growing 210 trees for 10 years. Practices reported that virtual facilitation fostered greater engagement and allowed more clinicians and staff to attend sessions. DISCUSSION Climate change poses a significant threat to the health of people and communities. Given their commitment to improving population health, it may be time for PBRNs to routinely assess their environmental impact and minimize preventable environmental costs.
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Affiliation(s)
- Ben Webel
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (BW, GV, AH, JBB, EMB, AHK); and Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA (MSR).
| | - Gabriela Villalobos
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (BW, GV, AH, JBB, EMB, AHK); and Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA (MSR)
| | - Michelle S Rockwell
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (BW, GV, AH, JBB, EMB, AHK); and Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA (MSR)
| | - Alison Huffstetler
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (BW, GV, AH, JBB, EMB, AHK); and Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA (MSR)
| | - Jacqueline B Britz
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (BW, GV, AH, JBB, EMB, AHK); and Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA (MSR)
| | - E Marshall Brooks
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (BW, GV, AH, JBB, EMB, AHK); and Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA (MSR)
| | - Alex H Krist
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (BW, GV, AH, JBB, EMB, AHK); and Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA (MSR)
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Huffstetler AN, Villalobos G, Brooks EM, Funk A, Richards A, Sabo RT, Rockwell MS, Epling JW, Webel B, Krist AH. The Current State of Alcohol Screening and Management in Virginia Primary Care Practices: An Evaluation of Preventive Service Use. Med Clin North Am 2023; 107:e1-e17. [PMID: 38609278 DOI: 10.1016/j.mcna.2023.07.001] [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] [Indexed: 04/14/2024]
Abstract
The US Preventive Services Task Force (USPSTF) recommends screening and behavioral counseling for adults over 18 years for unhealthy alcohol use. Recommended screening instruments include the Alcohol Use Disorders Identification Test-Concise and or Single Alcohol Screening Question. Behavioral counseling is feasible in primary care, taking on average 30 minutes. Baseline data for a practice facilitation trial demonstrated clinicians appropriately screened only 10.8% of patients and only identified 9.6% as having risky drinking. Yet, 24% of patients reported risky drinking on a survey, demonstrating the implementation gap of the USPSTF recommendation and opportunity to improve health.
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Affiliation(s)
- Alison N Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA; Inova Fairfax Family Practice Residency, Fairfax, VA, USA.
| | - Gabriela Villalobos
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - E Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam Funk
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Alicia Richards
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle S Rockwell
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - John W Epling
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA; Inova Fairfax Family Practice Residency, Fairfax, VA, USA
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Krist AH, Huffstetler AN, Villalobos G, Rockwell MS, Richards A, Funk A, Sabo RT, Bortz B, Webel B, Lee JH, Russel K, Kuzel A, Britz JB, Moeller FG. Use of population health data to promote equitable recruitment for a primary care practice implementation trial addressing unhealthy alcohol use. J Clin Transl Sci 2023; 7:e110. [PMID: 37250994 PMCID: PMC10225269 DOI: 10.1017/cts.2023.530] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Recruiting underrepresented people and communities in research is essential for generalizable findings. Ensuring representative participants can be particularly challenging for practice-level dissemination and implementation trials. Novel use of real-world data about practices and the communities they serve could promote more equitable and inclusive recruitment. Methods We used a comprehensive primary care clinician and practice database, the Virginia All-Payers Claims Database, and the HealthLandscape Virginia mapping tool with community-level socio-ecological information to prospectively inform practice recruitment for a study to help primary care better screen and counsel for unhealthy alcohol use. Throughout recruitment, we measured how similar study practices were to primary care on average, mapped where practices' patients lived, and iteratively adapted our recruitment strategies. Results In response to practice and community data, we adapted our recruitment strategy three times; first leveraging relationships with residency graduates, then a health system and professional organization approach, followed by a community-targeted approach, and a concluding approach using all three approaches. We enrolled 76 practices whose patients live in 97.3% (1844 of 1907) of Virginia's census tracts. Our overall patient sample had similar demographics to the state for race (21.7% vs 20.0% Black), ethnicity (9.5% vs 10.2% Hispanic), insurance status (6.4% vs 8.0% uninsured), and education (26.0% vs 32.5% high school graduate or less). Each practice recruitment approach uniquely included different communities and patients. Discussion Data about primary care practices and the communities they serve can prospectively inform research recruitment of practices to yield more representative and inclusive patient cohorts for participation.
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Affiliation(s)
- Alex H. Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Inova Health System, Fairfax, VA, USA
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Alison N. Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Inova Health System, Fairfax, VA, USA
| | - Gabriela Villalobos
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Michelle S. Rockwell
- Department of Family & Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Alicia Richards
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam Funk
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T. Sabo
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Beth Bortz
- Virginia Center for Health Innovation, Richmond, VA, USA
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Jong Hyung Lee
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Kyle Russel
- Virginia Health Information, Richmond, VA, USA
| | - Anton Kuzel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Jaqueline B. Britz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - F. Gerard Moeller
- Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
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Huffstetler AN, Sabo RT, Lavallee M, Webel B, Kashiri PL, Britz J, Carrozza M, Topmiller M, Wolf ER, Bortz BA, Edwards AM, Krist AH. Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia. Ann Fam Med 2022; 20:446-451. [PMID: 36228075 PMCID: PMC9512553 DOI: 10.1370/afm.2854] [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] [Received: 09/30/2021] [Revised: 02/24/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Primary care is the foundation of the health care workforce and the only part that extends life and improves health equity. Previous research on the geographic and specialty distribution of physicians has relied on the American Medical Association's Masterfile, but these data have limitations that overestimate the workforce. METHODS We present a pragmatic, systematic, and more accurate method for identifying primary care physicians using the National Plan and Provider Enumeration System (NPPES) and the Virginia All-Payer Claims Database (VA-APCD). Between 2015 and 2019, we identified all Virginia physicians and their specialty through the NPPES. Active physicians were defined by at least 1 claim in the VA-APCD. Specialty was determined hierarchically by the NPPES. Wellness visits were used to identify non-family medicine physicians who were providing primary care. RESULTS In 2019, there were 20,976 active physicians in Virginia, of whom 5,899 (28.1%) were classified as providing primary care. Of this primary care physician workforce, 52.4% were family medicine physicians; the remaining were internal medicine physicians (18.5%), pediatricians (16.8%), obstetricians and gynecologists (11.8%), and other specialists (0.5%). Over 5 years, the counts and relative percentages of the workforce made up by primary care physicians remained relatively stable. CONCLUSIONS Our novel method of identifying active physicians with a primary care scope provides a realistic size of the primary care workforce in Virginia, smaller than some previous estimates. Although the method should be expanded to include advanced practice clinicians and to further delineate the scope of practice, this simple approach can be used by policy makers, payers, and planners to ensure adequate primary care capacity.
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Affiliation(s)
- Alison N Huffstetler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Martin Lavallee
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Paulette Lail Kashiri
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jacquelyn Britz
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Elizabeth R Wolf
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Beth A Bortz
- Virginia Center for Health Innovation, Richmond, Virginia
| | | | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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O'Loughlin K, Shadowen HM, Haley AD, Gilbert J, Lail Kashiri P, Webel B, Huebschmann AG, Krist AH. Patient Preferences for Discussing and Acting on Health-Related Needs in Primary Care. J Prim Care Community Health 2022; 13:21501319221115946. [PMID: 35920033 PMCID: PMC9358340 DOI: 10.1177/21501319221115946] [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: 11/15/2022] Open
Abstract
Background: Addressing social needs, health behaviors, and mental health may help
patients more than traditional medical care. However, these root causes of
poor health are difficult to address and the role of primary care is
unclear. This qualitative study assesses patient’s willingness and
motivations to discuss and accept assistance for these needs from their
primary care team. Methods: In July and August of 2020, semi-structured virtual interviews were conducted
with family medicine patients (n = 6) and residents of low resource
neighborhoods (n = 11) in Richmond, Virginia. Interviews were conducted over
Zoom. We conducted a qualitative analysis of patient and resident interview
transcripts. A rapid qualitative analysis approach and
immersion-crystallization processes were used to identify themes and
categories. Results: Interviewees reported varying degrees of comfort discussing topics with their
health care team. They were less comfortable discussing needs they
considered outside the realm of “traditional primary care” including
finances, transportation, and housing, but interviewees expressed
willingness to discuss these needs under certain conditions. Important
factors were a strong patient-clinician relationship to create a trusted and
safe space for discussion, adequate time for discussion during visits,
communication of practices’ ability to provide resources to help patients,
and ensuring appropriate high quality referrals. Conclusions: Primary care provides opportunity for identifying and addressing needs that
adversely impact health. Some needs are more sensitive for patients to work
with their care team on, though, there was willingness to work on
any need when a strong provider relationship and clinic
structure for providing support were in place. This study highlights
critical care delivery factors which may be used to enhance patient comfort
accepting support for their needs and ultimately improve clinical care and
chronic disease management.
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Affiliation(s)
| | | | - Amber D Haley
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | - Ben Webel
- Virginia Commonwealth University, Richmond, USA
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