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El Mouaddib H, Sebbani M, Mansouri A, Adarmouch L, Amine M. Cross-cultural adaptation of the Moroccan Arabic dialect version of the Primary Care Assessment Tool. Gac Sanit 2023; 37:102350. [PMID: 38052119 DOI: 10.1016/j.gaceta.2023.102350] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To adapt the Primary Primary Care Assessment Tool-Adult Edition into the Moroccan Arabic dialect and to assess its reliability and validity from the perspective of Moroccan adult patients. METHOD A committee of experts carried out the cross-cultural adaptation of the Primary Care Assessment Tool. The adapted questionnaire was subject to forward and backward translation and a pilot study. Exploratory factor analysis assessed the internal consistency, reliability, and construct validity of items and scales. Finally, descriptive statistics were performed on the final factor structure. RESULTS A 43-item Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition was developed. It consisted of six multi-item scales that represented the four main dimensions of primary care: first contact, continuity, comprehensiveness, and coordination. Four derived dimensions were included: cultural competence, communication, advice, and community orientation. All six scales demonstrated robust internal consistency, item-total solid correlations, and construct validity. The calculated Cronbach's alpha coefficients ranged from 0.78 to 0.90. CONCLUSIONS Comprehensive metric analyses supported the reliability and validity of the Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition in assessing core primary care domains from the patients' experience. This tool could be used for future research on primary care in Morocco.
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Affiliation(s)
- Hicham El Mouaddib
- Biosciences & Health Laboratory, Cadi Ayyad University, Marrakesh, Morocco.
| | - Majda Sebbani
- Biosciences & Health Laboratory, Cadi Ayyad University, Marrakesh, Morocco; Clinical Research Unit, Mohammed VI University Hospital, Marrakesh, Morocco; Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Marrakesh, Morocco; Unit of Development and Research in Medical Education, Geneva University, Geneva, Switzerland
| | - Adil Mansouri
- Clinical Research Unit, Mohammed VI University Hospital, Marrakesh, Morocco; Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Marrakesh, Morocco
| | - Latifa Adarmouch
- Biosciences & Health Laboratory, Cadi Ayyad University, Marrakesh, Morocco; Clinical Research Unit, Mohammed VI University Hospital, Marrakesh, Morocco; Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Marrakesh, Morocco
| | - Mohamed Amine
- Biosciences & Health Laboratory, Cadi Ayyad University, Marrakesh, Morocco; Clinical Research Unit, Mohammed VI University Hospital, Marrakesh, Morocco; Community Medicine and Public Health Department, School of Medicine, Cadi Ayyad University, Marrakesh, Morocco
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O'Leary MC, Reuland DS, Correa SY, Moore AA, Malo TL, Tan X, Rohweder CL, Wheeler SB, Brenner AT. Uptake of colorectal cancer screening after mailed fecal immunochemical test (FIT) outreach in a newly eligible 45-49-year-old community health center population. Cancer Causes Control 2023; 34:125-133. [PMID: 37300632 PMCID: PMC10256969 DOI: 10.1007/s10552-023-01717-8] [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: 11/04/2022] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE We assessed fecal immunochemical test (FIT) uptake following a mailed FIT intervention among 45-49-year-olds newly eligible for colorectal cancer (CRC) screening based on 2021 United States Preventive Services Task Force screening recommendations. We also tested the effect of an enhanced versus plain mailing envelope on FIT uptake. METHODS In February 2022 we mailed FITs to eligible 45-49-year-olds at one Federally Qualified Health Center (FQHC) clinic. We determined the proportion who completed FITs within 60 days. We also conducted a nested randomized trial comparing uptake using an enhanced envelope (padded with tracking label and colored messaging sticker) versus plain envelope. Finally, we determined the change in CRC screening by any modality (e.g., FIT, colonoscopy) among all clinic patients in this age group (i.e., clinic-level screening) between baseline and 6 months post-intervention. RESULTS We mailed FITs to 316 patients. Sample characteristics: 57% female, 58% non-Hispanic Black, and 50% commercially insured. Overall, 54/316 (17.1%) returned a FIT within 60 days, including 34/158 (21.5%) patients in the enhanced envelope arm versus 20/158 (12.7%) in the plain envelope arm (difference 8.9 percentage points, 95% CI: 0.6-17.2). Clinic-level screening among all 45-49-year-olds increased 16.6 percentage points (95% CI: 10.9-22.3), from 26.7% at baseline to 43.3% at 6 months. CONCLUSION CRC screening appeared to increase following a mailed FIT intervention among diverse FQHC patients aged 45-49. Larger studies are needed to assess acceptability and completion of CRC screening in this younger population. Visually appealing mailers may improve uptake when implementing mailed interventions. Trial registration The trial was registered on May 28, 2020 at ClinicalTrials.gov (identifier NCT04406714).
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Affiliation(s)
- Meghan C O'Leary
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sara Y Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Teri L Malo
- Patient Support Pillar, American Cancer Society, Kennesaw, GA, USA
| | - Xianming Tan
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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O'Leary MC, Hassmiller Lich K, Reuland DS, Brenner AT, Moore AA, Ratner S, Birken SA, Wheeler SB. Optimizing process flow diagrams to guide implementation of a colorectal cancer screening intervention in new settings. Cancer Causes Control 2023; 34:89-98. [PMID: 37731072 PMCID: PMC10689519 DOI: 10.1007/s10552-023-01769-w] [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: 11/05/2022] [Accepted: 07/26/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The goal of this study was to assess acceptability of using process flow diagrams (or process maps) depicting a previously implemented evidence-based intervention (EBI) to inform the implementation of similar interventions in new settings. METHODS We developed three different versions of process maps, each visualizing the implementation of the same multicomponent colorectal cancer (CRC) screening EBI in community health centers but including varying levels of detail about how it was implemented. Interviews with community health professionals and practitioners at other sites not affiliated with this intervention were conducted. We assessed their preferences related to the map designs, their potential utility for guiding EBI implementation, and the feasibility of implementing a similar intervention in their local setting given the information available in the process maps. RESULTS Eleven community health representatives were interviewed. Participants were able to understand how the intervention was implemented and engage in discussions around the feasibility of implementing this type of complex intervention in their local system. Potential uses of the maps for supporting implementation included staff training, role delineation, monitoring and quality control, and adapting the components and implementation activities of the existing intervention. CONCLUSION Process maps can potentially support decision-making about the adoption, implementation, and adaptation of existing EBIs in new contexts. Given the complexities involved in deciding whether and how to implement EBIs, these diagrams serve as visual, easily understood tools to inform potential future adopters of the EBI about the activities, resources, and staffing needed for implementation.
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Affiliation(s)
- Meghan C O'Leary
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shana Ratner
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Castañeda SF, Gupta S, Nodora JN, Largaespada V, Roesch SC, Rabin BA, Covin J, Ortwine K, Preciado-Hidalgo Y, Howard N, Halpern MT, Martinez ME. Hub-and-Spoke centralized intervention to optimize colorectal cancer screening and follow-up: A pragmatic, cluster-randomized controlled trial protocol. Contemp Clin Trials 2023; 134:107353. [PMID: 37802222 PMCID: PMC10840449 DOI: 10.1016/j.cct.2023.107353] [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: 05/25/2023] [Revised: 09/01/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Guidelines recommend screening for colorectal cancer (CRC), but participation and abnormal test follow up rates are suboptimal, with disparities by demography. Evidence-based interventions exist to promote screening, but community adoption and implementation are limited. METHODS The San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) program is an academic-community partnership testing regional implementation of a Hub-and-Spoke model for increasing CRC screening and follow-up. The "hub" is a non-academic, non-profit organization that includes 17 community health center (CHC) systems, serving over 190 rural and urban clinic sites. The "spokes" are 3 CHC systems that oversee 11-28 clinics each, totaling over 60 clinics. Using a cluster-randomized trial design, 9 clinics were randomized to intervention and 16 to usual care. Within intervention clinics, approximately 5000 eligible patients not up-to-date with CRC screening per year were identified for intervention. Interventions include an invitation primer, a mailed fecal immunochemical test with completion instructions, and phone and text-based reminders (hub) and patient navigation protocol to promote colonoscopy completion after abnormal FIT (spoke). Outcomes include: 1) proportion of patients up-to-date with screening after three years in intervention versus non-intervention clinics; 2) proportion of patients with abnormal FIT completing colonoscopy within six months of the abnormal result. Implementation science measures are collected to assess acceptability, intervention and usual care adaptations, and sustainability of the intervention strategies. CONCLUSION This large-scale, regional cluster randomized trial among CHCs serving diverse populations is anticipated to accelerate progress in CRC prevention in underserved populations. TRIAL REGISTRATION NCT04941300.
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Affiliation(s)
- Sheila F Castañeda
- Department of Psychology, San Diego State University, San Diego, CA, United States of America.
| | - Samir Gupta
- UC San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, United States of America.
| | - Jesse N Nodora
- UC San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, United States of America; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States of America
| | - Valesca Largaespada
- UC San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, United States of America
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, United States of America
| | - Borsika A Rabin
- UC San Diego Altman Clinical and Translational Research Institute, Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States of America
| | - Jennifer Covin
- Health Quality Partners of Southern California, San Diego CA, United States of America
| | - Kristine Ortwine
- Integrated Health Partners of Southern California, San Diego, CA, United States of America
| | | | - Nicole Howard
- Health Quality Partners of Southern California, San Diego CA, United States of America
| | | | - Maria Elena Martinez
- UC San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, United States of America; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States of America.
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Reisner SL, Pletta DR, Harris A, Campbell J, Asquith A, Pardee DJ, Deutsch MB, Aguayo-Romero R, Quint M, Keuroghlian AS, Radix A. Exploring gender euphoria in a sample of transgender and gender diverse patients at two U.S. urban community health centers. Psychiatry Res 2023; 329:115541. [PMID: 37857133 DOI: 10.1016/j.psychres.2023.115541] [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: 05/25/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Transgender and gender diverse (TGD) people are affected by mental health inequities. Gender euphoria-positive emotions or joy in gender-may be associated with positive mental health. Between February 2019-July 2021, we surveyed 2,165 adult TGD patients (median age = 28 years; 29.2 % people of color; 29.6 % nonbinary; 81.0 % taking hormones) evaluating gender euphoria and mental health. Overall, 35.0 % self-reported gender euphoria, 50.9 % gender dysphoria, 23.5 % alcohol misuse, and 44.5 % resilience. Gender euphoria differed by race, gender, insurance, and hormone use, and was associated with reduced gender dysphoria (adjusted Odds Ratio[aOR] = 0.58; 95 % confidence interval [95 %CI] = 0.47-0.72) and alcohol misuse (aOR = 0.75; 95 %CI = 0.60-0.95), and increased resilience (aOR = 1.31; 95 %CI = 1.07-1.61). The construct of gender euphoria may be a promising mental health target.
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Affiliation(s)
- Sari L Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - David R Pletta
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexander Harris
- Medical Research Division, Callen-Lorde Community Health Center, New York City, NY, USA
| | | | | | - Dana J Pardee
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Madeline B Deutsch
- Family and Community Medicine, University of California San Francsico, San Francisco, CA, USA
| | - Rodrigo Aguayo-Romero
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Asa Radix
- Medical Research Division, Callen-Lorde Community Health Center, New York City, NY, USA
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Wang M, Perzynski A, Ronis S. Bringing community oriented primary care into an academic training setting: A qualitative study. Prev Med Rep 2023; 35:102313. [PMID: 37752984 PMCID: PMC10518791 DOI: 10.1016/j.pmedr.2023.102313] [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] [Received: 01/24/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 09/28/2023] Open
Abstract
Objectives Identify patient-informed strategies through which an urban resident continuity clinic can implement the principles of community oriented primary care (COPC). Methods As part of a larger sequential mixed methods study supporting implementation evaluation of a new urban academic medical center in Cleveland, Ohio, semi-structured telephone interviews using a descriptive phenomenological approach were conducted spring 2021 with patients to explore perspectives regarding community involvement by healthcare providers and what they want clinicians to know about their community. A constant comparative analysis of emerging themes was used to analyze the thematic contents of interviews. Results Twenty-one participants completed interviews. Almost all thought clinicians' community involvement is important. Thematic guidance from participants highlighted that clinicians should be: (1) knowledgeable about the Black experience, (2) seen in the community outside the clinic, and (3) aware that "knowing my community is knowing me." Conclusions Design with a target community in mind is a necessary but not sufficient step to implement COPC in practice. The visibility of clinicians in community settings is essential for COPC.
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Affiliation(s)
- Mia Wang
- Case Western Reserve School of Medicine, Department of Population and Quantitative Health Sciences, Cleveland, OH, United States
| | - Adam Perzynski
- Case Western Reserve School of Medicine, Department of Population and Quantitative Health Sciences, Cleveland, OH, United States
| | - Sarah Ronis
- University Hospitals, Rainbow Center for Child Health and Policy, Cleveland, OH, United States
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Ferrari RM, Leeman J, Brenner AT, Correa SY, Malo TL, Moore AA, O'Leary MC, Randolph CM, Ratner S, Frerichs L, Farr D, Crockett SD, Wheeler SB, Lich KH, Beasley E, Hogsed M, Bland A, Richardson C, Newcomer M, Reuland DS. Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers. Implement Sci Commun 2023; 4:118. [PMID: 37730659 PMCID: PMC10512568 DOI: 10.1186/s43058-023-00485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Adoption of colorectal cancer (CRC) screening has lagged in community health center (CHC) populations in the USA. To address this implementation gap, we developed a multilevel intervention to improve screening in CHCs in our region. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide this effort. Here, we describe the use of implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) compilation in both the Exploration and Preparation phases of this project. During these two EPIS phases, we aimed to answer three primary questions: (1) What factors in the inner and outer contexts may support or hinder colorectal cancer screening in North Carolina CHCs?; (2) What evidence-based practices (EBPs) best fit the needs of North Carolina CHCs?; and (3) How can we best integrate the selected EBPs into North Carolina CHC systems? METHODS During the Exploration phase, we conducted local needs assessments, built a coalition, and conducted local consensus discussions. In the Preparation phase, we formed workgroups corresponding to the intervention's core functional components. Workgroups used cyclical small tests of change and process mapping to identify implementation barriers and facilitators and to adapt intervention components to fit inner and outer contexts. RESULTS Exploration activities yielded a coalition of stakeholders, including two rural CHCs, who identified barriers and facilitators and reached consensus on two EBPs: mailed FIT and navigation to colonoscopy. Stakeholders further agreed that the delivery of those two EBPs should be centralized to an outreach center. During Preparation, workgroups developed and refined protocols for the following centrally-delivered intervention components: a registry to identify and track eligible patients, a centralized system for mailing at-home stool tests, and a process to navigate patients to colonoscopy after an abnormal stool test. CONCLUSIONS This description may be useful both to implementation scientists, who can draw lessons from applied implementation studies such as this to refine their implementation strategy typologies and frameworks, as well as to implementation practitioners seeking exemplars for operationalizing strategies in early phases of implementation in healthcare.
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Affiliation(s)
- Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Nursing, University of North Carolina at Chapel Hill, 120 North Medical Drive, Chapel Hill, NC, 27599, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
| | - Sara Y Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Meghan C O'Leary
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Connor M Randolph
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Shana Ratner
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- UNC Institute for Healthcare Quality Improvement, CB #8005, Chapel Hill, NC, 27599, USA
| | - Leah Frerichs
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Deeonna Farr
- College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Greenville, NC, 27858, USA
| | - Seth D Crockett
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- Division of Gastroenterology & Hepatology, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR, 97239, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Evan Beasley
- Blue Ridge Health, UNC Health, 2579 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Michelle Hogsed
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Ashley Bland
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Claudia Richardson
- Ahoskie Comprehensive Care, Roanoke Chowan Community Health Center, 120 Health Center Drive, Ahoskie, NC, 27910, USA
| | - Mike Newcomer
- Digestive Health Partners, 191 Biltmore Avenue, Asheville, NC, 28801, USA
- Western Carolina Medical Society, 304 Summit Street, Asheville, NC, 28803, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
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Choi S, Powers T. Engaging and informing patients: Health information technology use in community health centers. Int J Med Inform 2023; 177:105158. [PMID: 37494783 DOI: 10.1016/j.ijmedinf.2023.105158] [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: 02/27/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This paper aims to address the relationship between the community health center (CHC) patient mix and the level of patient engagement health information technology (HIT) comprehensiveness. PARTICIPANTS The study was conducted on sample CHCs (n = 3,592 CHC-years) active between 2016 and 2018. METHODS Patient engagement HIT comprehensiveness was measured based on a framework of patient engagement through HIT that includes a two-part dichotomy of patient engagement and patient informing. Univariate analysis was used to describe CHC characteristics and multivariable ordered logistic regression analysis was used to test hypothesized relationships. RESULTS The study identified four levels of patient engagement HIT comprehensiveness: 1) to neither engage nor inform, 2) to primarily inform, 3) to primarily engage, and 4) to engage and inform. It was found that CHCs serving disproportionate shares of patients with disadvantageous socioeconomic characteristics are less likely to incorporate more comprehensive patient engagement HIT. CONCLUSION The results highlight the different levels of patient engagement HIT use among CHCs and a negative association between CHC's higher proportion of patients with a disadvantageous sociodemographic background and patient engagement HIT comprehensiveness.
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Affiliation(s)
- Seongwon Choi
- Department of Management, California State University Los Angeles, College of Business and Economics, 5154 University Dr, Los Angeles, CA 90032, USA.
| | - Thomas Powers
- Department of Marketing, Industrial Distribution and Economics, University of Alabama at Birmingham, Collat School of Business, 710 13th St S, Birmingham, AL 35294, USA
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Santiago-Rodríguez EJ, Hoeft KS, Lugtu K, McGowen M, Ofman D, Adler J, Somsouk M, Potter MB. Implementation of a novel program to support colorectal cancer screening in a community health center consortium before and after the onset of COVID-19: a qualitative study of stakeholders' perspectives. Implement Sci Commun 2023; 4:54. [PMID: 37218022 DOI: 10.1186/s43058-023-00439-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND In 2017, the San Francisco Cancer Initiative (SF CAN) established the Colorectal Cancer (CRC) Screening Program to provide technical assistance and financial support to improve CRC screening processes, and outcomes in a consortium of community health centers (CHCs) serving low-income communities in San Francisco. The purpose of this study was twofold: to evaluate the perceived influence of the support provided by the CRC Screening Program's Task Force on CRC screening processes and outcomes in these settings and to identify facilitators and barriers to SF CAN-supported CRC screening activities before and after the onset of the COVID-19 pandemic. METHODS Semi-structured key informant interviews were conducted with consortium leaders, medical directors, quality improvement team members, and clinic screening champions. Interviews were audio-recorded, professionally transcribed, and analyzed for themes. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview questions and organize the analysis. RESULTS Twenty-two participants were interviewed. The most commonly cited facilitators of improved screening processes included the expertise, funding, screening resources, regular follow-up, and sustained engagement with clinic leaders provided by the task force. The most salient barriers identified were patient characteristics, such as housing instability; staffing challenges, such as being understaffed and experiencing high staff turnover; and clinic-level challenges, such as lack of ability to implement and sustain formalized patient navigation strategies, and changes in clinic priorities due to the COVID-19 pandemic and other competing health care priorities. CONCLUSIONS Implementing CRC screening programs in a consortium of CHCs is inherently challenging. Technical assistance from the Task Force was viewed positively and helped to mitigate challenges both before and during the pandemic. Future research should explore opportunities to increase the robustness of technical assistance offered by groups such as SF CAN to support cancer screening activities in CHCs serving low-income communities.
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Affiliation(s)
| | - Kristin S Hoeft
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, CA, USA
| | - Kara Lugtu
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU3E - Room 330, San Francisco, CA, 94143, USA
| | - Matthew McGowen
- San Francisco Community Clinic Consortium, San Francisco, CA, USA
| | - David Ofman
- San Francisco Community Clinic Consortium, San Francisco, CA, USA
| | | | - Ma Somsouk
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Michael B Potter
- Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, MU3E - Room 330, San Francisco, CA, 94143, USA.
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Kaur R, Lieberman M, Mason MK, Dapkins IP, Gallager R, Hopkins K, Wu Y, Troxel AB, Rashwan A, Hope C, Kane DJ, Northridge ME. A feasibility and acceptability study of screening the parents/guardians of pediatric dental patients for the social determinants of health. Pilot Feasibility Stud 2023; 9:36. [PMID: 36895054 PMCID: PMC9996555 DOI: 10.1186/s40814-023-01269-3] [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] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. Lack of SDOH training of dental providers on SDOH may result in suboptimal care provided to pediatric dental patients and their families. The purpose of this pilot study is to report the feasibility and acceptability of SDOH screening and referral by pediatric dentistry residents and faculty in the dental clinics of Family Health Centers at NYU Langone (FHC), a Federally Qualified Health Center (FQHC) network in Brooklyn, NY, USA. METHODS Guided by the Implementation Outcomes Framework, 15 pediatric dentists and 40 pediatric dental patient-parent/guardian dyads who visited FHC in 2020-2021 for recall or treatment appointments participated in this study. The a priori feasibility and acceptability criteria for these outcomes were that after completing the Parent Adversity Scale (a validated SDOH screening tool), ≥ 80% of the participating parents/guardians would feel comfortable completing SDOH screening and referral at the dental clinic (acceptable), and ≥ 80% of the participating parents/guardians who endorsed SDOH needs would be successfully referred to an assigned counselor at the Family Support Center (feasible). RESULTS The most prevalent SDOH needs endorsed were worried within the past year that food would run out before had money to buy more (45.0%) and would like classes to learn English, read better, or obtain a high school degree (45.0%). Post-intervention, 83.9% of the participating parents/guardians who expressed an SDOH need were successfully referred to an assigned counselor at the Family Support Center for follow-up, and 95.0% of the participating parents/guardians felt comfortable completing the questionnaire at the dental clinic, surpassing the a priori feasibility and acceptability criteria, respectively. Furthermore, while most (80.0%) of the participating dental providers reported being trained in SDOH, only one-third (33.3%) usually or always assess SDOH for their pediatric dental patients, and most (53.8%) felt minimally comfortable discussing challenges faced by pediatric dental patient families and referring patients to resources in the community. CONCLUSIONS This study provides novel evidence of the feasibility and acceptability of SDOH screening and referral by dentists in the pediatric dental clinics of an FQHC network.
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Affiliation(s)
- Raghbir Kaur
- Department of Dental Medicine, Advanced Education in Pediatric Dentistry Program, Family Health Centers at NYU Langone, 150 55Th Street, First Floor, Brooklyn, NY, 11220, USA
| | - Martin Lieberman
- Graduate Dental Education and Distance Learning, NYU Langone Dental Medicine Postdoctoral Residency Programs, Family Health Centers at NYU Langone, Department of Dental Medicine, Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, 5800 Third Avenue, Third Floor, Brooklyn, NY, 11220, USA
| | - Margaret K Mason
- Department of Dental Medicine, Family Health Centers at NYU Langone, 5800 Third Avenue, Room 320, Brooklyn, NY, 11220, USA
| | - Isaac P Dapkins
- Departments of Medicine and Population Health, Family Health Centers at NYU Langone, NYU Grossman School of Medicine, 5800 Third Avenue, Suite 2-020, Brooklyn, NY, 11220, USA
| | - Rebecca Gallager
- Youth and Adolescent Services, Family Health Centers at NYU Langone, 150 55Th Street, Brooklyn, NY, 11256, USA
| | - Kathleen Hopkins
- Department of Community Programs, Family Health Centers at NYU Langone, 6025 6Th Avenue, Second Floor, Brooklyn, NY, 11220, USA
| | - Yinxiang Wu
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, Fifth Floor, New York, NY, 10016, USA
| | - Andrea B Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, Fifth Floor, 5-55, New York, NY, 10016, USA
| | - Ayah Rashwan
- Department of Dental Medicine, Advanced Education in Pediatric Dentistry Program, Family Health Centers at NYU Langone, 150 55Th Street, First Floor, Brooklyn, NY, 11220, USA
| | - Chelsea Hope
- Department of Dental Medicine, Advanced Education in Pediatric Dentistry Program, Family Health Centers at NYU Langone, 150 55Th Street, First Floor, Brooklyn, NY, 11220, USA
| | - Daniel J Kane
- Department of Dental Medicine, Advanced Education in Pediatric Dentistry Program, Family Health Centers at NYU Langone, 150 55Th Street, Third Floor, Brooklyn, NY, 11220, USA
| | - Mary E Northridge
- Family Health Centers at NYU Langone, Department of Dental Medicine, Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, 5800 Third Avenue, Room 344, Brooklyn, NY, 11220, USA.
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11
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Burns J, Reeves J, Adams M, Darville-Sanders G, Johnstone KA, Ozuna-Harrison R, Johnson K, Ware D, Shade GH, Bradley WW. Young Men's Health Matters: Implementing a Community-Academic Partnership in an Urban Federally Qualified Health Center. Inquiry 2022; 59:469580221142488. [PMID: 36537624 PMCID: PMC9772934 DOI: 10.1177/00469580221142488] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Community-based participatory research (CBPR) approaches are being leveraged more and more in efforts to improve health equity. Informing the building of community-academic partnerships, CBPR draws on the community's expressed needs and engages stakeholders in future intervention development. To date, however, little has been published on such efforts targeting the health of young Black men (ages 18-24), despite this population's disproportionate need. In this paper, we describe the formation of a community-academic partnership in a federally qualified health center, with the goal of improving the health of young Black men in Detroit, Michigan. After conducting a needs assessment, we built upon existing networks to form a Community Advisory Board (CAB). We held three community forums during which CAB members highlighted key health issues in their community and described how they could be addressed. We developed a plan for future research and community engagement based on community input. Finally, we provide insights on community engagement strategies, forum structure, setting boundaries, trust-building, and valuable information in addressing the inequities in health that affect young Black men.
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Affiliation(s)
- Jade Burns
- University of Michigan School of Nursing, Ann Arbor, MI, USA,Jade Burns, University of Michigan School of Nursing, Department of Health Behavior & Biological Sciences, 400 N. Ingalls Street, Room 3175, Ann Arbor, MI 48109, USA.
| | | | - Mackenzie Adams
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | | | | | - Kedar Johnson
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Derek Ware
- Detroit Community Health Connection, Inc., Detroit, MI, USA
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12
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Meador M, Coronado F, Roy D, Bay RC, Lewis JH, Chen J, Cheung R, Utman C, Hannan JA. Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers. BMC Public Health 2022; 22:2295. [PMID: 36476418 PMCID: PMC9730629 DOI: 10.1186/s12889-022-14763-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Uncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient's BP is assumed uncontrolled. METHODS To examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP). RESULTS The percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021). CONCLUSIONS The transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.
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Affiliation(s)
- Margaret Meador
- grid.475992.40000 0000 8526 7986Director of Clinical Integration and Education, National Association of Community Health Centers, Bethesda, MD USA
| | - Fátima Coronado
- grid.416738.f0000 0001 2163 0069Associate Director for Science, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Debosree Roy
- grid.251612.30000 0004 0383 094XPost-doctoral Research Scholar, Department of Public Health, A.T. Still University-School of Osteopathic Medicine in Arizona, Mesa, AZ USA
| | - R. Curtis Bay
- grid.251612.30000 0004 0383 094XProfessor, Biostatistics, Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ USA
| | - Joy H. Lewis
- grid.251612.30000 0004 0383 094XProfessor of Medicine and Public Health; Chair, Department of Public Health, A.T. Still University-School of Osteopathic Medicine in Arizona, Mesa, AZ USA
| | - Jessica Chen
- Quality Improvement Program Manager, The Health Federation of Philadelphia, Philadelphia, PA USA
| | - Rachel Cheung
- Manager of Quality, Esperanza Health Centers, Chicago, IL USA
| | | | - Judith A. Hannan
- grid.416738.f0000 0001 2163 0069Million Hearts® Senior Advisor, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
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13
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Vizeshfar F, Ahmadinezhad M, Pakniat A. Design and psychometric evaluation of the maternal perception of postpartum care in comprehensive health centers. Bol Med Hosp Infant Mex 2022; 79:381-387. [PMID: 36477443 DOI: 10.24875/bmhim.21000181] [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] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Mothers' perceptions of the quality and quantity of care they have received and their relationship with healthcare personnel significantly impact continuity of care and future referrals. This study evaluated the psychometric dimensions of the Iranian version of the Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers. METHODS We conducted a cross-sectional study in which the questionnaire was administered to 250 women from different comprehensive health centers. First, the questionnaire was translated verbatim from English to Persian. Then, we evaluated the face, content, structural validity, and reliability of the questionnaire. RESULTS The results showed that this questionnaire's face, content, structure validity, and reliability were adequate. Cronbach's alpha coefficient for the entire questionnaire was 0.668. The interclass correlation coefficient was 0.688, which confirmed divergent validity. CONCLUSIONS Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers is valid and reliable for measuring maternal perception of these vital services.
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Affiliation(s)
- Fatemeh Vizeshfar
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz
| | - Maryam Ahmadinezhad
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas
| | - Azadeh Pakniat
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz. Iran
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14
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Fathoni M, Rachmawati TA, Dewi ES, Djati AP, Lestari S, Yusuf A, Waluyo CS. The preparedness of disaster among nurses in community health centers in rural areas during the COVID-19 pandemic in Malang City. Enferm Clin 2022; 32:S54-S57. [PMID: 35935732 PMCID: PMC9344195 DOI: 10.1016/j.enfcli.2022.03.018] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/26/2022] [Indexed: 11/23/2022]
Abstract
Positive COVID-19 cases in Malang City, Indonesia continue to increase. Until 04 August 2021, the COVID-19 update shows 3301 positive cases with 7754 cured and 832 deaths. This study aims to identify nurses preparedness in rural area community health centers during the COVID-19 pandemic in Malang for self-control to implement health protocol. This study intends to provide insights on controlling COVID-19 spread in Malang, Indonesia. This research is a quantitative study with correlative analytic observational design and a cross-sectional approach involving 120 nurses from 16 primary health centers. The results of the bivariate analysis using gamma correlation test are: knowledge factors (p = 0.005; r = 0.35), attitude (p = 0.000; r = 0.46), means of infrastructure (p = 0.000; r = 0.54), and self-control (p = 0.000; r = 0.52) for the quarantined COVID-19 patients. Knowledge, attitude, infrastructure, and safe house factors can influence self-control for COVID-19. In rural areas, health education-as education and empowerment for patient self-control-is an effort to encourage them to obey health protocol during the pandemic. Nurse readiness and preparedness during the pandemic is crucial for strengthening the assertive behavior commitment through self-control. This ensures the community's awareness of the importance of complying with health protocols for the common good. Mental nursing intervention needs to be added as a part of psychosocial therapy for the community's social problems, primarily in reducing the pressure due to the social distancing enforcement to control and prevent COVID-19 spread.
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Affiliation(s)
- Mukhamad Fathoni
- Department of Nursing, Faculty of Health, Universitas Brawijaya, Malang, Indonesia
- Universitas Brawijaya, Malang, Indonesia
| | | | - Elvira Sari Dewi
- Department of Nursing, Faculty of Health, Universitas Brawijaya, Malang, Indonesia
| | | | | | - Ah Yusuf
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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15
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Kruse GR, Pelton-Cairns L, Taveras EM, Dargon-Hart S, Gundersen DA, Lee RM, Bierer BE, Lawlor E, LaRocque RC, Marcus JL, Davies ME, Emmons KM. Implementing expanded COVID-19 testing in Massachusetts community health centers through community partnerships: Protocol for an interrupted time series and stepped wedge study design. Contemp Clin Trials 2022; 118:106783. [PMID: 35533978 PMCID: PMC9076025 DOI: 10.1016/j.cct.2022.106783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/27/2022] [Revised: 04/15/2022] [Accepted: 05/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Community Health Centers (CHCs) are a critical source of care for low-income and non-privately insured populations. During the pandemic, CHCs have leveraged their infrastructure and role as a trusted source of care to engage the communities they serve in COVID-19 testing. METHODS To directly address the impact that COVID-19 has had on historically marginalized populations in Massachusetts, we designed a study of community-engaged COVID-19 testing expansion: (1) leveraging existing partnerships to accelerate COVID-19 testing and rapidly disseminate effective implementation strategies; (2) incorporating efforts to address key barriers to testing participation in communities at increased risk for COVID-19; (3) further developing partnerships between communities and CHCs to address testing access and disparities; (4) grounding the study in the development of a shared ethical framework for advancing equity in situations of scarcity; and (5) developing mechanisms for communication and science translation to support community outreach. We use a controlled interrupted time series design, comparing number of COVID-19 tests overall and among people identified as members of high-risk groups served by intervention CHCs compared with six matched control CHCs in Massachusetts, followed by a stepped wedge design to pilot test strategies for tailored outreach by CHCs. CONCLUSIONS Here, we describe a community-partnered strategy to accelerate COVID-19 testing in historically marginalized populations that provides ongoing resources to CHCs for addressing testing needs in their communities. The study aligns with principles of community-engaged research including shared leadership, adequate resources for community partners, and the flexibility to respond to changing needs over time.
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Affiliation(s)
- Gina R Kruse
- Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA 02114, USA; Harvard Medical School, Boston, MA 02114, USA.
| | | | - Elsie M Taveras
- Harvard Medical School, Boston, MA 02114, USA; Massachusetts General Hospital, Kraft Center for Community Health, Boston, MA 02114, USA; Massachusetts General Hospital, Division of Academic Pediatrics, Boston, MA 02114, USA
| | - Susan Dargon-Hart
- Massachusetts League of Community Health Centers, Boston, MA 02114, USA
| | - Daniel A Gundersen
- Dana Farber Cancer Institute, Division of Population Sciences, Boston, MA, USA
| | - Rebekka M Lee
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA
| | - Barbara E Bierer
- Harvard Medical School, Boston, MA 02114, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Erica Lawlor
- Harvard Medical School, Boston, MA 02114, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA
| | - Regina C LaRocque
- Harvard Medical School, Boston, MA 02114, USA; Massachusetts General Hospital, Division of Infectious Diseases, Boston, MA 02114, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Madeline E Davies
- Massachusetts General Hospital, Kraft Center for Community Health, Boston, MA 02114, USA
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA; Harvard Catalyst | The Harvard Clinical and Translational Science Center, Boston, MA, USA
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Abstract
OBJECTIVE The author examined associations between COVID-19 prevalence at community health centers (CHCs) and the percentage of eligible CHC patients who had ongoing depression care documented in 2020. METHODS Using 2020 Uniform Data System data, the author analyzed 1,113 CHCs in the 50 U.S. states (representing 26,865,015 total patients). Multivariable linear regression models were used to examine associations between COVID-19 prevalence and the percentage of patients who screened positive for depression and had follow-up depression care documented at CHCs in 2020. RESULTS On average, each increase of 1 percentage point in COVID-19 prevalence within a CHC patient population was independently associated with a 0.47-percentage point decrease of eligible patients with a follow-up depression care plan documented in 2020. CONCLUSIONS Findings appear to be consistent with recent evidence indicating disruptions in health care delivery coinciding with the COVID-19 pandemic. This observation is concerning given the history of mental health disparities experienced by patients with lower incomes.
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Affiliation(s)
- Evan V Goldstein
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City
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17
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Bailey SR, Voss R, Angier H, Huguet N, Marino M, Valenzuela SH, Chung-Bridges K, DeVoe JE. Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study. BMC Health Serv Res 2022; 22:488. [PMID: 35414079 PMCID: PMC9004133 DOI: 10.1186/s12913-022-07860-3] [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] [Received: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background Smoking among cancer survivors can increase the risk of cancer reoccurrence, reduce treatment effectiveness and decrease quality of life. Cancer survivors without health insurance have higher rates of smoking and decreased probability of quitting smoking than cancer survivors with health insurance. This study examines the associations of the Affordable Care Act (ACA) Medicaid insurance expansion with smoking cessation assistance and quitting smoking among cancer survivors seen in community health centers (CHCs). Methods Using electronic health record data from 337 primary care community health centers in 12 states that expanded Medicaid eligibility and 273 CHCs in 8 states that did not expand, we identified adult cancer survivors with a smoking status indicating current smoking within 6 months prior to ACA expansion in 2014 and ≥ 1 visit with smoking status assessed within 24-months post-expansion. Using an observational cohort propensity score weighted approach and logistic generalized estimating equation regression, we compared odds of quitting smoking, having a cessation medication ordered, and having ≥6 visits within the post-expansion period among cancer survivors in Medicaid expansion versus non-expansion states. Results Cancer survivors in expansion states had higher odds of having a smoking cessation medication order (adjusted odds ratio [aOR] = 2.54, 95%CI = 1.61-4.03) and higher odds of having ≥6 office visits than those in non-expansion states (aOR = 1.82, 95%CI = 1.22-2.73). Odds of quitting smoking did not differ significantly between patients in Medicaid expansion versus non-expansion states. Conclusions The increased odds of having a smoking cessation medication order among cancer survivors seen in Medicaid expansion states compared with those seen in non-expansion states provides evidence of the importance of health insurance coverage in accessing evidence-based tobacco treatment within CHCs. Continued research is needed to understand why, despite increased odds of having a cessation medication prescribed, odds of quitting smoking were not significantly higher among cancer survivors in Medicaid expansion states compared to non-expansion states.
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Affiliation(s)
- Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
| | - Robert Voss
- OCHIN, Inc, 1881 SW Naito Parkway, Portland, OR, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,Division of Biostatistics, School of Public Health, Oregon Health & Science University - Portland State University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Steele H Valenzuela
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
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18
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Martinez GS, White K, Yue D, Franzini L, Fryer CS, Sinaii N, Roby DH. Relationships between enabling services use and access to care among adults with cardiometabolic risk factors: findings from the 2014 National Health Center Patient Survey. BMC Health Serv Res 2022; 22:334. [PMID: 35287668 PMCID: PMC8922912 DOI: 10.1186/s12913-022-07739-3] [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] [Received: 08/30/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community health centers (CHCs) provide comprehensive primary and preventive care to medically underserved, low-income, and racially/ethnically diverse populations. CHCs also offer enabling services, non-clinical assistance to reduce barriers to healthcare due to unmet social and material needs, to improve access to healthcare and reduce health disparities. For patients with modifiable cardiometabolic risk factors, including obesity, hypertension, and diabetes, enabling services may provide additional support to improve disease management. However, little is known about the relationship between enabling services and healthcare accessibility and utilization among patients with cardiometabolic risk factors. METHODS This study uses data from the 2014 Health Center Patient Survey to examine the relationship between enabling services use and delayed/foregone care, routine check-ups, and emergency room visits, among adult community health center patients in the United States with cardiometabolic risk factors (N = 2358). Outcomes of enabling services users were compared to nonusers using doubly robust propensity score matching methods and generalized linear regression models. RESULTS Overall, enabling service users were 15.4 percentage points less likely to report delayed/foregone care and 29.4 percentage points more likely to report routine check-ups than nonusers. Enabling service users who lived in urban areas, younger and middle-aged adults, and those with two cardiometabolic risk factors were also less likely to report delayed/foregone care and/or more likely to report routine check-ups in comparison with nonusers. However, among adults with three or more cardiometabolic risk factors, enabling services use was associated with a 41.3 percentage point increase in emergency room visits and a 7.6 percentage point decrease in routine check-ups. CONCLUSIONS The findings highlight the value in utilizing enabling services to improve timeliness and receipt of care among CHC patients with heightened cardiometabolic risk. There is a need for targeting high-risk populations with additional enabling services to support management of multiple chronic conditions.
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Affiliation(s)
- G Sofia Martinez
- Department of Health Policy and Management, University of Maryland, College Park School of Public Health, Room 3310, College Park, 20742, USA.
| | - Kellee White
- Department of Health Policy and Management, University of Maryland, College Park School of Public Health, Room 3310, College Park, 20742, USA
| | - Dahai Yue
- Department of Health Policy and Management, University of Maryland, College Park School of Public Health, Room 3310, College Park, 20742, USA
| | - Luisa Franzini
- Department of Health Policy and Management, University of Maryland, College Park School of Public Health, Room 3310, College Park, 20742, USA
| | - Craig S Fryer
- Department of Behavioral and Community Health, University of Maryland, College Park School of Public Health, College Park, USA
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Rockville, USA
| | - Dylan H Roby
- Department of Health, Society, and Behavior, University of California, Irvine, USA
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19
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Zeng Y, Yu Y, Liu Q, Su S, Lin Y, Gu H, Chen S, Li P, Xu T, Sun N, Lin T, Huang Q, Fan Y, Wang F, Yan S. Comparison of the prevalence and nature of potentially inappropriate medication use in geriatric outpatients between tertiary and community healthcare settings: a multicenter cross-sectional study. Int J Clin Pharm 2022; 44:619-629. [PMID: 35212907 DOI: 10.1007/s11096-022-01380-0] [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] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/22/2022] [Indexed: 11/05/2022]
Abstract
Background Geriatric outpatients with polypharmacy have a high risk of potentially inappropriate medication (PIM) use. Aim To identify differences in both prevalence and patterns of PIMs and drug-related problems (DRPs) in older outpatients who visited the tertiary hospitals (THs) and community health centers (CHCs) and analyze associated factors. Method A prospective cross-sectional study was conducted in five THs and five CHCs from September 2018 to November 2019 in Beijing, China. Data were collected from outpatients aged ≥ 65 years with chronic diseases and polypharmacy. PIMs were evaluated using the 2015 and 2019 Beers Criteria and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria. DRPs were classified using the Helper-Strand DRP Classification. The prevalence and types of PIMs and DRPs were compared, and relevant factors were analyzed. Results The prevalence of PIMs based on the 2015 Beers Criteria was higher in patients from the THs, while PIMs based on the 2019 Beers Criteria did not show a significant difference. PIM prevalence based on STOPP Criteria and DRPs was higher in patients from CHCs. Visiting CHCs was an independent factor of PIMs based on the 2015 Beers Criteria (OR 0.774, 95% CI 0.604-0.992) and the STOPP Criteria (OR 2.427, 95% CI 1.883-3.128), and DRPs (OR 3.612, 95% CI 2.682-4.865). Conclusion Differences in PIM and DRP might be due to the patients and settings. Specific measures to improve the appropriateness of medications in both settings should be used.
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Affiliation(s)
- Yan Zeng
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yongpei Yu
- Department of Biostatistics, Peking University Clinical Research Institution, Beijing, China
| | - Qingyang Liu
- Department of Clinical Pharmacy, Capital Medical University, Beijing, China
| | - Su Su
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongyan Gu
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shicai Chen
- Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Tong Xu
- Department of Pharmacy, Taiyanggong Community Health Center, Beijing, China
| | - Naizhao Sun
- Department of Pharmacy, Datun Community Health Center, Beijing, China
| | - Tao Lin
- Department of Pharmacy, Ganjiakou Community Health Center, Beijing, China
| | - Qian Huang
- Department of Pharmacy, Konggang Community Health Center, Beijing, China
| | - Yujie Fan
- Department of Pharmacy, Guangnei Community Health Center, Beijing, China
| | - Fengzhi Wang
- Department of Data Management, Peking University Clinical Research Institute, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Suying Yan, No.45 Changchun Street, Xicheng District, Beijing, China.
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20
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Zhu X, Xu Y, Lu L, Zou H. Telescreening satisfaction: disparities between individuals with diabetic retinopathy and community health center staff. BMC Health Serv Res 2022; 22:160. [PMID: 35130901 PMCID: PMC8822836 DOI: 10.1186/s12913-022-07500-w] [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] [Received: 07/05/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The success of telescreening and the management of diabetic retinopathy (DR) in communities depends on stakeholder satisfaction, including both individuals with diabetes and community health center (CHC) staff. In this study, we investigated the satisfaction of both individuals with vision-threatening DR (VTDR) and CHC staff within the Shanghai Eye Disease Study (SEDS) comprehensive system for managing diabetic eye diseases at the primary care level. Methods The cross-sectional survey of patients receiving the service included 3,817 respondents with VTDR and focused on their satisfaction with the SEDS system, including the telescreening process, speed of feedback, interpretation of results, increased awareness of related diseases, and eye care services. The survey of the providers included 234 CHC staff respondents and focused on their satisfaction and the main barriers encountered during the implementation of the system. Sociodemographic characteristics and perceived barriers related to satisfaction were identified by conducting univariate and multivariate logistic regression analyses. Results The overall satisfaction of service recipients was 96.0%, and 75.8% of them were willing to undergo future telescreening for DR. The convenience of telescreening, organization of telescreening, and improvement in related disease awareness significantly correlated with satisfaction. Only 48.3% of the providers were satisfied with the SEDS system. The most frequently mentioned barriers to the development of the system were the inadequate levels of staffing (particularly technical staff), insufficient funding, and incomplete information transmission systems. Conclusions Disparities between high patient satisfaction and low provider satisfaction with the SEDS system were mainly related to the current weak level of ophthalmic expertise in the CHCs and the low awareness of screening for diabetic eye diseases among both patients and providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07500-w.
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Affiliation(s)
- Xiaofeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Yi Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Lu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Haidong Zou
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China. .,National Clinical Research Center for Eye Diseases, Shanghai, China. .,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.
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21
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Ali M, Gasca V, Schrier R, Pensa M, Brockman A, Olson DP, Oldfield BJ. Social Determinants and COVID-19 in a Community Health Center Cohort. J Immigr Minor Health 2021. [PMID: 34850318 DOI: 10.1007/s10903-021-01320-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/25/2022]
Abstract
Associations between social determinants of health (SDOH), demographic factors including preferred language, and SARS-CoV-2 detection are not clear. We conducted a retrospective cohort study among those seeking testing for SARS-CoV-2 at a multi-site, urban community health center. Logistic regression and exact matching methods were used to identify independent predictors of SARS-CoV-2 detection among demographic, SDOH, and neighborhood-level variables. Of 1,361 included individuals, SARS-CoV-2 was detected among 266 (19.5%). Logistic regression demonstrated that SARS-CoV-2 detection was less likely in White participants relative to Hispanic participants (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI] 0.05–0.46). and more likely in patients who prefer Spanish relative to those that prefer English (aOR 2.04, 95% CI 1.43–2.96). No observed SDOH predicted SARS-CoV-2 detection in adjusted models. A robustness analysis using a matched subset of the study sample produced findings similar to those in the main analysis. Preferring to receive care in Spanish is an independent predictor of SARS-CoV-2 detection in a community health center cohort.
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22
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Haddad MS, Bifulco L, McIntosh J, Garcia MMC. Rectal specimen self-collection for chlamydia and gonorrhea screening: a cross-sectional feasibility study at a community health center. Pilot Feasibility Stud 2021; 7:208. [PMID: 34782013 DOI: 10.1186/s40814-021-00928-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Men who have sex with men (MSM) are at increased risk for extra-genital sexually transmitted infections (STIs). Without extra-genital screening, many chlamydia and gonorrhea infections would be missed among MSM. Yet, many barriers exist to extra-genital testing, and, in particular, to rectal collection. Self-collection increases screening and detection of asymptomatic chlamydia and gonorrhea among at-risk MSM and transgender women. This feasibility study assessed use of rectal self-collection and its acceptance among patients and primary care providers (PCPs) at a large, general practice community health center. The primary objective of this project was to assess the feasibility of including rectal self-collection as part of an implementation study looking to embed an STI care program in a safety-net primary care setting that would shift routine screening tasks to non-provider clinical team members such as medical assistants and nurses. Methods Three PCPs identified and offered rectal self-collection to their MSM and transgender female patients who were due for routine or risk-based STI screening. For those patients who elected to participate in the study, the PCP’s medical assistant (MA) reviewed the self-collection instructions with them as part of their routine preventive care duties, and patients collected their own sample. Patients and PCPs completed brief cross-sectional surveys assessing the self-collection process. Results Of 1191 patients with sexual orientation and gender identity (SOGI) data on file who were seen for a medical visit by one of the three PCPs, 87 (7.3%) identified as MSM or transgender female. Seventy-five were due for rectal screening, of whom 33 (44%) were offered and completed rectal self-collection. Survey results indicated that self-collection was acceptable to and preferred over clinician-collection by both PCPs and patients. Conclusions This study demonstrated that rectal self-collection is feasible as part of STI screening in a high-volume primary care setting, and can be administered as part of the clinical tasks that MAs routinely conduct. The overall acceptance by both PCPs and patients will allow the inclusion of rectal self-collection in an implementation study looking to increase STI screening at a large community health center by facilitating MA-led collection during medical provider visits and by establishing standalone nurse-led STI visits.
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23
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Baek S, Han S. Factors influencing emergency medical competencies of health centers and fire stations in areas that are vulnerable to earthquakes. Clin Exp Emerg Med 2021; 8:192-200. [PMID: 34649407 PMCID: PMC8517458 DOI: 10.15441/ceem.20.138] [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] [Received: 10/10/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate the factors influencing the emergency medical competency (EMC), perceived by the fire station and health center staff, in the areas where of emergency medical vulnerability where earthquakes had occurred. Methods This study was conducted between December 2019 and February 2020. A proper questionnaire was created to evaluate EMC in disaster situations and administered to the fire station and the health center groups. Descriptive variables of each group were calculated. The Kendall rank correlation analysis was used to measure the relationships between the demographic variables, disaster-related variables, and EMC. The factors influencing the EMC for both groups were investigated in the linear regression analysis. Results For a total of 200 respondents, the mean scores of EMC were 99.85±21.24 and 95.24±20.05 for the fire station (n=96) and the health center (n=104) groups, respectively (P=0.121). EMC was significantly correlated with age, years of service, job position, natural disaster experience, disaster relief service experience, and joint disaster response exercise (P<0.050). Linear regression analysis revealed that the duration of joint disaster response exercise (β=0.640, t=11.696) in Model 1 (F=136.806, P<0.001), the duration of joint disaster response exercise (β=0.627, P<0.001), and disaster rescue service experience (β=0.124, P<0.001) in Model 2 (F=72.431, P<0.001) were independently associated with EMC improvement. Conclusion Our findings indicate that the disaster preparedness program with a longer duration of joint disaster response exercise and more frequent disaster rescue service experience is necessary for improved and systematic response to a disaster.
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Affiliation(s)
- Seolhyang Baek
- Department of Nursing, College of Nursing, Dongguk University, Gyeongju, Korea
| | - Seungwoo Han
- Department of Emergency Medical Technology, College of Smart Life, Kyungil University, Gyeongsan, Korea
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24
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Malo TL, Correa SY, Moore AA, Ferrari RM, Leeman J, Brenner AT, Wheeler SB, Tan X, Reuland DS. Centralized colorectal cancer screening outreach and patient navigation for vulnerable populations in North Carolina: study protocol for the SCORE randomized controlled trial. Implement Sci Commun 2021; 2:113. [PMID: 34620250 PMCID: PMC8499575 DOI: 10.1186/s43058-021-00194-x] [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: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background Although colorectal cancer (CRC) screening is effective in reducing CRC mortality, screening rates in vulnerable populations served by community health centers (CHCs) remain below national targets. CHCs in North Carolina are challenged to reach CRC screening targets as they tend to be under-resourced, have limited capacity to implement and sustain population health interventions, and typically operate independently from one another and from regional colonoscopy providers. The Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE) project is designed to address barriers to CRC screening in partnership with CHCs by implementing a multilevel intervention that includes centralized support infrastructure for mailed fecal immunochemical test (FIT) outreach and patient navigation to follow-up colonoscopy. This paper describes protocols for the SCORE implementation trial. Methods We will conduct a type 2 hybrid effectiveness-implementation trial that will assess effectiveness at increasing CRC screening and follow-up rates while also assessing implementation outcomes. The planned trial sample will include 4000 CHC patients who are at average CRC risk and due for screening. Participants will be randomized 1:1 to receive either usual care or a multilevel intervention that includes mailed FIT outreach and patient navigation support to follow-up colonoscopy for those with abnormal FIT. The primary effectiveness outcome is completion of any CRC screening test at six months after randomization. We will also conduct a multilevel assessment of implementation outcomes and determinants. Discussion This hybrid effectiveness-implementation trial will evaluate the effectiveness and implementation of an intervention that provides centralized infrastructure for mailed FIT screening and patient navigation for CHCs that operate independently of other healthcare facilities. Findings from this research will enhance understanding of the effectiveness of a centralized approach and factors that determine successful implementation in vulnerable patient populations. Trial registration The trial was registered on May 28, 2020, at ClinicalTrials.gov (identifier NCT04406714).
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Affiliation(s)
- Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Sara Y Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.,School of Nursing, University of North Carolina at Chapel Hill, 120 North Medical Drive, Chapel Hill, NC, 27599, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.,School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA. .,School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA.
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25
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Leibowitz A, Livaditis L, Daftary G, Pelton-Cairns L, Regis C, Taveras E. Using mobile clinics to deliver care to difficult-to-reach populations: A COVID-19 practice we should keep. Prev Med Rep 2021; 24:101551. [PMID: 34522575 PMCID: PMC8428151 DOI: 10.1016/j.pmedr.2021.101551] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 04/29/2021] [Revised: 07/31/2021] [Accepted: 09/04/2021] [Indexed: 11/17/2022] Open
Abstract
During COVID-19, pediatric preventive care visits and vaccination rates declined. In response, two Boston community health centers implemented mobile health clinics. The clinics served 50 children, gave 146 shots, and had high patient satisfaction. This program reached families who were hesitant to attend traditional clinic visits. Mobile clinics are a valuable way to deliver primary care to hard-to-reach patients.
In the United States, mobile health clinics are an important method for delivering care to medically underserved populations. Mobile clinics have long been used in pediatric primary care, but there is little published to help pediatricians disseminate this practice more widely. During the COVID-19 pandemic, reduced in-person medical visits and subsequent declines in routine pediatric vaccination rates highlighted the importance of using a variety of care delivery models to reach patients. To improve vaccination coverage among young children in Boston during summer 2020, Mattapan Community Health Center and Codman Square Health Center deployed mobile clinics as an adjunct to their in-person preventive pediatric clinical services. In total, the health centers completed 17 mobile clinic sessions and served 50 unique patients, 77% of whom were African-American/Black and 75% of whom were under the age of two. A total of 146 vaccine injections were administered. A quality improvement survey of participating families demonstrated high levels of patient satisfaction and a high likelihood of using mobile services again in the future. The mobile clinic model was most valuable in reaching families who avoided in-person care due to COVID-19 transmission concerns or faced barriers to in-person care. The health centers fostered trust and demonstrated cultural competency during this novel initiative by leveraging established patient-provider relationships, using interpreters, and involving staff who reflected the diversity of the communities. Although there are challenges to implementing mobile health clinics, this initiative demonstrates the value of mobile clinics in delivering high quality pediatric preventive care to difficult-to-reach populations.
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Affiliation(s)
- Abigail Leibowitz
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, United States.,University of Colorado School of Medicine, 13001 E 17 Pl, Aurora, CO, United States
| | - Laura Livaditis
- Mattapan Community Health Center, 1575 Blue Hill Ave, Mattapan, MA, United States.,Boston University School of Medicine, 72 E Concord St, Boston, MA, United States
| | - Genevieve Daftary
- Boston University School of Medicine, 72 E Concord St, Boston, MA, United States.,Codman Square Health Center, 637 Washington St, Boston, MA, United States
| | - Leslie Pelton-Cairns
- Massachusetts League of Community Health Centers, 40 Court Street, 10th Floor, Boston, MA, United States
| | - Craig Regis
- Kraft Center for Community Health, Community Health Improvement, Massachusetts General Hospital, Boston, MA, United States
| | - Elsie Taveras
- Kraft Center for Community Health, Community Health Improvement, Massachusetts General Hospital, Boston, MA, United States.,Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
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26
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Biagioli V, Pol A, Gawronski O, Carlin C, Cirulli L, Piga S, Stelitano R, Offidani C, Raucci U, Reale A, Tiozzo E, Villani A, Dall'Oglio I. Pediatric patients accessing Accident and Emergency Department (A&E) for non-urgent treatment: Why do parents take their children to the A&E? Int Emerg Nurs 2021; 58:101053. [PMID: 34520965 DOI: 10.1016/j.ienj.2021.101053] [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: 02/09/2021] [Revised: 06/04/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION About 20-30% of children access the Pediatric Accident and Emergency Department (A&E) for non-urgent health care that should normally follow other health care paths. This study aimed to investigate why parents take their children to the A&E for non-urgent visits rather than using primary care services. METHODS A one-year cross-sectional study was conducted in a large pediatric A&E in Italy. A paper-and-pencil 40-item questionnaire was administered to parents of children aged between 3 months to 6 years who accessed the A&E for non-urgent visits between July 2018 and June 2019. RESULTS Parents of 238 children completed the questionnaire (mean age = 2.6 years; male 58%). The most common symptoms were fever (n = 105; 44.1%) and skin rash (n = 63; 26.5%); symptoms usually started more than 24 h earlier (n = 163; 69.4%). Reasons for accessing the A&E for non-urgent visits included the availability of rapid medical tests (n = 71; 29.8%), deterioration of the clinical conditions after the pediatrician's visit (n = 67; 28.2%), and the perceived need for urgent care (n = 65; 27.3%). Besides, 26.6% (n = 63) of parents reported not being able to contact their pediatrician before accessing A&E. CONCLUSION Parents may need further education to distinguish between urgent and non-urgent pediatric health conditions.
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Affiliation(s)
- Valentina Biagioli
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alessandra Pol
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Orsola Gawronski
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Claudia Carlin
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Luisa Cirulli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Simone Piga
- Bachelor for Pediatric Nursing, Sapienza University of Rome, Italy.
| | - Rocco Stelitano
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Caterina Offidani
- Paediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Umberto Raucci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Antonino Reale
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Emanuela Tiozzo
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alberto Villani
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Immacolata Dall'Oglio
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Blackburn BE, Marino M, Schmidt T, Heintzman J, Hatch B, DeVoe J, Moreno L, Huguet N. Preventive service utilization among low-income cancer survivors. J Cancer Surviv 2021; 16:1047-1054. [PMID: 34409521 PMCID: PMC8857290 DOI: 10.1007/s11764-021-01095-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
Purpose Adequate access to and utilization of preventive services are vital among cancer survivors. This study examined preventive service utilization of cancer survivors compared to matched patients with no history of cancer among patients seeking care at community health centers (CHCs). Methods We utilized electronic health record data from the OCHIN network between 2014 and 2017. Cancer survivors (N = 20,538) ages ≥ 18 years were propensity score matched to three individuals with no history of cancer (N = 61,617) by age, sex, region, urban/rural, ethnicity, race, BMI, and Charlson Comorbidity Index. Preventive screenings included cancer, mental health and substance abuse, cardiovascular, and infectious disease screenings, and vaccinations. Patient-level preventive service indices were calculated for each screening as the total person-time covered divided by the total person-time eligible. Preventive service rate ratios comparing cancer survivors to patients with no history of cancer were estimated using negative binomial regression. Results Cancer survivors had higher overall preventive service utilization (incidence rate ratio = 1.11, 95% confidence interval = 1.09–1.13) and higher rates of cancer screenings (IRR = 1.16, 95% CI = 1.12–1.20). There was no difference between the two groups in mental health screenings. Conclusions Cancer survivors were more likely to be up-to-date with preventive care than their matched counterparts. However, mental health and substance abuse screenings were low in both groups, despite reports of increased mental health conditions among cancer survivors. Implications for Cancer Survivors With the growing number of cancer survivors in the USA, efforts are needed to ensure their access to and utilization of preventive services, especially related to behavioral and mental healthcare. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01095-7.
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Affiliation(s)
- Brenna E Blackburn
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA. .,Department of Family and Preventive Medicine, School of Medicine, University of Utah, 375 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA.,Division of Biostatistics, School of Public Health, Oregon Health & Science University - Portland State University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA.,OCHIN, Inc., 1881 SW Naito Pkwy, Portland, OR, USA
| | - Brigit Hatch
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA.,OCHIN, Inc., 1881 SW Naito Pkwy, Portland, OR, USA
| | - Jennifer DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA.,OCHIN, Inc., 1881 SW Naito Pkwy, Portland, OR, USA
| | - Laura Moreno
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, USA
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Das A, Singh P, Bruckner T. Continuity of Mental Health Care at Community Health Centers and Reduced Emergency Department Visits for Suicidal Ideation/Self-Harm. Community Ment Health J 2021; 57:1142-1150. [PMID: 33165690 DOI: 10.1007/s10597-020-00745-x] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
We examined whether county-level increases in continuity of mental health care (i.e., mental health visits per mental health patient) at Community Health Centers (CHCs) correspond with a decline in Emergency Department (ED) visits for suicidal ideation and self-harm (1) overall, and (2) among specific race/ethnicities across 211 counties from 10 US states, from 2006 to 2015 (sample size = 1412 county-years). We used fixed effects linear regression analyses with county-level socioeconomic covariates and year indicators. In the full sample, continuity of mental health care at CHCs varies inversely with ED visits for suicidal ideation/self-harm (coefficient: -0.04, p < 0.1). Race-specific analyses show that a one unit increase in continuity of mental health care at CHCs corresponds with a 5% decline in ED visits for suicidal ideation/self-harm among whites (p < 0.05). Expansion of mental health care services at CHCs may serve as a key point of prevention for suicidal behavior.
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Affiliation(s)
- Abhery Das
- University of California, Irvine, 653 E. Peltason Drive, Irvine, CA, 92617, USA.
| | - Parvati Singh
- University of California, Irvine, 653 E. Peltason Drive, Irvine, CA, 92617, USA
| | - Tim Bruckner
- University of California, Irvine, 653 E. Peltason Drive, Irvine, CA, 92617, USA
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Baek S, Ha Y, Mok J, Lee H, Song W. Community-Based Aerobic Exercise Program for Primary Prevention of Cardiovascular Disease in Adults With Visual or Auditory Impairments: A Feasibility Study. Ann Rehabil Med 2021; 45:204-214. [PMID: 34126672 PMCID: PMC8273723 DOI: 10.5535/arm.20220] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/28/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of a public health center-based aerobic and resistance training program for primary prevention of cardiovascular disease in people with visual, auditory, or physical/brain impairments. METHODS The study included 25 adults aged >40 years who lived in Cheorwon-gun in South Korea, had a disability registered for visual, auditory, or physical/brain impairments under the Disability Welfare Act, and had either known cardiovascular disease or two or more risk factors for cardiovascular disease. The program comprised four education sessions and 12 weeks of customized aerobic and strengthening exercises performed twice a week at moderate intensity, with each exercise session lasting for 1 hour. The body mass index (BMI), percent body fat, 6-minute walk distance (6MWD), and 30-second sit-to-stand test results were measured at baseline and on program completion. RESULTS Seventeen subjects (68%) completed the program. There were significant decreases in BMI and percent body fat (both p<0.05), with a significant increase in 30-second sit-to-stand strength (p<0.05) but no changes in the 6MWD. In subjects with visual or auditory impairments, BMI and percent body fat were significantly decreased after the program; however, there was no significant change in the results of the 30-second sit-to-stand strength test or the 6MWD. CONCLUSION In people with disabilities, a 3-month community-based exercise program can decrease body mass index and percent body fat and increase sit-to-stand strength. The 30-second sit-to-stand test may be a useful measure of the strength and endurance of the lower extremities in people with disabilities.
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Affiliation(s)
- Sora Baek
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yuncheol Ha
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jaemin Mok
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Public Health and Social Work Office, Kangwon National University Hospital, Chuncheon, Korea
| | | | - Woojoo Song
- Cheorwon Public Health Center, Cheorwon, Korea
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Vallatharasu Y, Chennamadhavuni A, Van Every MJ. Twenty-year Experience with Genitourinary Lymphoma at a Community Hospital. Clin Med Res 2021; 19:72-81. [PMID: 33789953 PMCID: PMC8231695 DOI: 10.3121/cmr.2021.1531] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 09/22/2020] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
Introduction: Non-Hodgkin lymphoma is the seventh most common cancer in the United States. It may involve any extranodal organ, although involvement of the genitourinary (GU) tract accounts for <5% of all primary extranodal lymphomas. Published GU lymphoma literature is currently limited to small case series and case reports. The last substantial American series was published in 2009. Our objective was to characterize cases of GU lymphoma from our institution based on organ involved and to review relevant literature.Patients and Methods: After institutional review board approval, we retrospectively reviewed medical records of patients diagnosed with lymphoma involving the GU organs from 1995 through 2015. Patients with obstructive uropathy from retroperitoneal adenopathy without parenchymal involvement of a GU organ were excluded. We classified extranodal GU lymphomas as primary or secondary, based on involvement of other organs and distant lymphadenopathy.Results: Thirty-six patients had lymphoid neoplasms involving the kidney, ureters, bladder, testis, penile skin, or prostate in our health system during the study period. Of these, 15 (41.6%) were primary. Most patients initially sought consultation for GU-related symptoms, such as bladder obstruction, hematuria, testicular mass, or abdominal pain. Histological subtypes and flow cytometry findings varied broadly.Conclusion: Our series reports site-specific outcomes data and adds detail to findings from other published series. Although GU lymphomas are rare, our series confirms prior studies demonstrating presentation in urologic organs. They should be considered in the differential diagnosis in all patients, especially those with unusual findings on examination, cystoscopy, or computed tomography scan.
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Affiliation(s)
- Yazhini Vallatharasu
- Department of Medical Education, Gundersen Health System, La Crosse, Wisconsin, USA; Current Affiliation: Thedacare Regional Cancer Center, Appleton, Wisconsin, USA
| | - Adithya Chennamadhavuni
- Department of Medical Education, Gundersen Health System, La Crosse, Wisconsin, USA; Current Affiliation: Hematology/Oncology Fellow at University of Iowa Health Care, Iowa City, Iowa, USA
| | - Marvin J Van Every
- Department of Urology, Gundersen Health System, La Crosse, Wisconsin, USA
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Talavera GA, Castañeda SF, Mendoza PM, Lopez-Gurrola M, Roesch S, Pichardo MS, Garcia ML, Muñoz F, Gallo LC. Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes. Transl Behav Med 2021; 11:1665-1675. [PMID: 34057186 DOI: 10.1093/tbm/ibab052] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p < .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = -0.35, p = <.01) versus Usual Care (ΔHbA1c = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
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Affiliation(s)
- Gregory A Talavera
- South Bay Latino Research Center, Chula Vista, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | | | | | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Margaret S Pichardo
- College of Medicine, Howard University, Washington, DC, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Melawhy L Garcia
- Center for Latino Community Health, Evaluation, and Leadership Training, Department of Health Science, California State University Long Beach, Long Beach, CA, USA
| | - Fatima Muñoz
- Department of Research, San Ysidro Health, San Diego, CA, USA
| | - Linda C Gallo
- South Bay Latino Research Center, Chula Vista, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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Lassar M, Tao K, Bond T, Qadir S, Stulberg DB. Closing the contraceptive coverage gap: A multipronged approach to advancing reproductive equity in Illinois. Contraception 2021:S0010-7824(21)00157-8. [PMID: 34052207 DOI: 10.1016/j.contraception.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/23/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022]
Abstract
Despite Illinois' progress in the area of reproductive health, Black, Indigenous, and People of Color, young people, and people with low resources face persistent barriers to high-quality contraceptive care and experience inequities in reproductive health outcomes. Illinois Contraceptive Access Now (ICAN!) is a 5-year initiative that aims to improve the quality and coverage of contraceptive care at community health centers statewide. By leveraging state policies, a robust community health infrastructure, digital innovation, and with a focus on sustainability, ICAN! seeks to cut the "contraceptive coverage gap" in Illinois in half by 2025. As Illinois democratizes access to contraceptive care, this initiative can serve as a model for advancing reproductive equity nationwide.
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Trapl ES, VanFrank B, Kava CM, Trinh V, Land SR, Williams RS, Frost E, Babb S. Smoking and cessation behaviors in patients at federally funded health centers - United States, 2014. Drug Alcohol Depend 2021; 221:108615. [PMID: 33652378 PMCID: PMC11001259 DOI: 10.1016/j.drugalcdep.2021.108615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/03/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Federally funded health centers (HCs) provide care to the most vulnerable populations in the U.S., including populations with disproportionately higher smoking prevalence such as those with lower incomes. METHODS This study compared characteristics of adult HC patients, by cigarette smoking status, and assessed smoking cessation-related behaviors using 2014 Health Center Patient Survey data; analysis was restricted to adults with data on cigarette smoking status (n = 5583). Chi-square and logistic regression analyses were conducted. RESULTS Overall, 28.1 % were current smokers and 19.2 % were former smokers. Current smokers were more likely to report fair/poor health (48.2 %) and a high burden of behavioral health conditions (e.g., severe psychological distress 23.9 %) versus former and never smokers. Most current smokers reported wanting to quit in the past 12 months (79.0 %) and receiving advice to quit from a healthcare professional (78.7 %). In a multivariable model, age <45, non-white race, COPD diagnosis, and past 3-month marijuana use were significantly associated with desire to quit. Few former smokers (15.2 %) reported using cessation treatment, though use was higher among those who quit within the previous year (30.6 %). CONCLUSIONS Although most current smokers reported a desire to quit, low uptake of evidence-based treatment may reduce the number who attempt to quit and succeed. Given the burden of tobacco use, future efforts could focus on identifying and overcoming unique personal, healthcare professional, or health system barriers to connecting them with cessation treatments. Increasing access to cessation treatments within HCs could reduce smoking-related disparities and improve population health.
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Affiliation(s)
- Erika S Trapl
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA.
| | - Brenna VanFrank
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
| | - Christine M Kava
- Health Promotion Research Center, Department of Health Services, University of Washington School of Public Health, 3980 15th Avenue NE, Seattle, WA, 98105, USA
| | - Vinh Trinh
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephanie R Land
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Elizabeth Frost
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephen Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
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Wang Y, Han HR, Yang W, Zhang H, Zhang J, Ruan H, Tang N, Ren J, Sun X, Li C, Han L. Associations between risk factors for cardiovascular diseases and frailty among community-dwelling older adults in Lanzhou, China. Int J Nurs Sci 2021; 8:168-174. [PMID: 33997130 PMCID: PMC8105554 DOI: 10.1016/j.ijnss.2021.03.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/09/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives To examine the relationship between cardiovascular disease risk factors and frailty in a sample of older Chinese adults. Methods A total of 458 community-dwelling older adults (≥65 years) in Lanzhou, Gansu Province of China participated in a cross-sectional survey. Their status was evaluated in terms of frailty phenotype (unintentional weight loss, exhaustion, low activity levels, slowness and weakness). Participants were categorized as not frail, prefrail or frail. Cardiovascular disease risk factors that were assessed included: blood pressure, body mass index, waist circumference, blood glucose, total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins. Results Individuals with obesity had an increased risk of prefrailty (OR: 2.26; 95% CI: 1.05, 4.84). Hypertension was inversely associated with frailty among the participants (OR: 0.31; 95% CI: 0.11, 0.87) after adjusting for covariates. Conclusions The findings suggest that much more attention should be paid to weight control of the elderly in the community for preventing them from transition to prefrailty or frailty. Active prevention and control of cardiovascular diseases among the community-dwelling elder are still of great importance.
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Affiliation(s)
- Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Maryland, USA
| | - Wei Yang
- Gastroenterology Department, The First Hospital of Lanzhou University, Lanzhou, China
| | | | - Jing Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Haihui Ruan
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jingjing Ren
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xia Sun
- Community Health Services Center of Tuanjiexincun, Lanzhou, China
| | - Chunrong Li
- Community Health Services Center of Jiaojiawan, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University, Lanzhou, China
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Rosales R, Calvo R. The Affordable Care Act: policy predictors of integrated care between Hispanic-serving and mainstream mental health organizations. BMC Health Serv Res 2021; 21:186. [PMID: 33639952 PMCID: PMC7916277 DOI: 10.1186/s12913-021-06198-6] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 02/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background The Patient Protection and Affordable Care Act increased funding for integrated care to improve access to quality health care among underserved populations. There is evidence that integrated care decreases inequities in access and quality of mental health care among Hispanic clients. Increasing integrated care at Hispanic-Serving Organizations may help to eliminate mental health service disparities among Hispanic clients. Method Using organizational responses from the 2014 and 2016 waves of the National Mental Health Service survey, this study conducted multivariate logistic analyses to assess whether the ACA policies related to integrated care increased the provision of integrated addictions treatment and primary care at mental health Hispanic-Serving Organizations, relative to Mainstream Organizations. Results Findings showed that Hispanic-Serving Organizations (54.4%) were less likely to provide integrated health services than Mainstream Organizations (59.1%) after the ACA. However, federal funding to help organizations transition into integrated care services (AOR = 1.74, p = 0.01) and accepting Medicaid payments (AOR = 1.59, p = 0.01) increased the provision of integrated care services at Hispanic-Serving Organizations over time. Conclusions Health care policies that increase funding to adopt integrated health services at community Hispanic-Serving Organizations may help decrease inequities in mental health access for Hispanics in the United States.
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Affiliation(s)
- Robert Rosales
- Department of Behavioral & Social Sciences, Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI, 02903, USA.
| | - Rocío Calvo
- Boston College, School of Social Work, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
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Abstract
Hispanic immigrants have long faced barriers to accessing health care in the U.S., as they are largely excluded from federal programs like Medicaid. Since the 1960s, the federal government has operated a nationwide network of Community Health Centers (CHCs) that serve anyone, regardless of ability to pay or citizenship status. To what extent has this widespread, immigrant-inclusive institution been accessible to Hispanic immigrants? Using novel administrative data joined with Census and American Community Survey data from 1970 to 2017, this study documents spatial variation in population-level proximity to CHCs in relation to changing Hispanic migration patterns. Findings show that health centers, both historically and contemporarily, have been far more spatially proximate to poor and foreign-born Hispanics than to poor whites. In 2017, 56% of poor and foreign-born Hispanics in the U.S. lived within two miles of a CHC compared to 30% of poor whites. While access to CHCs has been consistently greater in established gateways, regardless of urbanicity, growth in new destination safety net infrastructure has increased at a faster rate. The CHC program has been substantially more accessible to the foreign-born than U.S.-born Hispanic and uninsured populations, showing the geographic potential for CHCs to provide care to underserved immigrant communities. This study provides the first descriptive evidence of the programmatic reach of this safety net institution across time and space, highlighting a crucial yet underexplored factor in understanding the health of Hispanic immigrants.
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Affiliation(s)
- Emily Parker
- Department of Policy Analysis and Management, Cornell University, 2308 Martha Van Rensselaer Hall, Ithaca, NY, 14850, USA.
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Hatch B, Schmidt T, Davis E, Templeton AR, Hoopes M, Darney B, Cottrell EK. Clinic factors associated with utilization of a pregnancy-intention screening tool in community health centers. Contraception 2021; 103:336-41. [PMID: 33592233 DOI: 10.1016/j.contraception.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Routine pregnancy-intention screening in the primary care setting is a promising practice to help patients achieve their reproductive goals. We aim to describe the utilization of a pregnancy-intention screening tool integrated in the electronic health record (EHR) of a national network of community health centers (CHCs) and identify clinic-level factors associated with tool use. STUDY DESIGN We conducted a clinic-level retrospective observational study to assess tool utilization during the first 3 years after the tool was made available in the EHR (November 2015 to October 2018). We describe characteristics of clinics with higher tool utilization (≥90th percentile) versus lower utilization (<90th percentile) and the types of providers who used the tool. We then employ negative binomial regression to identify independent clinic-level factors associated with tool utilization. RESULTS Across 194 clinics in our study sample which served 289,754 eligible female patients, the tool was used for 113,116 (39%). Medical assistants performed 60.3% of screenings and clinicians performed 11.2%. CHCs with higher tool utilization rates were more likely to be located in rural settings (RR 1.75, 95% CI 1.07-2.87) and serve patient populations with higher proportions of women (RR 1.32, 95% CI 1.24-1.41) and lower proportions of patients with non-English language preference (RR 0.92, 95% CI 0.89-0.95). CONCLUSIONS Many health centers utilized pregnancy-intention screening after an EHR-based tool was made available, though overall screening rates were low. IMPLICATIONS Additional study of implementation strategies and effectiveness of pregnancy-intention screening tools is needed. Implementation of future pregnancy-intention screening interventions must be tailored to address clinic-level barriers and facilitators to screening.
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Nam K, Park E, Chung Y, Kim CY. Effects of the Out-of-pocket Payment Exemption in the Public Health Center on Medical Utilization of the Korean Elderly. J Prev Med Public Health 2020; 53:455-464. [PMID: 33296586 PMCID: PMC7733758 DOI: 10.3961/jpmph.20.341] [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] [Received: 07/20/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals. Methods This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources. Results The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48). Conclusions The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.
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Affiliation(s)
- Kiryong Nam
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Eunhye Park
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Yuhjin Chung
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Chang-Yup Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea.,Institute of Health and Environment, Seoul National University, Seoul, Korea
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Baek S, Ha Y, Mok J, Park HW, Son HR, Jin MS. Community-Based Cardiac Rehabilitation Conducted in a Public Health Center in South Korea: A Preliminary Study. Ann Rehabil Med 2020; 44:481-492. [PMID: 33440096 PMCID: PMC7808795 DOI: 10.5535/arm.20084] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the safety and effectiveness of the community-based cardiac rehabilitation (CBCR) program that we had developed. METHODS Individuals aged >40 years with cardiovascular disease or its risk factors who were residing in a rural area were recruited as study subjects. The CBCR program, which consisted of 10 education sessions and 20 weeks of customized exercises (twice a week), was conducted in a public health center for 22 weeks. Comprehensive outcomes including body weight, blood glucose level, and 6-minute walk distance (6MWD) were measured at baseline, 11th week, and completion. Furthermore, the outcomes of young-old (65-74 years) and old-old (≥75 years) female subjects were compared. RESULTS Of 31 subjects, 21 completed the program (completion rate, 67.7%). No adverse events were observed, and none of the subjects discontinued the exercise program because of chest pain, dyspnea, and increased blood pressure. Body weight and blood glucose level were significantly decreased, and 6MWD was significantly increased following program implementation (p<0.05). Both young-old and old-old women exhibited an improvement in blood glucose level and 6MWD test (p<0.05). CONCLUSION We reported the results of the first attempted CBCR in South Korea that was implemented without adverse events during the entire program. Improved aerobic exercise ability and reduced risk factors in all participants were observed. These improvements were also achieved by older adults aged ≥75 years.
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Affiliation(s)
- Sora Baek
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yuncheol Ha
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jaemin Mok
- Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
- Division of Public Health, Kangwon National University Hospital, Chuncheon, Korea
| | - Hee-won Park
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hyo-Rim Son
- Hongcheon County Hypertension and Diabetes Registration and Education Center, Hongcheon-gun, Korea
| | - Mi-Suk Jin
- Hongcheon Public Health Center, Hongcheon-gun, Korea
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Patil SS, Gaikwad RA, Deshpande TN, Patil SR, Durgawale PM. Gaps in facilities available at Community Health Centers/Rural Hospitals as per Indian public health standards - Study from Western Maharashtra. J Family Med Prim Care 2020; 9:4869-4874. [PMID: 33209814 PMCID: PMC7652104 DOI: 10.4103/jfmpc.jfmpc_717_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The launch of the National Rural Health Mission (NRHM) gives us the opportunity to review the functioning and bring up the Community Health Centers (CHC) services to the level of Indian Public Health Standards and thus improve the lives of citizens. Objectives: Assessment of the gaps in the facilities available at Community health centers/Rural hospitals as per Indian Public health standards. Methods: Facility based cross-sectional study was conducted in the Satara district of Maharashtra. Results: This study in the majority showed that the gap in the delivery of healthcare according to IPHS. It was observed that the Funded CHCs had a better quality of services than the non-funded CHCs. The non-funded CHCs lacked essential emergency services. Along with ANC care, newborn care in the first few minutes of life is very crucial, but very little priority was given to the newborn care as those services were not as per norms. Specialists as well as paramedical and other support staff are deficient in both funded and non funded CHCs/rural hospitals (RHs). Conclusion: Standards were greatly influenced by funds delivered by IPHS itself. A staffing pattern is one of the important pillars in delivering various health services. A better salary, working place with continuous water supply, electricity, and cleanliness will improve the staffing pattern. Therefore, competent manpower and well-built infrastructure will help in the standard delivery of healthcare at CHC/RH and will thus serve the purpose of dispensing basic health services to every individual in the remotest areas.
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Affiliation(s)
- Supriya S Patil
- Department of Community Medicine, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Rajesh A Gaikwad
- Department of Community Medicine, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Tanvi N Deshpande
- Department of Community Medicine, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - S R Patil
- Department of Microbiology, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - P M Durgawale
- Department of Community Medicine, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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Abstract
Community health centers are a vital part of the primary and behavioral health care systems in rural areas. We compared behavioral health care staffing and services in rural and urban centers. In the period 2013-17 the overall staff-to-patient ratio in behavioral health rose by 66 percent in rural centers, faster than growth in urban centers (49 percent). Growth in both settings was mostly driven by clinical social workers and other licensed mental health providers; staffing by psychiatrists and psychologists changed only slightly. In rural centers the average adjusted increase in annual visits per additional behavioral health staff member was 411 for substance use disorders, slightly higher than at urban centers. Additional annual visits per additional staff member in rural centers were 539 for depression, 466 for anxiety, and 300 for other mental disorders, similar to the numbers in urban centers. Behavioral health staff currently participating in the National Health Service Corps (NHSC) contributed more to visits for depression and anxiety in rural centers, compared to both their urban counterparts and non-NHSC staff in rural centers. Enhancing behavioral health staffing in rural community health centers could help reduce the urban-rural gap in the availability of behavioral health services, but still more could be done.
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Affiliation(s)
- Xinxin Han
- Xinxin Han is a postdoctoral fellow at Tsinghua University School of Medicine, in Beijing, China. She was a senior research associate at the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, in Washington, D.C., when this article was written
| | - Leighton Ku
- Leighton Ku ( lku@gwu. edu ) is a professor in the Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University
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Shi J, Jin H, Shi L, Chen C, Ge X, Lu Y, Zhang H, Wang Z, Yu D. The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China. BMC Fam Pract 2020; 21:178. [PMID: 32854623 PMCID: PMC7453522 DOI: 10.1186/s12875-020-01250-6] [Citation(s) in RCA: 3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. METHODS Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. FINDINGS A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P < 0.001) compared with those from urban CHCs. CONCLUSION That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
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Affiliation(s)
- Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South RD, Shanghai, 200025, China.,Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Hua Jin
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Leiyu Shi
- Department of Health Policy and Management, Primary Care Policy Center, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Chen Chen
- Shanghai Jing 'an District Jiangning Road Community Health Service Center, Shanghai, 200041, China
| | - Xuhua Ge
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Hanzhi Zhang
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, 227 Chongqing South RD, Shanghai, 200025, China. .,Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China. .,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China. .,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China. .,Academic Department of General Practice, Tongji University School of Medicine, 450 Tengyue RD, Shanghai, 200090, China.
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43
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Greaney ML, Wallington SF, Rampa S, Vigliotti VS, Cummings CA. Assessing health professionals' perception of health literacy in Rhode Island community health centers: a qualitative study. BMC Public Health 2020; 20:1289. [PMID: 32843002 PMCID: PMC7448344 DOI: 10.1186/s12889-020-09382-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/12/2020] [Indexed: 11/11/2022] Open
Abstract
Background Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. Methods Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. Results Eight unique themes centered on health literacy, sources of health information, organizational culture’s impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients’ health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. Conclusions Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids.
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Affiliation(s)
- Mary L Greaney
- Department of Health Studies, University of Rhode Island, Kingston, RI, 02881, USA.
| | - Sherrie F Wallington
- The George Washington School of Nursing & Milken Institute School of Public Health, Washington, DC, 20006, USA
| | - Sankeerth Rampa
- School of Business, Rhode Island College, Providence, RI, 02908-1991, USA
| | - Vivian S Vigliotti
- Robbins Institute for Health Policy & Leadership, Baylor University, Waco, TX, 76798, USA
| | - Carol A Cummings
- Department of Health & Physical Education, Feinstein School of Education and Human Development, Rhode Island College, Providence, RI, 02908-1991, USA
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44
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Thorsen M, McGarvey R, Thorsen A. Diabetes management at community health centers: Examining associations with patient and regional characteristics, efficiency, and staffing patterns. Soc Sci Med 2020; 255:113017. [PMID: 32413683 PMCID: PMC7295229 DOI: 10.1016/j.socscimed.2020.113017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Revised: 03/04/2020] [Accepted: 04/28/2020] [Indexed: 01/22/2023]
Abstract
A major source of primary health care for millions of Americans, community health centers (CHCs) act as a key point of access for diabetes care. The ability of a CHC to deliver high quality care, that supports patients' management of their diabetes, may be impacted by the unique set of resources and constraints it faces, both in terms of characteristics of its patient population and aspects of operations. This study examines how patient and regional characteristics, staffing patterns, and efficiency were associated with diabetes management at CHCs (percentage of patients with uncontrolled diabetes, HbA1C > 9%). Data on a sample of 1229 CHCs came from multiple sources. CHC-level information was obtained from the Uniform Data System and regional-level information from the Behavioral Risk Factor Surveillance System and the US Census American Community Survey. A clustering methodology, latent class analysis, identified seven underlying staffing patterns at CHCs. Data envelopment analysis was performed to evaluate the efficiency of CHCs, relative to centers with similar staffing patterns. Finally, generalized linear models were used to examine the association between staffing patterns, efficiency, and patient and regional-level characteristics. Findings from this study have sociological, practical, and methodological implications. Findings highlight that the intersection of patient racial composition with regional racial composition is significant; diabetes control appears to be worse at CHCs serving racial minorities living in predominantly White areas. Findings suggest that CHCs that incorporate more behavioral health care into their staffing mix have lower rates of uncontrolled diabetes among their patients. Finally, greater efficiency in CHC operations is associated with better diabetes control among patients. By identifying sociodemographic and operational characteristics associated with better hemoglobin control among diabetes patients, the current study contributes to our understanding of both health care operations and health inequalities.
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Affiliation(s)
- Maggie Thorsen
- Department of Sociology and Anthropology, Montana State University, P.O. Box 172380, Bozeman, MT, 59717, USA.
| | - Ronald McGarvey
- Department of Industrial and Manufacturing Systems Engineering and Truman School of Public Affairs, University of Missouri, E3437H Lafferre Hall, Columbia, MO, 65211, USA.
| | - Andreas Thorsen
- Jake Jabs College of Business and Entrepreneurship, Montana State University, P.O. Box 173040, Bozeman, MT, 59717, USA.
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Hatch B, Tillotson C, Huguet N, Marino M, Baron A, Nelson J, Sumic A, Cohen D, E DeVoe J. Implementation and adoption of a health insurance support tool in the electronic health record: a mixed methods analysis within a randomized trial. BMC Health Serv Res 2020; 20:428. [PMID: 32414376 PMCID: PMC7227079 DOI: 10.1186/s12913-020-05317-z] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background In addition to delivering vital health care to millions of patients in the United States, community health centers (CHCs) provide needed health insurance outreach and enrollment support to their communities. We developed a health insurance enrollment tracking tool integrated within the electronic health record (EHR) and conducted a hybrid implementation-effectiveness trial in a CHC-based research network to assess tool adoption using two implementation strategies. Methods CHCs were recruited from the OCHIN practice-based research network. Seven health center systems (23 CHC clinic sites) were recruited and randomized to receive basic educational materials alone (Arm 1), or these materials plus facilitation (Arm 2) during the 18-month study period, September 2016–April 2018. Facilitation consisted of monthly contacts with clinic staff and utilized audit and feedback and guided improvement cycles. We measured total and monthly tool utilization from the EHR. We conducted structured interviews of CHC staff to assess factors associated with tool utilization. Qualitative data were analyzed using an immersion-crystallization approach with barriers and facilitators identified using the Consolidated Framework for Implementation Research. Results The majority of CHCs in both study arms adopted the enrollment tool. The rate of tool utilization was, on average, higher in Arm 2 compared to Arm 1 (20.0% versus 4.7%, p < 0.01). However, by the end of the study period, the rate of tool utilization was similar in both arms; and observed between-arm differences in tool utilization were largely driven by a single, large health center in Arm 2. Perceived relative advantage of the tool was the key factor identified by clinic staff as driving tool utilization. Implementation climate and leadership engagement were also associated with tool utilization. Conclusions Using basic education materials and low-intensity facilitation, CHCs quickly adopted an EHR-based tool to support critical outreach and enrollment activities aimed at improving access to health insurance in their communities. Though facilitation carried some benefit, a CHC’s perceived relative advantage of the tool was the primary driver of decisions to implement the tool. Trial registration ClinicalTrials.gov: NCT02355262, Posted February 4, 2015.
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Affiliation(s)
- Brigit Hatch
- Oregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA. .,OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | | | - Nathalie Huguet
- Oregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA
| | - Miguel Marino
- Oregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA
| | - Andrea Baron
- Oregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA
| | - Joan Nelson
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
| | | | - Deborah Cohen
- Oregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA
| | - Jennifer E DeVoe
- Oregon Health & Science University, 3405 SW Perimeter Court, Portland, OR, 97239, USA.,OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
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46
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Abstract
Outside major urban centers, LGBTQ patients often travel hours to find trusted clinicians. One Iowa clinic has created a safe space just down the road.
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Affiliation(s)
- David Tuller
- This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/ . David Tuller ( davetuller@berkeley. edu ) is a senior fellow in public health and journalism at the Center for Global Public Health at the University of California Berkeley
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47
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Lehtovuori T, Heikkinen AM, Raina M, Kauppila T. The effect of electronic reminders on the recording of diagnoses in primary care: A quasi-experimental before and after study. SAGE Open Med 2020; 8:2050312120918267. [PMID: 32435481 PMCID: PMC7222644 DOI: 10.1177/2050312120918267] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/27/2020] [Indexed: 01/19/2023] Open
Abstract
Objectives: This study examined whether using electronic reminders leads to an increase in the rate of diagnosis recordings in the electronic health record system following visits to a general practitioner. The impact of electronic reminders was studied in the primary health care of a Finnish city. Methods: This observational quasi-experimental study based on a before-and-after design was carried out by installing an electronic reminder to improve the recording of diagnoses in the computerized electronic health record system. The quantity of the recorded diagnoses was observed before and after the intervention. The effect of this intervention on the distribution of different diagnoses was also studied. Results: Before intervention, 33%–46% of visits (to general practitioners/month) had recorded diagnose in the primary health care units. After 4 years, the recording rate had risen to 87%–95% (p < 0.001). The rate of change in the recording of diagnoses was highest during the first year of intervention and plateaued about 3.5 years after application reminders. In the present study, most of the visits concerned mild respiratory infections, elevated blood pressure, low back pain and type 2 diabetes. Conclusion: An electronic reminder is likely to improve the recording of diagnoses during the visits to general practitioners. The distribution of diagnoses was in line with former reports concerning diagnoses in Finnish primary care.
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Affiliation(s)
| | - Anna M Heikkinen
- Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki, Helsinki, Finland
| | | | - Timo Kauppila
- City of Vantaa, Vantaa, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Tampere, Tampere, Finland
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48
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Ali M, Williams MD. No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015-2016. J Community Health 2020; 44:387-394. [PMID: 30604224 PMCID: PMC6411664 DOI: 10.1007/s10900-018-00595-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mystery patient drills using simulated patients have been used in hospitals to assess emergency preparedness for infectious diseases, but these drills have seldom been reported in primary care settings. We conducted three rounds of mystery patient drills designed to simulate either influenza-like illness (ILI) or measles at 41 community health centers in New York City from April 2015 through December 2016. Among 50 drills conducted, 49 successfully screened the patient–actor (defined as provision of a mask or referral to the medical team given concern of infection requiring potential isolation), with 35 (70%) drills completing screening without any challenges. In 47 drills, the patient was subsequently isolated (defined as placement in a closed room to limit transmission), with 29 (58%) drills completing isolation without any challenges. Patient–actors simulating ILI were more likely to be masked than those simulating measles (93% vs. 59%, p = 0.007). Median time to screening was 2 min (interquartile range [IQR] 2–6 min) and subsequently to isolation was 1 min (IQR 0–2 min). Approximately 95% of participants reported the drill was realistic and prepared them to deal with the hazards addressed. Qualitative analysis revealed recurring themes for strengths (e.g., established protocols, effective communication) and areas for improvement (e.g., hand hygiene, explaining isolation rationale). We conclude that mystery patient drills are an effective and feasible longitudinal collaboration between health departments and primary care clinics to assess and inform emergency preparedness for infectious diseases.
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Affiliation(s)
- Mohsin Ali
- Bureau of Healthcare System Readiness, Office of Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, Queens, NY, USA.
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 2, Boston, MA, 02115, USA.
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
| | - Marsha D Williams
- Bureau of Healthcare System Readiness, Office of Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, Queens, NY, USA
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49
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Adams SA, Haynes VE, Brandt HM, Choi SK, Young V, Eberth JM, Hébert JR, Friedman DB. Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina. Cancer Epidemiol 2020; 65:101681. [PMID: 32035294 DOI: 10.1016/j.canep.2020.101681] [Citation(s) in RCA: 1] [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: 08/08/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina. METHODS Data were obtained from FQHC patient visits (from 3 centers) between 2007-2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area. RESULTS Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05). CONCLUSIONS Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.
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Affiliation(s)
- Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; College of Nursing, University of South Carolina, 1601 Greene Street Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Venice E Haynes
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Seul Ki Choi
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States; Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, South Korea.
| | - Vicki Young
- South Carolina Primary Care Association, 3 Technology Circle Columbia, SC, 29203, United States.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
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50
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Gyamfi J, Allegrante JP, Iwelunmor J, Williams O, Plange-Rhule J, Blackstone S, Ntim M, Apusiga K, Peprah E, Ogedegbe G. Application of the Consolidated Framework for Implementation Research to examine nurses' perception of the task shifting strategy for hypertension control trial in Ghana. BMC Health Serv Res 2020; 20:65. [PMID: 31996195 PMCID: PMC6990487 DOI: 10.1186/s12913-020-4912-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.
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Affiliation(s)
- Joyce Gyamfi
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - John P. Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, Salus Center, Saint Louis University, 3545 Lafayette Ave., Saint Louis, MO 63103 USA
| | - Olajide Williams
- Columbia University Medical Center, 710 West 168th Street, New York, NY 10032 USA
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Sarah Blackstone
- Health and Behavioral Studies Building, James Madison University, MSC 4301,235 Martin Luther King Jr Way, Harrisonburg, VA 22807 USA
| | - Michael Ntim
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Kingsley Apusiga
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Emmanuel Peprah
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Gbenga Ogedegbe
- Department of Population Health/ Section for Global Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
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