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Brault MA, Linnander EL, Ginindza TM, Mabuza K, Christie S, Canavan ME, Jones A, Desai MM. Assessing changes in adolescent girls' and young women's sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini. Glob Health Action 2023; 16:2243760. [PMID: 37565704 PMCID: PMC10424588 DOI: 10.1080/16549716.2023.2243760] [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: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls' and young women's (AGYW; aged 15-24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini's electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW's SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period.
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Affiliation(s)
- Marie A. Brault
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Erika L. Linnander
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Health Policy & Management, Yale School of Public Health, New Haven, CT, USA
| | - Thokozani M. Ginindza
- Health Management Information Systems (HMIS), eSwatini Ministry of Health, Mbabane, eSwatini
| | | | - Sarah Christie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
| | - Maureen E. Canavan
- Yale School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| | - Anastasia Jones
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, San Antonio, TX, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Beldick SR, Rohde JF, Short VL, Abatemarco D, Goyal NK. Pediatric Primary Care Diagnoses Among Children with Intrauterine Opioid Exposure. J Health Care Poor Underserved 2023; 34:161-179. [PMID: 37464487 PMCID: PMC10483573 DOI: 10.1353/hpu.2023.0011] [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] [Indexed: 02/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Characterizing common concerns for children with intrauterine opioid exposure (IOE) can inform tailored primary care. METHODS Retrospective analysis of primary care data of children with IOE from birth to age two years within one multi-state pediatric health system. Well child care (WCC) and problem-based visit diagnoses were categorized, and descriptive statistics were tabulated. RESULTS Three hundred and eighty-five (385) children with IOE had 3,622 primary care visits, of which 51.4% were WCC and 48.6% were problem-based. Most frequent visit diagnoses were upper respiratory complaints (14.8% of visits), feeding difficulties (12.2%), and perinatal viral exposure (9.8%). Although visit type (WCC vs. problem-based) varied across diagnostic category, frequent utilization of both visit types were documented for several diagnoses in infancy (e.g., fussiness/colic, feeding difficulties). CONCLUSIONS Well child care visits for children with IOE are key opportunities for anticipatory guidance with an emphasis on problems that may contribute to acute health care utilization, particularly in early infancy.
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Affiliation(s)
| | | | - Vanessa L. Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Diane Abatemarco
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Neera K. Goyal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA
- Nemours Children’s Health, Philadelphia, PA
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Liu X, Seidel JE, McDonald T, Waters N, Patel AB, Shahid R, Bertazzon S, Marshall DA. Rural-Urban Differences in Non-Local Primary Care Utilization among People with Osteoarthritis: The Role of Area-Level Factors. Int J Environ Res Public Health 2022; 19:6392. [PMID: 35681975 PMCID: PMC9180262 DOI: 10.3390/ijerph19116392] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 12/04/2022]
Abstract
The utilization of non-local primary care physicians (PCP) is a key primary care indicator identified by Alberta Health to support evidence-based healthcare planning. This study aims to identify area-level factors that are significantly associated with non-local PCP utilization and to examine if these associations vary between rural and urban areas. We examined rural-urban differences in the associations between non-local PCP utilization and area-level factors using multivariate linear regression and geographically weighted regression (GWR) models. Global Moran's I and Gi* hot spot analyses were applied to identify spatial autocorrelation and hot spots/cold spots of non-local PCP utilization. We observed significant rural-urban differences in the non-local PCP utilization. Both GWR and multivariate linear regression model identified two significant factors (median travel time and percentage of low-income families) with non-local PCP utilization in both rural and urban areas. Discontinuity of care was significantly associated with non-local PCP in the southwest, while the percentage of people having university degree was significant in the north of Alberta. This research will help identify gaps in the utilization of local primary care and provide evidence for health care planning by targeting policies at associated factors to reduce gaps in OA primary care provision.
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Affiliation(s)
- Xiaoxiao Liu
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
| | - Judy E. Seidel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
| | - Terrence McDonald
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Nigel Waters
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Civil Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Environmental Science and Policy, College of Science, George Mason University, Fairfax, VA 22030, USA
| | - Alka B. Patel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
| | - Rizwan Shahid
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Stefania Bertazzon
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Deborah A. Marshall
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (N.W.); (R.S.); (S.B.)
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Moore JR, Castro Y, Cubbin C, von Sternberg K. Associations of At-Risk Drinking, Current Smoking, and Their Co-Occurrence With Primary Care Service Utilization. Am J Health Promot 2022; 36:429-439. [PMID: 34865517 PMCID: PMC10409595 DOI: 10.1177/08901171211056130] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization. DESIGN Cross-sectional telephone survey. SETTING All United States and Territories. SUBJECTS 246 801 adults aged 18-64. MEASURES The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined. ANALYSIS Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions. RESULTS The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25-35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior. CONCLUSION Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.
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Affiliation(s)
- John R. Moore
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Kirk von Sternberg
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Keefe RJ, Van Horne BS, Cain CM, Budolfson K, Thompson R, Greeley CS. A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clin Pediatr (Phila) 2020; 59:252-258. [PMID: 31896282 DOI: 10.1177/0009922819898182] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to compare the utilization of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system. The data for this study were analyzed from a clinical database of a multipractice pediatric health system in Houston, Texas. The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period. The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis. Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.
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Affiliation(s)
- Rachael J Keefe
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Bethanie S Van Horne
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Cary M Cain
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | | | - Richard Thompson
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Christopher S Greeley
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
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Taylor YJ, Spencer MD, Mahabaleshwarkar R, Ludden T. Racial/ethnic differences in healthcare use among patients with uncontrolled and controlled diabetes. Ethn Health 2019; 24:245-256. [PMID: 28393538 DOI: 10.1080/13557858.2017.1315372] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To examine racial/ethnic differences in healthcare use among patients classified as having controlled and uncontrolled diabetes. DESIGN Data from the Carolinas HealthCare System electronic data warehouse were used. Glycemic control was defined as glycosylated hemoglobin (HbA1c) < 8% (64 mmol/mol) in 2012 (n = 9996). Patients with HbA1c ≥ 8% (64 mmol/mol) in 2012 were classified as uncontrolled (n = 2576). Race and ethnicity were jointly classified as non-Hispanic Black, non-Hispanic White or Other. Separate mixed effects negative binomial models estimated the independent effect of race/ethnicity on the number of emergency department (ED) visits, hospitalizations and physician office visits in 2013, in each patient group, adjusting for significant confounding variables. RESULTS Rates of diabetes-related ED visits were two to three times higher for non-Hispanic Blacks compared to non-Hispanic Whites (uncontrolled rate ratio [RR]: 3.41 95% CI: 1.41-8.22; controlled RR: 2.95; 95% CI: 1.78-4.91). Similar differences were observed for all-cause ED visits (uncontrolled RR: 1.83, 95% CI: 1.50-2.24; controlled RR: 2.45, 95% CI: 2.17-2.77). Non-Hispanic Blacks with controlled and uncontrolled diabetes also had lower rates of all-cause physician office visits when compared to non-Hispanic Whites (uncontrolled RR: 0.84, 95% CI: 0.77-0.91; controlled RR: 0.81, 95% CI: 0.78-0.84). CONCLUSION Notable racial/ethnic disparities exist in the use of emergency services and physician offices for diabetes care. Strategies such as patient education and care delivery changes that address healthcare access issues in racial/ethnic minorities should be considered to offer better diabetes management and address diabetes disparities.
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Affiliation(s)
- Yhenneko J Taylor
- a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA
| | - Melanie D Spencer
- a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA
| | - Rohan Mahabaleshwarkar
- a Center for Outcomes Research and Evaluation , Carolinas HealthCare System , Charlotte , USA
| | - Thomas Ludden
- b Department of Family Medicine , Carolinas HealthCare System , Charlotte , USA
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Barnett ML, Song Z, Rose S, Bitton A, Chernew ME, Landon BE. Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study. J Gen Intern Med 2017; 32:1146-55. [PMID: 28523475 DOI: 10.1007/s11606-017-4072-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/30/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Shopping for health insurance is encouraged as a way to find the most affordable coverage that best meets an enrollee's needs. However, the extent to which individuals switch insurance and subsequent changes in health care utilization that might arise, particularly new physician visits, are not well understood. OBJECTIVE To examine the relationship between insurance switching and new physician and emergency department visits around the time of a switch. DESIGN Observational study using a difference-in-differences design to compare those switching insurance carriers with propensity score-matched controls who did not switch, stratified based on whether individuals initially had private or Medicaid insurance coverage. All analyses adjusted for individual and insurance characteristics. PARTICIPANTS Continuously insured, non-elderly individuals with private or Medicaid insurance coverage in Massachusetts from 2010 to 2013. MAIN MEASURES Rates of new primary care and specialist physician visits, as well as rates of emergency department visits. KEY RESULTS Before matching, among 1,628,057 continuously insured individuals, 418,231 (26%) switched insurance carriers during a 2-year period. Characteristics of switchers and non-switchers were similar after matching (n = 316,343 in each group). After matching, switching plans was associated with a 203% and 47.5% increase in the rate of new primary care physician visits following switching for those initially with Medicaid or private coverage, respectively (both p < 0.001), with a large short-term increase, diminishing over time. Among those with Medicaid coverage, switching was associated with a 14.9% higher rate of ED visits during the month of switching (p < 0.001), but otherwise decreased modestly after switching. CONCLUSIONS Insurance switching is common, and is associated with increased new physician visits and temporarily increased ED use among the publicly insured. As insurance markets become more volatile in the current policy environment, understanding changes in utilization after insurance switching may become increasingly important.
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DeVoe JE, Marino M, Gold R, Hoopes MJ, Cowburn S, O'Malley JP, Heintzman J, Gallia C, McConnell KJ, Nelson CA, Huguet N, Bailey SR. Community Health Center Use After Oregon's Randomized Medicaid Experiment. Ann Fam Med 2015; 13. [PMID: 26195674 PMCID: PMC4508170 DOI: 10.1370/afm.1812] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment"). METHODS We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008-2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging. RESULTS The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals. CONCLUSIONS Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings.
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Affiliation(s)
- Jennifer E DeVoe
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon OCHIN, Inc, Portland, Oregon
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, Oregon
| | - Rachel Gold
- OCHIN, Inc, Portland, Oregon Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | | | - Jean P O'Malley
- Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, Oregon
| | - John Heintzman
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
| | - Charles Gallia
- Office of Health Analytics, Oregon Health Authority, Portland, Oregon
| | - K John McConnell
- Center for Health System Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Nathalie Huguet
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
| | - Steffani R Bailey
- Oregon Health & Science University, Department of Family Medicine, Portland, Oregon
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Mosen DM, Feldstein AC, Perrin N, Rosales AG, Smith DH, Liles EG, Schneider JL, Myers RE, Elston-Lafata J. More comprehensive discussion of CRC screening associated with higher screening. Am J Manag Care 2013; 19:265-271. [PMID: 23725359 PMCID: PMC3891849] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening. STUDY DESIGN Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization. METHODS A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs' discussion of CRC screening and patient beliefs regarding screening. PRIMARY OUTCOME MEASURE receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents' agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression. RESULTS Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 0-1) and 4.0 (range 1-5), respectively. A total of 28.2% (n = 249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test. More comprehensive discussion of CRC screening was associated with increased screening (odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.03-2.21). Higher perceived benefits (OR = 1.46, 95% CI = 1.13-1.90) and 1 or more PCP visits (OR = 5.82, 95% CI = 3.87-8.74) were also associated with increased screening. CONCLUSIONS More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening.
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Affiliation(s)
- David M. Mosen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Adrianne C. Feldstein
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Northwest Permanente, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nancy Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - David H. Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Elizabeth G. Liles
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
- Northwest Permanente, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Ronald E. Myers
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jennifer Elston-Lafata
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia USA
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Gadomski A, Wissow LS, Slade E, Jenkins P. Training clinicians in mental health communication skills: impact on primary care utilization. Acad Pediatr 2010; 10:346-52. [PMID: 20685190 PMCID: PMC2933967 DOI: 10.1016/j.acap.2010.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 10/29/2009] [Revised: 06/10/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although it is known that children with mental health problems utilize primary care services more than most other children, it is unknown how addressing mental health problems in primary care affects children's subsequent services utilization. This study measures primary care utilization in the context of a randomized trial of a communication skills training program for primary care clinicians that had a positive impact on child mental health outcomes. METHODS From 2002 to 2005, 48 pediatric primary care clinicians at 13 sites in rural upstate New York, urban Maryland, and Washington, DC, were randomized to in-office training or to a control group. Consecutive primary care patients between the ages of 5 and 16 years were screened for mental health problems, as indicated by a possible or probable score on the Strengths and Difficulties Questionnaire (SDQ). For 397 screened children, primary care visits during the next 6 months were identified using chart review and administrative databases. Using generalized estimating equation regression to account for clustering at the clinician level, primary care utilization was compared by study group and SDQ status. RESULTS The number of primary care visits to the trained clinicians did not differ significantly from those made to control clinicians (2.5 for both groups; P = .63). Children with possible or probable SDQ scores made, on average, 0.38 or 0.65 more visits on a per child basis, respectively, during the 6-month follow-up period than SDQ unlikely children (P = .0002). CONCLUSIONS Seeing a trained clinician did not increase subsequent primary care utilization. However, primary care utilization was greater among children with mental health problems as measured by the SDQ. Addressing children's mental health in primary care does not increase the primary care visit burden. Research on overall health services utilization is needed.
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Affiliation(s)
- Anne Gadomski
- Research Institute, Bassett Healthcare, Cooperstown, NY 13326, USA.
| | | | - Eric Slade
- U.S. Department of Veterans Affairs, VISN5 Mental Illness Research and Education Clinical Center Baltimore, MD
| | - Paul Jenkins
- Computing Center, Research Institute, Bassett Healthcare, Cooperstown, NY
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