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Peahl AF, Rubin-Miller L, Paterson V, Jahnke HR, Plough A, Henrich N, Moss C, Shah N. Understanding social needs in pregnancy: Prospective validation of a digital short-form screening tool and patient survey. AJOG Glob Rep 2023; 3:100158. [PMID: 36922957 PMCID: PMC10009524 DOI: 10.1016/j.xagr.2022.100158] [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: 01/07/2023] Open
Abstract
BACKGROUND Social determinants of health significantly affect health outcomes, yet are infrequently addressed in prenatal care. OBJECTIVE This study aimed to improve the efficiency and experience of addressing social needs in pregnancy through: (1) testing a digital short-form screening tool; and (2) characterizing pregnant people's preferences for social needs screening and management. STUDY DESIGN We developed a digital short-form social determinants of health screening tool from PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences), and a survey to query patients' preferences for addressing social needs. Instruments were administered online to peripartum participants, with equal representation of patients with public and private insurance. We calculated the sensitivity and specificity of the short-form tool vs PRAPARE. Quantitative responses were characterized using descriptive statistics. Free-text responses were analyzed with matrix and thematic coding. Survey data were analyzed by subgroups of historically marginalized populations. RESULTS A total of 215 people completed the survey. Participants were predominantly White (167; 77.7%) and multiparous (145; 67.4%). Unmet social needs were prevalent with both the short-form tool (77.7%) and PRAPARE (96.7%). The sensitivity (79.3%) and specificity (71.4%) of the short-form screener were high for detecting any social need. Most participants believed that it was important for their pregnancy care team to know their social needs (material: 173, 80.5%; support: 200, 93.0%), and over half felt comfortable sharing their needs through in-person or digital modalities if assistance was or was not available (material: 117, 54.4%; support: 122, 56.7%). Free-text themes reflected considerations for integrating social needs in routine prenatal care. Acceptability of addressing social needs in pregnancy was high among all groups. CONCLUSION A digital short-form social determinants of health screening tool performs well when compared with the gold standard. Pregnant people accept social needs as a part of routine pregnancy care. Future work is needed to operationalize efficient, effective, patient-centered approaches to addressing social needs in pregnancy.
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Affiliation(s)
- Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (Dr Peahl).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI (Dr Peahl).,Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Lily Rubin-Miller
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Victoria Paterson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island (Paterson)
| | - Hannah R Jahnke
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Avery Plough
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Natalie Henrich
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Christa Moss
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah)
| | - Neel Shah
- Maven Clinic, New York, NY (Dr Peahl, Ms Rubin-Miller, Dr Jahnke, Ms Plough, and Drs Henrich, Moss, and Shah).,Harvard Medical School Department of Obstetrics and Gynecology, Boston, MA (Dr Shah)
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Whorms DS, Narayan AK, Pourvaziri A, Miles RC, Glover M, Herrington J, Saini S, Brink JA, Flores EJ. Analysis of the Effects of a Patient-Centered Rideshare Program on Missed Appointments and Timeliness for MRI Appointments at an Academic Medical Center. J Am Coll Radiol 2020; 18:240-247. [PMID: 32791235 DOI: 10.1016/j.jacr.2020.05.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to assess the differences in timeliness to MRI appointments and missed MRI appointment rates before and after the implementation of a rideshare program. METHODS Retrospective analysis of a rideshare program was performed 9 months after implementation to compare the effects before and after implementation. Variables obtained included demographics, MRI appointment variables, and data related to rideshare use. Descriptive statistics and linear and logistic regression analyses were used to compare demographic characteristics among patients using the rideshare program with (1) those who did not use the rideshare program after implementation and (2) patients before rideshare implementation. Rates of missed appointments derived from patient-related, same-day appointment cancellations were analyzed using logistic regression analyses. Timeliness was analyzed using linear regression analyses. All analyses were adjusted for potential confounders. RESULTS Of 7,707 patients scheduled for MRI appointments during the postintervention period, 151 patients used the rideshare service (1.95%). There were no statistically significant differences in missed appointment rates after rideshare implementation (adjusted odds ratio, 1.09; 95% confidence interval, 0.93-1.27; P = .275). Patients using the rideshare service were more likely to be on time (adjusted coefficient = 13.0; 95% confidence interval, 5.4-20.5; P = .001). Older patients (P = .001), unemployed patients (P < .001), and patients without commercial insurance (P < .001) were more likely to use the rideshare service. CONCLUSIONS Implementation of a rideshare program did not significantly decrease missed appointment rates, but it significantly improved timeliness to MRI appointments while assisting at-risk patient populations reporting transportation barriers.
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Affiliation(s)
- Debra S Whorms
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anand K Narayan
- Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massacusetts
| | - Ali Pourvaziri
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Randy C Miles
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeremy Herrington
- Director of Clincal Operations, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sanjay Saini
- Vice-chair for Finance and Quality, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - James A Brink
- Juan M. Taveras Professor of Radiology; Radiologist-in-Chief, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J Flores
- Faculty, The Mongan Institute, Officer, Radiology Community Health and Equity, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Mayer CM, Owaraganise A, Kabami J, Kwarisiima D, Koss CA, Charlebois ED, Kamya MR, Petersen ML, Havlir DV, Jewell BL. Distance to clinic is a barrier to PrEP uptake and visit attendance in a community in rural Uganda. J Int AIDS Soc 2019; 22:e25276. [PMID: 31037845 PMCID: PMC6488759 DOI: 10.1002/jia2.25276] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/14/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Geographic and transportation barriers are associated with poorer HIV-related health outcomes in sub-Saharan Africa, but data on the impact of these barriers on prevention interventions are limited. We estimated the association between distance to clinic and other transportation-related barriers on pre-exposure prophylaxis (PrEP) uptake and initial clinic visit attendance in a rural community in southwestern Uganda enrolled in the ongoing SEARCH study (NCT01864603). METHODS Community-wide HIV testing was conducted and offered to adult (≥15 years) participants in Ruhoko. Participants were eligible for PrEP based on an empiric risk score, having an HIV-discordant partner, or self-referral at either the community health campaign or during home-based testing from March to April 2017. We collected data from PrEP-eligible households on GPS-measured distance to clinic, walking time to clinic and road difficulty. A sample of participants was also asked to identify their primary barriers to PrEP use with a semi-quantitative questionnaire. We used multivariable logistic regression to evaluate the association between transportation barriers and (1) PrEP uptake among PrEP-eligible individuals and (2) four-week clinic visit attendance among PrEP initiators. RESULTS Of the 701 PrEP-eligible participants, 272 (39%) started PrEP within four weeks; of these, 45 (17%) were retained at four weeks. Participants with a distance to clinic of ≥2 km were less likely to start PrEP (aOR 0.34; 95% CI 0.15 to 0.79, p = 0.012) and less likely to be retained on PrEP once initiated (aOR 0.29; 95% CI 0.10 to 0.84; p = 0.024). Participants who were deemed eligible during home-based testing and did not have the option of same-day PrEP start were also substantially less likely to initiate PrEP (aOR 0.16, 95% CI 0.07 to 0.37, p < 0.001). Of participants asked to name barriers to PrEP use (N = 98), the most frequently cited were "needing to take PrEP every day" (N = 18) and "low/no risk of getting HIV" (N = 18). Transportation-related barriers, including "clinic is too far away" (N = 6) and "travel away from home" (N = 4) were also reported. CONCLUSIONS Distance to clinic is a significant predictor of PrEP uptake and four-week follow-up visit attendance in a community in rural Uganda. Interventions that address geographic and transportation barriers may improve PrEP uptake and retention in sub-Saharan Africa.
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Affiliation(s)
| | | | - Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
| | | | | | | | | | | | - Diane V Havlir
- University of California San FranciscoSan FranciscoCAUSA
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