1
|
Lin SC, Chang KSG, Marjavi A, Chon KY, Dichter ME, DuBois Palardy J. Intimate Partner Violence and Human Trafficking Screening and Services in Primary Care Across Underserved Communities in the United States-Initial Examination of Trends, 2020-2021. Public Health Rep 2024:333549241239886. [PMID: 38562004 DOI: 10.1177/00333549241239886] [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: 04/04/2024] Open
Abstract
OBJECTIVES The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic. METHODS We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs. RESULTS The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37). CONCLUSIONS The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations.
Collapse
Affiliation(s)
- Sue C Lin
- Bureau of Primary Health Care Office of Quality Improvement, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD, USA
| | | | - Anna Marjavi
- Futures Without Violence, San Francisco, CA, USA
| | - Katherine Y Chon
- Office of Trafficking in Persons, Administration for Children and Families, US Department of Health and Human Services, Washington, DC, USA
| | - Melissa E Dichter
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Temple University School of Social Work, Philadelphia, PA, USA
| | | |
Collapse
|
2
|
Palimaru AI, Caldwell JI, Cohen DA, Shah D, Kuo T. Food recovery and produce distribution as a system strategy for increasing access to healthy food among populations experiencing food insecurity: lessons for post-pandemic planning. Glob Health Promot 2024; 31:25-35. [PMID: 37661757 DOI: 10.1177/17579759231193354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Using data from an intercept survey of 428 adults who received free surplus produce at five distribution sites and qualitative data from 15 interviews with site personnel, we examined facilitators (e.g. community partnerships, coalition support) and challenges (e.g. limited refrigerated storage, lack of transportation infrastructure) to operating a food recovery and distribution program in Los Angeles County. Overall, this food system intervention appeared to fill an unmet need for recipients, nearly 80% of whom were food insecure and 60% visited a site several months/year or monthly. For many living in this county's underserved communities, this effort was instrumental in increasing access to healthy food before and during the COVID-19 pandemic. To sustain/expand this program's reach, local governments and food assistance programs should provide greater coordination and oversight, and invest more resources into this food recovery and distribution infrastructure.
Collapse
Affiliation(s)
| | - Julia I Caldwell
- Nutrition and Physical Activity Program, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Deborah A Cohen
- Kaiser Permanente Research and Evaluation, Pasadena, CA, USA
| | - Dipa Shah
- Nutrition and Physical Activity Program, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA, USA
| |
Collapse
|
3
|
Wippold GM, Abshire DA, Garcia KA, Crichlow Z, Frary SG, Murphy ER, Frank L, Johnson L, Woods T. Lessons Learned From a Community-Based Men's Health Fair. J Prim Care Community Health 2024; 15:21501319231222766. [PMID: 38178605 PMCID: PMC10768586 DOI: 10.1177/21501319231222766] [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: 10/10/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Strategies are needed to promote the uptake of preventive health services among Black, Hispanic, and rural men because these men underutilize health services. Previous research indicates that men prefer community-based health promotion programming, such as health fairs; however, specific guidance on how to tailor health fairs for Black, Hispanic, and rural men are lacking. The present seeks to study provides that guidance. METHODS A multisectoral team developed, implemented, and evaluated a men's health fair in a county of South Carolina with a sizeable Black, Hispanic, and rural-dwelling population. Although the health fair was open to all men in the county, specific outreach campaigns were implemented to attract Black and Hispanic men. The health fair occurred on Father's Day weekend in 2023 and consisted of health screenings, health information, and other resources (eg, condoms, research studies). Participants who attended the health fair were asked to complete a check-in survey (N = 103) that assessed demographic information and how they heard about the health fair, followed by a survey (N = 58) that assessed facilitators/barriers to participation in a men's health fair. RESULTS Results were stratified by the gender of respondent. The results highlight the facilitators/barriers experienced by men to attending health fairs and also highlight important differences in facilitators/barriers for men to attend a health fair as perceived by men and women. CONCLUSIONS These findings have implications for the design and implementation of future men's health fairs to promote preventive health service use among Black, Hispanic, and rural men.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - LaVonda Johnson
- Sandhills Medical Foundation, Inc., Sumter, SC, USA
- Sumter Prevention Team, Sumter, SC, USA
| | - Terry Woods
- Main Attraction Barbershop, Sumter, SC, USA
- Healthy Mind, Body, and Family Foundation, Sumter, SC, USA
| |
Collapse
|
4
|
Freese J, Abuzaid F, Sayles H, Abdellatif M, Fadul N. Perceptions of the COVID-19 Vaccination Within a Convenience Sample of Sudanese Americans. J Prim Care Community Health 2024; 15:21501319241234868. [PMID: 38414263 PMCID: PMC10900865 DOI: 10.1177/21501319241234868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Sudanese American and other immigrant and refugee communities are at greater risk for exposure to COVID-19. This survey sought to better characterize COVID-19 vaccination practices, motivators, and drivers for hesitancy among Sudanese Americans. METHODS We developed an online, cross-sectional survey in English and Arabic distributed by Sudanese American community leaders in April 2022 with data stored anonymously in REDCap. Inclusion criteria were self-reporting being born within Sudan and living in the US within the last 2 years. Descriptive analysis tested survey responses for possible associations between the primary outcome, self-reported vaccination status, and questions regarding vaccination history, perspectives on vaccination, and demographic characteristics using Fishers Exact and Chi Squared Tests. RESULTS Of 111 survey responses received, 107 met inclusion criteria. 93% of respondents reported COVID-19 vaccine uptake with the primary motivation to protect oneself from disease. The most cited reason for vaccine hesitancy was belief it had not been studied enough. The group that reported vaccination had higher levels of education (.032) and were more likely to perceive that COVID-19 vaccinations were able to reduce spread (.001), decrease severe outcomes (.004), and benefits outweighing their risks (.004). DISCUSSION AND CONCLUSIONS This survey population of Sudanese Americans demonstrated high levels of vaccine uptake (93%), far greater than either the corresponding US (78%) or Sudanese population (15%). It is likely that high levels of educational attainment moderated vaccine uptake, though our survey may not have had the power to fully evaluate vaccine hesitancy.
Collapse
Affiliation(s)
| | | | - Harlan Sayles
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Nada Fadul
- University of Nebraska Medical Center, Omaha, NE, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
5
|
Tiwari A, Ghosh A, Agrawal PK, Reddy A, Singla D, Mehta DN, Girdhar G, Paiwal K. Artificial intelligence in oral health surveillance among under-served communities. Bioinformation 2023; 19:1329-1335. [PMID: 38415032 PMCID: PMC10895529 DOI: 10.6026/973206300191329] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/31/2023] [Accepted: 12/31/2023] [Indexed: 02/29/2024] Open
Abstract
A sizable percentage of the population in India still does not have easy access to dental facilities. Therefore, it is of interest to document the role of artificial intelligence (AI) in oral surveillance of underserved communities. Available data shows that AI makes it possible to screen, diagnose, track, prioritize, and monitor dental patients remotely via smart devices. As a result, dentists won't have to deal with simple situations that only require standard treatments; freeing them up to focus on more complicated cases. Additionally, this would allow dentists to reach a broader, more underprivileged population in difficult-to-reach places. AI fracture recognition and categorization performance has shown promise in preliminary testing. Methods for detecting aberrations are frequently employed in public health practise and research continues to be focused on them.
Collapse
Affiliation(s)
- Anushree Tiwari
- Clinical Quality and Value, American Academy of Orthopaedic Surgeons, Rosemont, USA
| | - Anirbhan Ghosh
- Department of Orthodontics and Dentofacial Orthopedics, Bhabha College of Dental Sciences, Bhopal, M.P., India
| | - Pankaj Kumar Agrawal
- Department of Oral Pathology and Microbiology, Maitri College of Dentistry and Research Centre, Anjora, Durg, Chhattisgarh, India
| | - Arjun Reddy
- Manipal College of Dental Sciences, Manipal, India
| | - Deepika Singla
- Department of Conservative Dentistry and Endodontics, Desh Bhagat Dental College and Hospital, Malout, India
| | - Dhaval Niranjan Mehta
- Department of Oral Medicine and Radiology, Narsinbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
| | - Gaurav Girdhar
- Department of Periodontology, Karnavati School of Dentistry Karnavati University, Gandhinagar, Gujarat, India
| | - Kapil Paiwal
- Department of Oral and Maxillofacial Pathology, Daswani Dental College and Research Center, Kota, Rajasthan, India
| |
Collapse
|
6
|
So M, Sedarski E, Parries M, Sick B. "Many people know nothing about us": narrative medicine applications at a student-run free clinic. J Interprof Care 2023; 37:1018-1026. [PMID: 37293751 DOI: 10.1080/13561820.2023.2218885] [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: 10/03/2022] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
Narrative medicine is an approach to healthcare that acknowledges the stories of patients' lives both within and beyond the clinical setting. Narrative medicine has been increasingly recognized as a promising tool to support modern educational needs in health professions training, such as interprofessional practice, while enhancing quality of care. Here, we describe the development, implementation, and application of a narrative medicine program at the University of Minnesota Phillips Neighborhood Clinic. First, in a qualitative analysis of patient stories (n = 12) we identified themes regarding the value of the storytelling experience; patients' personal journeys; and patients' experiences in healthcare and other systems. Second, an interprofessional educational activity for student volunteers (n = 57) leveraging a patient narrative was observed to be satisfactory, significantly improve attitudes toward the underserved, and enhance quality of care from the perspectives of trainees. Together, findings from the two studies imply the potential benefits of broader incorporation of narrative medicine into interprofessional service settings, for both learners and patients.
Collapse
Affiliation(s)
- Marvin So
- LifeLong Medical Care, William Jenkins Health Center, Richmond, California, US
- University of Minnesota Medical School, Minneapolis, Minnesota, US
| | - Emma Sedarski
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota, US
| | - Megan Parries
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota, US
| | - Brian Sick
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, US
| |
Collapse
|
7
|
Moore TH, Dawson S, Wheeler J, Hamilton-Shield J, Barrett TG, Redwood S, Litchfield I, Greenfield SM, Searle A. Views of children with diabetes from underserved communities, and their families on diabetes, glycaemic control and healthcare provision: A qualitative evidence synthesis. Diabet Med 2023; 40:e15197. [PMID: 37573564 DOI: 10.1111/dme.15197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
AIMS Children and young people with diabetes (CYPD) from socio-economically deprived and/or ethnic minority groups tend to have poorer glucose control and greater risk of diabetes-related complications. In this systematic review of qualitative evidence (qualitative evidence synthesis, QES), we aimed to explore the experiences and views of clinical encounters in diabetes care from the perspectives of CYPD and their family/carers from underserved communities and healthcare professionals in diabetes care. METHODS We searched 6 databases to March 2022 with extensive search terms, and used a thematic synthesis following methods of Thomas and Harden. RESULTS We identified 7 studies and described 11 descriptive themes based on primary and secondary constructs. From these, three "analytical themes" were developed. (1) "Alienation of CYPD" relates to their social identity and interaction with peers, family and health service practitioners in the context of diabetes self- and family/carer management and is impacted by communication in the clinical encounter. (2) "Empowerment of CYPD and family/carers" explores families' understanding of risks and consequences of diabetes and taking responsibility for self- and family/carer management in the context of their socio-cultural background. (3) "Integration of diabetes (into self and family)" focuses on the ability to integrate diabetes self-management into the daily lives of CYPD and family/carers beyond the clinical consultation. CONCLUSIONS The analytical themes are interdependent and provide a conceptual framework from which to explore and strengthen the therapeutic alliance in clinical encounters and to foster greater concordance with treatment plans. Communicating the biomedical aspects of managing diabetes in the clinical encounter is important, but should be balanced with addressing socio-emotional factors important to CYPD and family/carers.
Collapse
Affiliation(s)
- Theresa H Moore
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jessica Wheeler
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Timothy G Barrett
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sabi Redwood
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ian Litchfield
- IOEM, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- IOEM, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aidan Searle
- NIHR Bristol Biomedical Research Centre Nutrition theme, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
8
|
Khalafalla FG, Eichmann KK, VanGarsse A, Ofstad W. Nutrition and Lifestyle Coaching: An Interprofessional Course for Pharmacy, Medical, and Dietetic Students. Cureus 2023; 15:e48302. [PMID: 38058349 PMCID: PMC10697130 DOI: 10.7759/cureus.48302] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
Background Poor nutrition and lifestyle choices are major contributors to the development and progression of various chronic diseases. Enhancing patients' awareness of healthy nutrition and lifestyle habits by interprofessional healthcare teams can play a significant role in tackling many chronic diseases, particularly in underserved communities with inequitable access to healthcare and educational opportunities. However, healthcare professionals are not adequately prepared to provide effective, culturally competent nutrition and lifestyle coaching due to a lack of emphasis on these topics in the curricula of many healthcare professional programs. Objective This study introduces a virtual, interprofessional, team-based elective course to address the curricular gap in nutrition education among healthcare professional programs. Methods Quantitative and qualitative pre-/post-surveys were utilized to evaluate course impact on student's knowledge, confidence in coaching families, and interprofessional competencies. Quantitative pre-/post-training scores were analyzed by a two-tailed, Mann-Whitney test, where P < 0.05 indicated a significant difference. Additionally, student learning outcomes were assessed using readiness assurance tests and application exercises, along with end-of-course presentations and mock interviews. Results Pre-/post-course assessments (n = 16) demonstrated significant improvement in students' confidence in coaching families (20%; P = 0.01) and knowledge of coaching curriculum (87%; P < 0.001). Improvement in different interprofessional competencies ranged between 15% (P = 0.002) and 46% (P < 0.001). Course material/activities, facilitation, impact on learning new knowledge/skills/mindset, and application in future practice were applauded by 81-94% of students. Conclusion Positive outcomes of this course encourage future offerings and systematic incorporation of similar training in healthcare professional programs to prepare clinicians capable of transforming lives through interprofessional, patient-centered nutrition and lifestyle coaching.
Collapse
Affiliation(s)
- Farid G Khalafalla
- Preclinical Basic Sciences, Touro University California, College of Education and Health Sciences, Vallejo, USA
| | - Kelly K Eichmann
- Career and Technical Education, Clovis Unified School District, Clovis, USA
| | - Anne VanGarsse
- Pediatrics, University of California Riverside, School of Medicine, Riverside, USA
| | - William Ofstad
- Pharmacy Practice, West Coast University, School of Pharmacy, Los Angeles, USA
| |
Collapse
|
9
|
Whitner C, Curtis SD, Allen JM, Duane KJ. Community Champions: The Crucial Contribution of an Independent Pharmacy in COVID-19 Vaccination Efforts in an Underserved Community. Int J Environ Res Public Health 2023; 20:6881. [PMID: 37835151 PMCID: PMC10572971 DOI: 10.3390/ijerph20196881] [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: 07/05/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
Historically, pharmacists in independent community pharmacies have been pivotal in promoting community health. During the COVID-19 pandemic, they demonstrated their commitment by advocating for vaccination and providing accessible care, particularly in underserved communities. By addressing disparities, implementing strategies like mobile clinics and community outreach, and fostering trust and engagement, independent community pharmacists played a crucial role in bridging gaps in healthcare access for vulnerable populations and mitigating the impact of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Chardaé Whitner
- Department of Pharmacotherapy and Translation Research, Jacksonville Campus, College of Pharmacy, University of Florida, 580 W. 8th Street, Jacksonville, FL 32209, USA
| | - Stacey D. Curtis
- Department of Pharmacotherapy and Translation Research, Gainesville Campus, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA;
| | - John M. Allen
- Department of Pharmacotherapy and Translation Research, Orlando Campus, College of Pharmacy, University of Florida, 6550 Sanger Rd., Orlando, FL 32827, USA;
| | - Kevin J. Duane
- Panama Pharmacy, 7307 N. Main St, Jacksonville, FL 32208, USA;
| |
Collapse
|
10
|
Kohli E, Morris E, Humphries J, Gertz S, Mabisi K, Hershberger S, Butsch Kovacic M. Promoting Community Health and Understanding of Science Topics by Reading Graphic-Style Stories Aloud Together. Health Educ Behav 2023; 50:658-661. [PMID: 37021378 DOI: 10.1177/10901981231159681] [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: 04/07/2023]
Abstract
Limited health literacy and access to engaging, relevant, understandable health promotion and disease prevention materials are barriers to achieving and maintaining health. The We-Engage-4-Health program co-created the graphic-style story "Foamy Soap Fun" with community members to reinforce the importance of the primary preventive strategy-handwashing-in limiting spread of COVID-19. Pre/postsurveys were administered, and a modified focus group was conducted to learn community participants' preferences for reading stories (aloud together and/or silently to themselves), versus reading typical health promotion information sheets. Three themes were identified related to reading the story aloud: increased enthusiasm, increased attentiveness, and improved interpretation skills, vocabulary, and information processing skills. Educational constructs included: empathy with the story's characters, engagement with previous health experiences, enthusiasm with sharing health information, and explanation of complex health topics. This study supports the value of graphic-style stories in helping communities to better understand the science behind health topics.
Collapse
Affiliation(s)
- Eshika Kohli
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Edith Morris
- University of Cincinnati Evaluation Services Center, Cincinnati, OH, USA
| | - Jaqueline Humphries
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Seven Hills Neighborhood Houses, Cincinnati, OH, USA
| | - Susan Gertz
- Miami University Center for Science Education, Oxford, OH, USA
| | - Keren Mabisi
- University of Cincinnati Evaluation Services Center, Cincinnati, OH, USA
| | | | - Melinda Butsch Kovacic
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati Cancer Center, College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
11
|
Narayanasamy S, Veldman TH, Lee MJ, Glover WA, Tillekeratne LG, Neighbors CE, Harper B, Raghavan V, Kennedy SW, Carper M, Denny T, Tsalik EL, Reller ME, Kibbe WA, Corbie G, Cohen-Wolkowiez M, Woods CW, Petti CA. RADx-UP Testing Core: Access to COVID-19 Diagnostics in Community-Engaged Research with Underserved Populations. J Clin Microbiol 2023; 61:e0036723. [PMID: 37395655 PMCID: PMC10446854 DOI: 10.1128/jcm.00367-23] [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: 07/04/2023] Open
Abstract
Research on the COVID-19 pandemic revealed a disproportionate burden of COVID-19 infection and death among underserved populations and exposed low rates of SARS-CoV-2 testing in these communities. A landmark National Institutes of Health (NIH) funding initiative, the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program, was developed to address the research gap in understanding the adoption of COVID-19 testing in underserved populations. This program is the single largest investment in health disparities and community-engaged research in the history of the NIH. The RADx-UP Testing Core (TC) provides community-based investigators with essential scientific expertise and guidance on COVID-19 diagnostics. This commentary describes the first 2 years of the TC's experience, highlighting the challenges faced and insights gained to safely and effectively deploy large-scale diagnostics for community-initiated research in underserved populations during a pandemic. The success of RADx-UP shows that community-based research to increase access and uptake of testing among underserved populations can be accomplished during a pandemic with tools, resources, and multidisciplinary expertise provided by a centralized testing-specific coordinating center. We developed adaptive tools to support individual testing strategies and frameworks for these diverse studies and ensured continuous monitoring of testing strategies and use of study data. In a rapidly evolving setting of tremendous uncertainty, the TC provided essential and real-time technical expertise to support safe, effective, and adaptive testing. The lessons learned go beyond this pandemic and can serve as a framework for rapid deployment of testing in response to future crises, especially when populations are affected inequitably.
Collapse
Affiliation(s)
- Shanti Narayanasamy
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
| | | | - Mark J. Lee
- Department of Pathology, School of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William A. Glover
- North Carolina State Laboratory of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - L. Gayani Tillekeratne
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Coralei E. Neighbors
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
| | - Barrie Harper
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Vidya Raghavan
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Scott W. Kennedy
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Miranda Carper
- Duke Human Vaccine Institute, Duke University, Durham, North Carolina, USA
| | - Thomas Denny
- Duke Human Vaccine Institute, Duke University, Durham, North Carolina, USA
| | - Ephraim L. Tsalik
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Megan E. Reller
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Warren A. Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Giselle Corbie
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Social Medicine and Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Internal Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christopher W. Woods
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
| | - Cathy A. Petti
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
- Healthspring Global Inc., Bradenton, Florida, USA
| |
Collapse
|
12
|
Holm RH, Osborne Jelks N, Schneider R, Smith T. Beyond COVID-19: Designing Inclusive Public Health Surveillance by Including Wastewater Monitoring. Health Equity 2023; 7:377-379. [PMID: 37351532 PMCID: PMC10282970 DOI: 10.1089/heq.2022.0055] [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] [Accepted: 05/09/2023] [Indexed: 06/24/2023] Open
Abstract
Wastewater-based epidemiology is a promising and expanding public health surveillance method. The current wastewater testing trajectory to monitor primarily at community wastewater treatment plants was necessitated by immediate needs of the pandemic. Going forward, specific consideration should be given to monitoring vulnerable and underserved communities to ensure inclusion and rapid response to public health threats. This is particularly important when clinical testing data are insufficient to characterize community virus levels and spread in specific locations. Now is a timely call to action for equitably protecting health in the United States, which can be guided with intentional and inclusive wastewater monitoring.
Collapse
Affiliation(s)
- Rochelle H. Holm
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | | | - Ted Smith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
13
|
Bridges S, Lamont‐Robinson C, Herbert A, Din M, Smith C, Ahmed N, Ali A, Bandyopadhyay S, Bibi S, Canu R, Correia MNG, Djalo MS, Hayan K, Horne A, Mita A, Svobodova M. Talking Trials: An arts-based exploration of attitudes to clinical trials amongst minority ethnic members of the South Riverside Community of Cardiff. Health Expect 2023; 26:1236-1245. [PMID: 36864604 PMCID: PMC10154814 DOI: 10.1111/hex.13740] [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: 10/17/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Clinical trials must include diverse participants to ensure the wide applicability of results. However, people from ethnic minorities are included in clinical trials at rates lower than expected given their share of the population. Working with South Riverside Community Development Centre (SRCDC), Talking Trials used public engagement to foster discussions around the underrepresentation of those from minority ethnic communities in clinical trials and to identify and address concerns surrounding trial participation. METHODS We conducted three workshops with 13 co-researchers from minority ethnic backgrounds. We explored perceptions and understanding of clinical trials alongside participatory art activities to help move away from verbocentric methods of communication. These artworks formed an exhibition that was presented to the community, prompting further discussions and engagement. FINDINGS Co-production workshops were an effective tool to introduce the public to trial research. With little knowledge of clinical trials at the beginning of the process, our co-researchers formed a cohesive group, sharing initial fears and mistrust towards trials. As conversations progressed these attitudes clearly shifted. Artwork produced during the workshops was incorporated into an exhibition. Quotes and creative pieces from the group were included to reflect the themes identified. Presenting the exhibition at Riverside Festival enabled further engagement with a wider diverse community. The focus on co-production helped build a network of individuals new to research and keen to become involved further. CONCLUSION Inclusive and democratic co-production, enriched by participatory art practices, provided a powerful means of enabling our group to create new insights and foster new relationships. Projects like Talking Trials can diversify the research process itself-for example, four co-researchers have commenced lay research partner roles on trial management groups and a lay advisory group is in development. PATIENT OR PUBLIC CONTRIBUTION Three members of staff at SRCDC were on the project delivery group and involved in the initial project design, subsequently helping to connect us with members of the Riverside community to work as co-researchers. Two of the SRCDC staff are co-authors of this manuscript. The project had 13 public co-researchers guiding the direction of this research and creating the artwork displayed in the art exhibition.
Collapse
Affiliation(s)
- Sarah Bridges
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | | | | | | | - Carl Smith
- South Riverside Community Development CentreCardiffUK
| | - Nasra Ahmed
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Arafa Ali
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Sudipta Bandyopadhyay
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Saleema Bibi
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Rossana Canu
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Mariama N. G. Correia
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Mamadu S. Djalo
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Kense Hayan
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Alka Horne
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Ayesha Mita
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| | - Martina Svobodova
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
| |
Collapse
|
14
|
Kawuki J, Chen S, Fang Y, Liang X, Chan PSF, Wang Z. COVID-19 Vaccine Acceptance, Attitude and Perception among Slum and Underserved Communities: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:vaccines11050886. [PMID: 37242990 DOI: 10.3390/vaccines11050886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/03/2023] [Revised: 03/23/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
This systematic review summarises the literature on Coronavirus Disease 2019 (COVID-19) vaccination, including acceptance, uptake, hesitancy, attitude and perceptions among slum and underserved communities. Relevant studies were searched from PubMed, Scopus, Web of Science and Google Scholar, following a pre-registered protocol in PROSPERO (CRD42022355101) and PRISMA guidelines. We extracted data, used random-effects models to combine the vaccine acceptance, hesitancy and uptake rates categorically, and performed meta-regression by R software (version 4.2.1). Twenty-four studies with 30,323 participants met the inclusion criteria. The overall prevalence was 58% (95% CI: 49-67%) for vaccine acceptance, 23% (95% CI: 13-39%) for uptake and 29% (95% CI: 18-43%) for hesitancy. Acceptance and uptake were positively associated with various sociodemographic factors, including older age, higher education level, male gender, ethnicity/race (e.g., Whites vs African Americans), more knowledge and a higher level of awareness of vaccines, but some studies reported inconsistent results. Safety and efficacy concerns, low-risk perception, long distance to vaccination centres and unfavourable vaccination schedules were prominent reasons for hesitancy. Moreover, varying levels of attitudes and perceptions regarding COVID-19 vaccination were reported with existing misconceptions and negative beliefs, and these were strong predictors of vaccination. Infodemic management and continuous vaccine education are needed to address existing misconceptions and negative beliefs, and this should target young, less-educated women and ethnic minorities. Considering mobile vaccination units to vaccinate people at home or workplaces would be a useful strategy in addressing access barriers and increasing vaccine uptake.
Collapse
Affiliation(s)
- Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Siyu Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Xue Liang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Paul Shing-Fong Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
15
|
Zahir MZ, Miles A, Hand L, Ward EC. Designing equitable speech-language pathology services in the Maldives to achieve Sustainable Development Goals 10 and 4. Int J Speech Lang Pathol 2023; 25:52-57. [PMID: 36511713 DOI: 10.1080/17549507.2022.2150308] [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] [Indexed: 05/13/2023]
Abstract
PURPOSE The United Nations adopted 17 Sustainable Development Goals (SDGs) in 2015 as a universal plan to address challenges experienced around the globe. SDG 4 focuses on inclusive and equitable education while SDG 10 aims to reduce inequality within and among countries. To achieve these goals for children with communication disabilities living in underserved communities, equitable access to services is required. Service delivery should be tailored to the unique characteristics of specific communities to best cater to the needs of the population. This commentary presents the Context-specific Service Delivery Framework (CSDF) that can be used to explore contexts systematically and identify suitable speech-language pathology service delivery approaches. CSDF focuses on the three dimensions of sustainability that are emphasised in the SDGs: environmental, social and economic. RESULT We present how CSDF was developed in the case of one Majority world country, the Maldives. Five studies were conducted to complete CSDF and the findings were used to derive recommendations for service delivery approaches that could help achieve SDG 4 and SDG 10. These included, building capacity by using asset-based approaches, collaborating with service providers and the community, using population-based methods to focus on prevention of communication disabilities and using available technology to provide support. CONCLUSION Other underserved communities could also benefit from using CSDF to design equitable services for children with communication disabilities in their countries. This commentary paper focuses on SDG 4 and SDG 10.
Collapse
Affiliation(s)
| | - Anna Miles
- The University of Auckland, Auckland, New Zealand
| | - Linda Hand
- The University of Auckland, Auckland, New Zealand
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia and
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
Bonuck KJ, Angier H, McCrimmon S, Holderness H, Erroba J, Huguet N, DeVoe JE, Carney PA. A Scoping Literature Review on Evidence-Based Strategies to Increase Cervical Cancer Screening. J Prim Care Community Health 2023; 14:21501319231220994. [PMID: 38131106 DOI: 10.1177/21501319231220994] [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: 12/23/2023] Open
Abstract
Previous reviews of strategies to increase cervical cancer screening are more than 10 years old, the U.S. continues to fall short of the Healthy People 2030 cervical cancer screening goal, and guidelines were revised in 2018, therefore an updated review of the existing literature is needed. We conducted a scoping review using electronic databases PubMed, Scopus, and Ovid Medline that included publication dates between 2012 and 2021 to answer the question, "Which strategies implemented in U.S. primary care settings have been most successful in increasing rates of cervical cancer screening since the 2012 US Preventative Services Task Force cervical cancer screening guidelines were published?" We mapped findings to pre-specified implementation strategy categories. After initially identifying 399 articles, we excluded 350 due to duplicates or not meeting review criteria, leaving 49 articles for full review. We excluded 37 of these during full-text review and identified 2 additional articles from the manual search of reference lists for a total of 14 studies for abstraction. Eleven articles reported on strategies resulting in increased cervical cancer screening, and 3 did not. Clinic workflow re-design strategies showed the greatest promise in improving cervical cancer screening rates, education strategies for patients had mixed results, and quality management strategies were not effective. These findings suggest clinical workflow re-structures and patient education strategies can increase cervical cancer screening in primary care settings. Results are particularly important in settings that care for underserved populations, as these settings may need additional implementation strategies to decrease cervical cancer screening disparities.
Collapse
Affiliation(s)
| | | | | | | | - Jeremy Erroba
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | |
Collapse
|
17
|
Karpel HC, Sampson A, Charifson M, Fein LA, Murphy D, Sutter M, Tamargo CL, Quinn GP, Schabath MB. Assessing Medical Students' Attitudes and Knowledge Regarding LGBTQ Health Needs Across the United States. J Prim Care Community Health 2023; 14:21501319231186729. [PMID: 37449447 PMCID: PMC10350786 DOI: 10.1177/21501319231186729] [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: 03/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community experiences health disparities. It is thus imperative that medical trainees receive training in the care of LGBTQ community. The objective of this study was to identify gaps in knowledge and comfort among medical school students in providing care for the LGBTQ community. METHODS An online survey was administered to medical students at 3 institutions in the United States from December 2020 to March 2021. Using a Likert scale, the survey assessed attitudes, comfort, and knowledge in providing care for the LGBTQ community. The survey included questions for each specific LGBTQ population. Results were quantified using descriptive and stratified analyses, and an exploratory factor analysis was used to calculate attitude summary measure (ASM) scores. A total knowledge score was calculated, with higher values indicating greater knowledge. RESULTS Among the 300 medical students who completed the survey, the majority were female (55.7%), White (54.7%), and heterosexual (64.3%). The majority of medical students felt comfortable (strongly agree/agree) participating in the care of lesbian (94.3%), gay (96.0%), and bisexual (96.3%) patients; this percentage dropped to 82.3% for non-binary and 71.3% for transgender patients. Only 27.0% of medical students reported confidence in their knowledge of health needs of transgender patients. LGBTQ self-identification, percent of core rotations completed in school, region of country, and friends and/or family who are part of the LGBTQ community were significantly associated with various ASM scores. Knowledge questions yielded high percentages of "neutral" responses, and medical students who identified as LGBTQ had significantly higher total knowledge scores. CONCLUSIONS Overall, the surveyed medical students feel comfortable and willing to provide care for LGBTQ persons. But, there is limited knowledge about specific LGBTQ health needs. More education and training in the needs of transgender and non-binary patients, in particular, is indicated.
Collapse
Affiliation(s)
| | | | | | - Lydia A. Fein
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Devin Murphy
- University of Texas Health, San Antonio, TX, USA
| | - Megan Sutter
- New York University, New York, NY, USA
- Emory University, Atlanta, GA, USA
| | | | | | | |
Collapse
|
18
|
Rivelli A, Fitzpatrick V, Shields M, Erwin K, Delfinado L, Cabiya M, Wennerberg K. The Benefits of Introducing a Pregnancy Support Tool for Low-Income Women During Routine Obstetrics Care. J Prim Care Community Health 2023; 14:21501319231164545. [PMID: 37057337 PMCID: PMC10108416 DOI: 10.1177/21501319231164545] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
The objective of the CONTINUE (conversations in routine OB care) pilot study was to gather preliminary data on the benefits of integrating a well-designed pregnancy support tool ("CONTINUE Tool") in low-income prenatal care. A total of 184 tools were distributed by 21 OB providers during the study implementation period. Follow-up data were collected from 71 (38.5%) prenatal patients across three community-based midwestern OB clinics serving a diverse prenatal patient population. Early-gestation prenatal patients received the strategically designed CONTINUE Tool during routine prenatal care and later completed a semi-structured interview or electronic survey to report pre-determined individual benefit items experienced due to tool usage. Factor analysis used individual benefit items to identify factors representing common underlying benefits ("factor benefits"). Logistic regression analyses were performed to describe the relative odds of participants with low income (public insurance) experiencing individual and factor benefits of tool use compared to participants of higher income (private insurance). Chi square tests (or Fisher's exact tests) were performed to generate P values reflecting statistically significant differences by income group. More low-income prenatal participants reported experiencing individual benefits as compared to higher-income participants. Among factor benefits, low-income participants were statistically more likely to report experiencing a time-related logistics benefit (OR = 4.00; 95% CI 1.02-15.73; P = .045). Low-income participants reported experiencing an overall logistics factor benefit (OR = 4.29; 95% CI 0.47-38.75), including a cost-related logistics benefit (OR = 3.08; CI 0.59-16.00), as well as an understanding benefit (OR = 1.90; 95% CI 0.72-5.04) and a self-efficacy benefit (OR = 1.30; 95% CI 0.44-3.87). While this study is limited by sample size due to being a pilot study, the findings suggest there may be tangible benefits to introducing the CONTINUE Tool among low-income prenatal patients. Given the staggering inequity in OB care and subsequent health outcomes, any preliminary findings on ways to help combat this are necessary and should lay the groundwork for subsequent randomized trials. Our preliminary findings show that supplementing routine OB care with the CONTINUE Tool can confer benefits to both providers and patients, but particularly for low-income prenatal patients who tend to have more structural barriers to adequate care in the first place.
Collapse
Affiliation(s)
- Anne Rivelli
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
| | - Veronica Fitzpatrick
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
| | - Maureen Shields
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
| | - Kim Erwin
- Illinois Institute of Technology Institute of Design, Chicago, IL, USA
| | - Leah Delfinado
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Marie Cabiya
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Karen Wennerberg
- Advocate Aurora Health, Downers Grove, IL; Milwaukee, WI, USA
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| |
Collapse
|
19
|
Thomas N, Ewart C, Lewinson Roberts D, Brown A. "You Can Change the World With a Haircut": Evaluating the Feasibility of a Barber-led Intervention for Men of Black and Ethnic Minority Heritage to Manage High Blood Pressure. J Prim Care Community Health 2023; 14:21501319231168336. [PMID: 37148215 PMCID: PMC10164844 DOI: 10.1177/21501319231168336] [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: 05/08/2023] Open
Abstract
BACKGROUND People of Black, Asian and minority ethnic (BAME) heritage have a higher-than-average incidence of, and mortality from hypertension and stroke. Therefore, it is important to identify new settings for engaging people at risk of high blood pressure (BP). AIM This feasibility study aimed to evaluate if barbers in a London borough can support and educate men of BAME heritage to manage their BP. Following UK Medical Research Council guidance, the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework was used to guide study objectives and feasibility outcomes. METHODS We collaborated with 8 barbers who were part of an existing BAME barber network. Barbers were trained online (1.5 h) and face-to-face (3 h) to provide BP healthcare advice and take customers BP readings. Qualitative field notes were collected to assess how best to recruit and train barbers, and to understand how to maintain motivation and retention of barbers. BP readings were recorded between June 2021 and March 2022. RESULTS Both online and face-to-face training were effective, however, greater focus on how to start conversations about BP with clients was needed. We found that motivation, incentivization and regular contact with barbers were important for recruitment, retention, and sustained BP measurement. Obtaining BP readings was challenging due to client concerns about recording their data and the impracticalities of recording results. We captured 236 BP recordings, of which 39 (16.53%) were over 140/90 mmHg; of these, 5 were over 180/100 mmHg. CONCLUSION The combined data showed that educating barbers to take BP readings and deliver healthcare advice about BP is a viable intervention for rollout in a large-scale study. It has demonstrated the need to identify strategies to motivate barbers for sustained recruitment and retention, as well as further efforts to build trust among customers for long-term BP surveillance.
Collapse
|
20
|
Kuehl S, Olsen E, Harris C, Mandal S(M, Watt M, Spicer JO, Sonu S. Improving Youth COVID-19 Knowledge, Attitudes, and Practices Through a Novel Medical Student Driven Curriculum. Health Promot Pract 2023; 24:20-25. [PMID: 34935530 PMCID: PMC9805923 DOI: 10.1177/15248399211060786] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Despite widespread media coverage and public health messaging, many high school students lacked formal education about COVID-19 during the pandemic. Providing this education, particularly to underserved communities, may reduce health disparities and encourage youth to engage in the sciences. Twenty-five medical students at Emory University School of Medicine created a virtual, synchronous, COVID-19 curriculum. Learners included 25 students enrolled in a pipeline program from five high schools in metro-Atlanta. The five lesson topics included virus epidemiology, COVID-19 testing and mask-wearing, vaccine fundamentals, COVID-19 risk in communities, and mental health and wellness. Lessons were standardized through medical student-teacher practice presentations to faculty. The curriculum was evaluated with a 23-item pre- and postsurvey assessing learners' COVID-19 knowledge, attitudes, and practices. Pre- and postsurvey scores were compared using descriptive statistics and paired-samples t test. After the curriculum, learners' (N = 9) COVID-19 knowledge scores increased from 67% correct to 90% correct. Participants were better able to identify risk factors for severe COVID-19 infection, define "herd immunity," and describe how socioeconomic status can influence infection risk. In addition, after the curriculum implementation, more learners thought vaccines were safe, with 67% responding that vaccines are "very safe," compared with 0% at pretest. This initiative increased learners' COVID-19 knowledge and established bridges between medical students and underserved communities. These connections are essential to combat misinformation surrounding COVID-19, encourage participation in the sciences from underrepresented areas, and empower students to be health advocates within their communities.
Collapse
Affiliation(s)
- Sarah Kuehl
- Emory University, Atlanta, GA, USA,Goizueta Business School, Atlanta, GA, USA,Sarah Kuehl, Emory University, Atlanta, GA 30322, USA;
| | | | | | | | - Matt Watt
- Emory College of Arts & Sciences, Atlanta, GA, USA
| | | | | |
Collapse
|
21
|
Weston N, Chang A, Malbari A, Dokania G. Role of Primary Care in Bridging Gaps in the Health Care System for Vulnerable Children in the United States of America: A Sickle Cell Disease Case Study. J Prim Care Community Health 2023; 14:21501319231201094. [PMID: 37731349 PMCID: PMC10515542 DOI: 10.1177/21501319231201094] [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: 06/28/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
Sickle cell disease (SCD) is a life-threatening condition. Given the nature of the disease and associated complications with high mortality and morbidity rates, it is imperative that patients are diagnosed in early infancy, are established with specialists and general pediatric care immediately, and receive continuity in care. A percentage of patients diagnosed with SCD fall within a vulnerable, at-risk population. This population may face greater social barriers that lead to missed or late diagnosis and therefore delayed management, significantly increasing the risk of morbidity and mortality. Screening tools such as state newborn screens help to identify the diagnosis early. However, patients in vulnerable, at-risk populations who are not established in the health care system may not receive timely communication about their illness and necessary next steps for care. We present a case of a 12-month-old female who is an example of one of the many patients who despite having undergone newborn screening, fell through the cracks due to social barriers including housing instability, food insecurity, and lack of access to transportation. This paper emphasizes the need for and provides a real example of the benefit of access to longitudinal primary care for vulnerable patients. We also demonstrate the role of primary care in clearing the care gaps and coordinating services quickly to ultimately prevent life-threatening complications specifically for children with previously undiagnosed chronic illnesses.
Collapse
Affiliation(s)
- Natalie Weston
- Dell Children’s Medical Center of Central Texas, Austin, TX, USA
| | - Alicia Chang
- Dell Children’s Medical Center of Central Texas, Austin, TX, USA
| | - Alefiyah Malbari
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | |
Collapse
|
22
|
Makutonin M, Dare J, Heekin M, Salancy A, Hood C, Dominguez LW. Remote Patient Monitoring for Hypertension: Feasibility and Outcomes of a Clinic-Based Pilot in a Minority Population. J Prim Care Community Health 2023; 14:21501319231204586. [PMID: 37815085 PMCID: PMC10563450 DOI: 10.1177/21501319231204586] [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: 06/26/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND In the US 48% of adults have hypertension, with direct costs in excess of $130 billion per year. Remote patient monitoring (RPM) has been discussed as a useful tool in the treatment of hypertension, but few studies evaluate its cost effectiveness or efficacy in minority, lower socio-economic (SES) populations. Our study aims to evaluate the clinical and financial outcomes of RPM in hypertension management in a primarily minority, low-SES population. METHODS In this prospective cohort pilot study, patients with uncontrolled primary hypertension (defined via Joint National Committee 8 guidelines) were randomly selected from a single academically affiliated primary care clinic. Patients were enrolled on a rolling basis for 90 days. Patients were given blood pressure cuffs and transmission hubs and asked to transmit daily blood pressure readings. Patients were called weekly by research assistants and concerns were escalated to the primary care physician. The control group was the remaining 299 uncontrolled hypertensive patients from the same clinic population analyzed via retrospective chart records at the conclusion of the interventional study period. The primary outcome was blood pressure control. Secondary outcomes were relative improvement in systolic pressure and direct costs. RESULTS A total of 13 patients were enrolled into the RPM intervention; these patients were 54% female, 100% African American, and 77% Medicaid. When assessed via intention-to-treat analysis, patients in the intervention group had non-inferior blood pressure control at 90 days (46% experimental vs 31% control, P = .33) and average change in systolic blood pressure at 90 days (13.5 vs 3.7 mmHg, P = .174) while experiencing a significant reduction in office-based visits at 90 days (1.5 vs 5.9, P < .001) as compared to control. Results on per-protocol analysis also showed non-inferior BP control (63% vs 31%, P = .135). Financially, the program generated margins of $29 per patient at 90 days. CONCLUSIONS Patients in our minority- and Medicaid-predominant cohort achieved noninferior blood pressure control as compared to retrospective control at 90 days and a significant reduction in all-cause clinic visits at 90 days. The program generated little revenue per patient, with main barriers to implementation including patient compliance and payor denial.
Collapse
Affiliation(s)
| | - Justin Dare
- Virginia Commonwealth University, Richmond, VA, USA
| | - Mary Heekin
- The George Washington University, Washington, DC, USA
| | | | - Colton Hood
- The George Washington University, Washington, DC, USA
| | | |
Collapse
|
23
|
Bifulco L, Guidotti O, Velez I, Grzejszczak L, Angelocci T, Okunade L, Anderson D. Impact of eConsults on Clinical Care in Primary Care: A Cross-Sectional Analysis of Primary Care Provider Behavior. J Prim Care Community Health 2023; 14:21501319231202201. [PMID: 37753619 PMCID: PMC10524039 DOI: 10.1177/21501319231202201] [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: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION/OBJECTIVES Asynchronous electronic consultations (eConsults) support primary care providers (PCPs) by providing rapid specialist feedback and improve medically underserved patients' access to care. METHODS This cross-sectional study assessed all eConsults requested over a one-year period at a multi-site federally qualified health center in Texas. We analyzed eConsult content and quality and conducted chart reviews for a randomly selected subsample (n = 100) to determine whether PCPs implemented specialists' recommendations within 90 days. Semi-structured interviews with PCPs assessed their ability and willingness to follow recommendations. RESULTS There were 367 eConsults submitted by 25 PCPs across 15 adult medical and surgical specialties. Of the 100 charts reviewed n = 77 (77.0%) contained documentation indicating that the PCP had followed at least 1 of the specialist's recommendations within 90 days. In two-thirds of the cases (n = 66, 66%) the reviewing specialist indicated that a face-to-face referral was not needed. PCPs were most likely to follow recommendations for new medications and least likely to document that they had obtained additional patient history. PCPs noted that they were sometimes unable to follow recommendations when patients could not afford or access treatment or did not return for follow up care, or when they felt that the specialist did not address their specific question. CONCLUSIONS eConsults delivered to medically underserved patients in primary care help PCPs provide timely care for their patients. PCPs utilized a broad range of eConsult specialties and generally implemented eConsult specialists' recommendations within 90 days.
Collapse
|
24
|
Shi M, Fiori K, Kim RS, Gao Q, Umanski G, Thomas I, Telzak A, Chambers E. Social Needs Assessment and Linkage to Community Health Workers in a Large Urban Hospital System. J Prim Care Community Health 2023; 14:21501319231166918. [PMID: 37083206 PMCID: PMC10126704 DOI: 10.1177/21501319231166918] [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: 01/06/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES Identifying social needs is a growing priority in primary care, but there is significant variation in how patients access services to meet such needs. This study identifies predictors of successful linkage with a community health worker (CHW) among patients with social needs seen in an outpatient setting. METHODS This study uses a cross-sectional analysis of social needs assessments administered in an urban health system between April 2018 and December 2019. Social needs included: food insecurity, housing quality, housing instability, healthcare cost, healthcare related transportation, utilities, care for dependents, legal assistance, safety, and getting along with household members. Patients with at least 1 social need and accepting help were included in the analysis. On contact with a CHW, patients were entered into a separate database. The primary outcome was successful "linkage," defined by having a positive social needs assessment in the medical record and a corresponding record in the CHW database. Multivariate logistic regression was used to assess predictors of linkage. RESULTS Among patients with at least 1 social need accepting help, 25% (758/3064) were linked to a CHW. Positive predictors included female gender (OR 1.28 [95% CI 1.01-1.63]), Spanish language preference compared to English (1.51 [1.14-1.03]), and having a food related need (1.35 [1.03-1.79]). Negative predictors included age 18 to 65 (0.34 [0.17-0.71] for age 18-24) and 0 to 5 (0.45 [0.24-0.78]) compared to over 65, non-Hispanic White race compared to Hispanic race (0.39 [0.18-0.84]), and having needs of getting along with household members (0.52 [0.38-0.71]) and safety (0.64 [0.42-0.98]). CONCLUSIONS Twenty-five percent of patients who had at least 1 social need and were accepting help had a successful CHW linkage. Predictors of linkage suggest areas of further system-level improvements to screening and referral interventions to target at risk patients and communities.
Collapse
Affiliation(s)
- Marc Shi
- Montefiore Medical Center, Bronx, NY,
USA
| | - Kevin Fiori
- Albert Einstein College of Medicine,
Bronx, NY, USA
- Montefiore Health System, Bronx, NY,
USA
| | - Ryung S. Kim
- Albert Einstein College of Medicine,
Bronx, NY, USA
| | - Qi Gao
- Albert Einstein College of Medicine,
Bronx, NY, USA
| | | | - Iby Thomas
- Albert Einstein College of Medicine,
Bronx, NY, USA
| | | | | |
Collapse
|
25
|
Lynch KA, McCoy M, Gabrielian S. Veterans Finding Community and a "Home" Within an Emergency Housing Environment. J Prim Care Community Health 2023; 14:21501319231180448. [PMID: 37300393 PMCID: PMC10272632 DOI: 10.1177/21501319231180448] [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: 04/18/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
In April 2020, the Department of Veterans Affairs responded to the COVID-19 pandemic and escalating unsheltered homelessness in Los Angeles by sanctioning a tent turned tiny shelter encampment at the West Los Angeles Veterans Affairs medical center. Initially, staff offered linkages to on-campus VA healthcare. However, as many Veterans living in the encampment struggled to avail themselves of these services, our "encampment medicine" team was launched to provide on-site care coordination and healthcare at the tiny shelters. This case study showcases the team's engagement with a Veteran experiencing homelessness struggling with opioid use disorder and depicts how this co-located, comprehensive care team allowed for trusting care relationships formed with, and empowerment of the Veterans living in the encampment. The piece highlights a healthcare model that engages with persons experiencing homelessness on their own terms while building trust and solidarity, focuses on the sense of community that formed in the tiny shelter encampment, and gives recommendations for how homeless services might adapt to use the strengths of this unique community.
Collapse
Affiliation(s)
- Kimberly A. Lynch
- VA Greater Los Angeles Healthcare System and UCLA National Clinician Scholars Program, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Matthew McCoy
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sonya Gabrielian
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
26
|
Keene Woods N, Ali U, Medina M, Reyes J, Chesser AK. Health Literacy, Health Outcomes and Equity: A Trend Analysis Based on a Population Survey. J Prim Care Community Health 2023; 14:21501319231156132. [PMID: 36852725 PMCID: PMC10071098 DOI: 10.1177/21501319231156132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/01/2023] Open
Abstract
Health literacy continues to be an issue among minority groups. Population surveys are one strategy used to help better understand health disparities. The Behavioral Risk Factor Surveillance System (BRFSS) in Kansas added health literacy questions to the survey in 2012. This study examined population health literacy levels and health trends from 2012 to 2018. The health status variables included health care coverage status, general health rating, presence of chronic conditions, and length of time since the last check-up. The percentage of individuals reporting low health literacy decreased from 67% in 2012 to 51% in 2018. The percentage of participants with income levels less than $15 000 was 9% in 2012 and 7% in 2018. Health literacy was lowest among the age group 18 to 24-year-olds, those who identified as multiracial, separated, not graduated from high school, out of work for more than 1 year, income less than $10 000, with other living arrangements, and living in a suburban county of metropolitan statistical area. Additionally, many health conditions improved, and those reporting health insurance increased slightly. The study demonstrates how health literacy continues to be an issue, and how education and primary prevention are necessary to improve limited health literacy and health outcomes. Findings from both state-level and national BRFSS population surveys can help educate the public health and clinical health services workforce to provide better care and address health disparities for highrisk populations.
Collapse
Affiliation(s)
| | - Umama Ali
- Wichita State University, Wichita, KS, USA
| | | | | | | |
Collapse
|
27
|
Hart L, Beaudoin J, Parsons G, Alonge O. How do Specialists Address Contraceptive Care Compared to General Practitioners in a Federally Qualified Health Center in Maryland. J Prim Care Community Health 2023; 14:21501319231173555. [PMID: 37158591 PMCID: PMC10176583 DOI: 10.1177/21501319231173555] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To determine associations between primary provider specialty and the contraceptive care that patients receive in a Federally Qualified Health Center setting in Maryland. METHODS A study of reproductive-age patients and their providers was performed from January 2018 to December 2021. A pooled crosssectional survey of electronic medical record data for 44 127 encounters of 22 828 patients was performed to calculate the odds of contraceptive care being addressed by patients who had General Practitioner, OB/GYN, pediatrician, or infectious disease (ID) specialists as their primary providers. RESULTS In 19 041 encounters (43%), contraception was addressed through either counseling alone, documentation of a contraceptive prescription, or long-acting reversible contraceptive (LARC) placement procedure. After adjusting for insurance status and race/ethnicity, the odds ratio (OR) of contraceptive care delivery was statistically significantly higher for OB/GYN providers compared to General Practitioners-OR 2.42 (CI 2.29-2.53) and statistically significantly lower for ID providers-OR 0.69 (CI 0.61-0.79). There was a non-statistically significant difference for Pediatricians-OR 0.88 (CI 0.77-1.01). CONCLUSION The provision of contraceptive care, a critical aspect of comprehensive primary care delivered in an FQHC setting, varies by provider specialty, and may be negatively influenced by Ryan White funding related structures. There is a need to intentionally design robust referral and tracking systems to ensure contraceptive care is equitably accessible to all, regardless of assigned primary care provider specialty or HIV status.
Collapse
Affiliation(s)
- Leah Hart
- Chase Brexton Health Care, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jarett Beaudoin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Olakunle Alonge
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
28
|
Clapp SB, Johnson CB. Providing Hepatitis C Treatment Locally for Substance-Using Patients. J Prim Care Community Health 2023; 14:21501319231186355. [PMID: 37424381 DOI: 10.1177/21501319231186355] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
This quality improvement (QI) project provided Hepatitis C virus (HCV) treatment at a Federally Qualified Health Clinic (FQHC) for persons who use illicit drugs. Many of these individuals sought treatment at the local Infectious Disease (ID) clinic but were denied care as they require a patient be drug-free for 6 months prior to HCV treatment. These individuals expressed a desire to be cured of HCV, which can lead to liver failure or cirrhosis if left untreated. This project bridged the existing gap in HCV treatment that currently exists for substance-users in this city. Pre-treatment HCV levels were obtained from 20 participants who completed an 8-week daily regimen of Mavyret, a direct-acting antiviral (DAA) agent, prescribed by a primary care Nurse Practitioner (NP), trained to treat HCV. Pre-treatment HCV loads were compared to the sustained viral load, obtained 12 weeks post-treatment (SVR-12), which is considered the "test of cure." The results indicate that 100% of returning patients were considered cured of HCV. This program successfully integrated HCV treatment at a community health center, in a population affected by substance use. Adoption of similar programs in primary care clinics can help meet the clinical needs of this often stigmatized and vulnerable population as well as cure them of HCV.
Collapse
|
29
|
Salisu M, Blackwell T, Lewis G, Hoglund MW, DiVittis A, Chahal K, Samuels C, Boutin-Foster C, Montgomery D, Afable A. Community Perceptions of Health Equity: A Qualitative Study. J Prim Care Community Health 2023; 14:21501319231211439. [PMID: 37978842 PMCID: PMC10657528 DOI: 10.1177/21501319231211439] [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: 07/14/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Notable inequities in patient experiences exist in the healthcare system. Communities with a large concentration of blacks and immigrants are often marginalized rather than centralized in the healthcare system. These inequities may fuel distrust and exacerbate adverse outcomes, thereby widening the health gap. Addressing differences in patients' experiences of care is paramount for reducing health inequities. METHODS In this qualitative study, we used a purposive sampling method to recruit 62 participants to conduct 10 FGs (44 participants total) and 18 key informant interviews with stakeholders across Central Brooklyn. RESULTS The data revealed three primary themes: Trust, Discrimination, and Social Determinants of Health (SDOHs). Each theme comprised subthemes as follows: For Trust, the subthemes included (1) confidence in the healthcare professional, (2) provider empathy, and (3) active participation in healthcare decisions. Regarding Discrimination, the subthemes involved (1) racism and identity, as well as (2) stigma related to diagnosis, disease state, and pain management. Lastly, for Social Determinants of Health, the key subtheme was the acknowledgment by providers that patients encounter competing priorities acting as barriers to care, such as housing instability and food insecurity. For the first theme, participants' interactions with the healthcare system were prompted by a necessity for medical attention, and not by trust. The participants reported that experiences of discrimination resulting from identity and stigma associated with diagnosis, disease state, and pain management amplified the disconnect between the community, the patients, and the healthcare system. This also exacerbated the poor healthcare experiences suffered by many people of color. For SDOHs, the participants identified housing, food security, and other various social factors that may undermine the effectiveness of the healthcare that patients receive. CONCLUSIONS Improvements in the health system, based on feedback from patients of color regarding their unique care experiences, are important initiatives in combating inequities in healthcare.
Collapse
Affiliation(s)
- Margaret Salisu
- Department of Family & Community Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Tenya Blackwell
- Arthur Ashe Institute for Urban Health (AAIUH), SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Mark W Hoglund
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Kunika Chahal
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Chellandra Samuels
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Carla Boutin-Foster
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Douglas Montgomery
- Department of Family & Community Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Aimee Afable
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| |
Collapse
|
30
|
Ziller E, Talbot JA, Elbaum M, Croll Z, Waterston LB, Korsen N, Han PKJ. Engaging At-Risk Rural Residents in Secondary Lung Cancer Prevention. J Prim Care Community Health 2023; 14:21501319231163368. [PMID: 36998226 PMCID: PMC10071205 DOI: 10.1177/21501319231163368] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Rural residents are at elevated risk for lung cancer and related mortality, yet limited research has explored their perspectives on cancer risk or prevention options, including tobacco treatment and lung cancer screening with low-dose computed tomography (LDCT). This qualitative study examined attitudes and beliefs among rural adults who reported either current or former tobacco use, as well as disengagement from the health care system. METHODS We conducted 6 focus groups with rural Maine residents at risk for lung cancer based on age and smoking history (n = 50). Semistructured interviews explored participants' knowledge, perceptions, and attitudes regarding lung cancer risk, LDCT screening, and patient provider relationships. Inductive qualitative analysis of interview transcripts was conducted to identify key themes. RESULTS Participants were cognizant of their elevated lung cancer risk, yet few were aware of LDCT screening. When informed about LDCT, most participants indicated a willingness to undergo screening, although a substantial minority indicated reluctance related to fear and fatalism. Participants generally expressed the belief that relationships with a primary care provider could support their health and identified several provider factors that influence these relationships, including attention and time for patient concerns; respect and non-judgmental, nonstigmatizing attitudes; treating patients as individuals; and provider empathy and emotional support. CONCLUSIONS Rural residents at risk for lung cancer report limited knowledge and substantial ambivalence regarding LDCT screening, but identify provider behaviors that may promote patient-provider relationships and greater engagement with their health. More research is needed to confirm these findings and understand how to help rural residents and healthcare providers work together to reduce lung cancer risk.
Collapse
Affiliation(s)
| | | | | | | | | | - Neil Korsen
- MaineHealth Institute for Research, Portland, ME, USA
| | - Paul K J Han
- MaineHealth Institute for Research, Portland, ME, USA
- National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
31
|
Lalika M, Woods C, Patel A, Scott C, Lee A, Weis J, Jones C, Abbenyi A, Brockman TA, Sia IG, White RO, Doubeni CA, Brewer LC. Factors Associated With COVID-19 Vaccine Acceptance Among Patients Receiving Care at a Federally Qualified Health Center. J Prim Care Community Health 2023; 14:21501319231181881. [PMID: 37350465 PMCID: PMC10291217 DOI: 10.1177/21501319231181881] [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: 04/10/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND COVID-19 vaccine hesitancy in the United States is high, with at least 63 million unvaccinated individuals to date. Socioeconomically disadvantaged populations experience lower COVID-19 vaccination rates despite facing a disproportionate COVID-19 burden. OBJECTIVE To assess the factors associated with COVID-19 vaccine acceptance among under-resourced, adult patients. METHODS Participants were patients receiving care at a Federally Qualified Health Center (FQHC) in St. Paul, Minnesota. Data were collected via multiple modes over 2 phases in 2020 (self-administered electronic survey) and 2021 (study team-administered survey by telephone, self-administered written survey) to promote diversity and inclusion for study participation. The primary outcome was COVID-19 vaccine acceptance. Using logistic regression analysis, associations between vaccine acceptance and factors including risk perception, concerns about the COVID-19 vaccine, social determinants of health (SDOH), co-morbidities, pandemic-induced hardships, and stress were assessed by adjusted odds ratios (AORs) and 95% confidence intervals (CI). RESULTS One hundred sixty-eight patients (62.5% female; mean age [SD]: 49.9 [17.4] years; 32% <$20 000 annual household income; 69% CONCLUSIONS Our study in a socioeconomically disadvantaged population suggests that risk perception is associated with an increased likelihood of vaccine acceptance, while concerns about the COVID-19 vaccine are associated with a lower likelihood of vaccine acceptance. As these factors could impact vaccine uptake, consistent, innovative, and context-specific risk communication strategies may improve vaccine coverage in this population.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Chyke A. Doubeni
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | |
Collapse
|
32
|
Bradley PM, Romanok KM, Smalling KL, Focazio MJ, Charboneau R, George CM, Navas-Acien A, O’Leary M, Red Cloud R, Zacher T, Breitmeyer SE, Cardon MC, Cuny CK, Ducheneaux G, Enright K, Evans N, Gray JL, Harvey DE, Hladik ML, Kanagy LK, Loftin KA, McCleskey RB, Medlock-Kakaley EK, Meppelink SM, Valder JF, Weis CP. Tapwater Exposures, Effects Potential, and Residential Risk Management in Northern Plains Nations. ACS ES T Water 2022; 2:1772-1788. [PMID: 36277121 PMCID: PMC9578051 DOI: 10.1021/acsestwater.2c00293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 05/10/2023]
Abstract
In the United States (US), private-supply tapwater (TW) is rarely monitored. This data gap undermines individual/community risk-management decision-making, leading to an increased probability of unrecognized contaminant exposures in rural and remote locations that rely on private wells. We assessed point-of-use (POU) TW in three northern plains Tribal Nations, where ongoing TW arsenic (As) interventions include expansion of small community water systems and POU adsorptive-media treatment for Strong Heart Water Study participants. Samples from 34 private-well and 22 public-supply sites were analyzed for 476 organics, 34 inorganics, and 3 in vitro bioactivities. 63 organics and 30 inorganics were detected. Arsenic, uranium (U), and lead (Pb) were detected in 54%, 43%, and 20% of samples, respectively. Concentrations equivalent to public-supply maximum contaminant level(s) (MCL) were exceeded only in untreated private-well samples (As 47%, U 3%). Precautionary health-based screening levels were exceeded frequently, due to inorganics in private supplies and chlorine-based disinfection byproducts in public supplies. The results indicate that simultaneous exposures to co-occurring TW contaminants are common, warranting consideration of expanded source, point-of-entry, or POU treatment(s). This study illustrates the importance of increased monitoring of private-well TW, employing a broad, environmentally informative analytical scope, to reduce the risks of unrecognized contaminant exposures.
Collapse
Affiliation(s)
- Paul M. Bradley
- U.S.
Geological Survey, Columbia, South Carolina 29210, United States
| | | | - Kelly L. Smalling
- U.S.
Geological Survey, Lawrenceville, New Jersey 08648, United States
| | | | - Robert Charboneau
- Spirit
Lake Tribe Office of Environmental Health, Fort Totten, North Dakota 58335, United States
| | - Christine Marie George
- Johns
Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
| | - Ana Navas-Acien
- Columbia
University Mailman School of Public Health, New York, New York 10032, United States
| | - Marcia O’Leary
- Missouri
Breaks Industries Research Inc., Eagle Butte, South Dakota 57625, United States
| | - Reno Red Cloud
- Oglala
Sioux Tribe Natural Resources Regulatory Agency, Pine Ridge, South Dakota 57770, United States
| | - Tracy Zacher
- Missouri
Breaks Industries Research Inc., Eagle Butte, South Dakota 57625, United States
| | | | - Mary C. Cardon
- U.S.
Environmental Protection Agency, Durham, North Carolina 27709, United States
| | - Christa K. Cuny
- Missouri
Breaks Industries Research Inc., Eagle Butte, South Dakota 57625, United States
| | - Guthrie Ducheneaux
- Missouri
Breaks Industries Research Inc., Eagle Butte, South Dakota 57625, United States
| | - Kendra Enright
- Missouri
Breaks Industries Research Inc., Eagle Butte, South Dakota 57625, United States
| | - Nicola Evans
- U.S.
Environmental Protection Agency, Durham, North Carolina 27709, United States
| | - James L. Gray
- U.S.
Geological Survey, Lakewood, Colorado 80228-3742, United States
| | - David E. Harvey
- Indian Health Service/HHS, Rockville, Maryland 20857, United States
| | | | - Leslie K. Kanagy
- U.S.
Geological Survey, Lakewood, Colorado 80228-3742, United States
| | - Keith A. Loftin
- U.S.
Geological Survey, Lawrence, Kansas 66049, United States
| | | | | | | | - Joshua F. Valder
- U.S. Geological
Survey, Rapid City, South Dakota 57702, United States
| | - Christopher P. Weis
- National Institute of Environmental Health
Sciences/NIH, Bethesda, Maryland 20814, United
States
| |
Collapse
|
33
|
Sharma A, Basu S. Does Primary Care Availability Mediate the Relationship Between Rurality and Lower Life Expectancy in the United States? J Prim Care Community Health 2022; 13:21501319221125471. [PMID: 36222656 PMCID: PMC9561680 DOI: 10.1177/21501319221125471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Rural counties in the United States have lower life expectancy than their urban counterparts and comprise the majority of primary care provider (PCP) shortage areas. We evaluated whether PCP availability mediates the relationship between rurality and lower life expectancy. METHODS We performed a mediation analysis on a panel dataset which included county-level estimates (N = 3103) for the years 2010, 2015, and 2017, and on a subset containing only rural counties (N = 1973), with life expectancy as the outcome variable, urbanity as the independent variable, and PCP density as the mediating variable. County-level socio-demographic data were included as covariates. RESULTS AND CONCLUSIONS PCP density mediated 10.1% of the relationship between urbanity and life expectancy in rural counties. Increasing PCP density in rural counties with PCP shortages to the threshold of being a non-shortage county (>1 physician/3500 population, as defined by the Health Resources and Services Administration) would be expected to increase mean life expectancy in the county by 26.1 days (95% confidence interval [CI]: 11.4, 49.3) and increasing it to the standards recommended by a Secretarial Negotiated Rulemaking Committee would be expected to increase mean life expectancy by 65.3 days (95% CI: 42.6, 87.5). PCP density is a meaningful mediator of the relationship between urbanity and life expectancy. The mediation effect observed was higher in rural counties compared to all counties. Understanding how PCP density may be increased in rural areas may be of benefit to rural life expectancy.
Collapse
Affiliation(s)
- Arjun Sharma
- Columbia Grammar & Preparatory
School, New York, NY, USA,Arjun Sharma, Columbia Grammar &
Preparatory School, 5 West 93rd Street, New York, NY 10128, USA.
| | - Sanjay Basu
- Research and Development, Waymark Care,
San Francisco, CA, USA
| |
Collapse
|
34
|
Dollar KR, Neutel BS, Hsia DW. Access to Care Limits Lung Cancer Screening Eligibility in an Urban Safety Net Hospital. J Prim Care Community Health 2022; 13:21501319221128701. [PMID: 36200665 PMCID: PMC9549100 DOI: 10.1177/21501319221128701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Lung cancer screening (LCS) results in earlier detection of malignancy and decreases mortality but requires access to care to benefit. We assessed factors associated with timing of lung cancer diagnosis in the absence of systematic LCS in an urban safety net hospital. PATIENTS AND METHODS Retrospective chart review was performed of patients with pathologic diagnosis and/or staging of lung cancer at our institution between 2015 and 2018. Patient socio-demographics, disease characteristics, factors associated with access to medical care, and time point and process by which the patient accessed care were collected and analyzed. RESULTS In total, 223 patients were identified with median age of 63 years and 57.8% male predominance. Racial distribution was 22.9%, 20.2%, 17.1%, and 9.4% for Black, White, Asian, and Hispanic, respectively. Stage at diagnosis was 8.1%, 4.5%, 17.0%, and 60.5% for stages I, II, III, and IV, respectively. Medicaid (59.6%) and Medicare/Medicaid (17.1%) were the most common insurance types, while 16.1% had no insurance. A majority (54.3%) had no established primary care provider (PCP), and only 17.9% had an in-network PCP. Patients without PCPs were more likely to have diagnostic evaluation initiated from Emergency Department or Urgent Care settings (95.0% vs 50.1%, P < .01) and present with later stage disease (92.7% vs 77.8%, P < .01). Of the 83 patients that met age and smoking history LCS criteria, only 33.7% (12.6% of total) also had an in-network PCP. CONCLUSION Absence of established PCPs is associated with later stage presentation of lung cancer and may limit system- level benefits of LCS implementation.
Collapse
Affiliation(s)
- Krista R. Dollar
- Harbor-University of California Los
Angeles Medical Center, Torrance, CA, USA,Krista R. Dollar, Harbor-University of
California Los Angeles Medical Center, 1000 W Carson Street, Torrance, CA 90509,
USA.
| | - Bradley S. Neutel
- Harbor-University of California Los
Angeles Medical Center, Torrance, CA, USA
| | - David W. Hsia
- Harbor-University of California Los
Angeles Medical Center, Torrance, CA, USA,The Lundquist Institute for Biomedical
Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| |
Collapse
|
35
|
Sheikhattari P, Shaffer E, Barsha RAA, Silver GB, Elliott B, Delgado C, Purviance P, Odero-Marah V, Bronner Y. Building Capacity for Community-Academia Research Partnerships by Establishing a Physical Infrastructure for Community Engagement: Morgan CARES. Int J Environ Res Public Health 2022; 19:12467. [PMID: 36231771 PMCID: PMC9566608 DOI: 10.3390/ijerph191912467] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Research partnerships between universities and communities following the principles of community-based participatory research (CBPR) have the potential to eliminate cycles of health disparities. The purpose of this article is to describe the process of establishing a community-campus network with a distinct mission and vision of developing trusting and successful research partnerships that are sustained and effective. In 2019, Morgan CARES was established to facilitate community engagement by founding a community center "within" a low-income residential neighborhood as a safe and accessible hub for creating a vibrant learning community. A community needs assessment and asset mapping was conducted and several necessary resources and services were provided to maximize networking opportunities, nurture innovative ideas and proposals, and provide seed funding. Lessons learned informed the optimization of a theoretical model that has guided the development and implementation of the program's key components. By December 2021, Morgan CARES had recruited 222 community and 137 academic members representing diverse expertise from across Baltimore City. We also successfully established new partnerships and funded a total of 17 small community-academic awards. Although in its early stages, Morgan CARES has established a dynamic learning community following a conceptual framework that could guide future similar initiatives.
Collapse
Affiliation(s)
- Payam Sheikhattari
- Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
- Center for Urban Health Disparities Research and Innovation, Morgan CARES Community Engagement Core, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | - Emma Shaffer
- Center for Urban Health Disparities Research and Innovation, Morgan CARES Community Engagement Core, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | - Rifath Ara Alam Barsha
- Center for Urban Health Disparities Research and Innovation, Morgan CARES Community Engagement Core, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | - Gillian Beth Silver
- Center for Urban Health Disparities Research and Innovation, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | - Bethtrice Elliott
- Center for Urban Health Disparities Research and Innovation, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | | | - Paula Purviance
- Hillen Road Improvement Association, Baltimore, MD 21218, USA
| | - Valerie Odero-Marah
- Center for Urban Health Disparities Research and Innovation, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
- Department of Biology, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| | - Yvonne Bronner
- Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
- Center for Urban Health Disparities Research and Innovation, Morgan CARES Community Engagement Core, Morgan State University, 1700 East Cold Spring Lane, Baltimore, MD 21251, USA
| |
Collapse
|
36
|
Treat S, Vanhook P, Hendrix L, Wallace K, McCook JG. Responding to the Challenges and Barriers Unique to Rural Appalachian Sexual Assault Nurse Examiner Programs. J Forensic Nurs 2022; 18:139-145. [PMID: 36007220 PMCID: PMC9415211 DOI: 10.1097/jfn.0000000000000388] [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] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 01/26/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this article is to explore the opportunities and barriers challenging sexual assault nurse examiners (SANEs) operating in rural and underserved areas. These challenges include the absence of established SANE programs, patient isolation and poverty, inadequate community support, and ensuring program sustainability. While not specific to rural communities, these challenges and barriers are further exacerbated by long-held beliefs and misconceptions that exist in small, close-knit communities. To mitigate these challenges, SANE programs in rural communities are asked to respond with creative and unique solutions. Through strong community partnerships and carefully coordinated efforts, SANE programs can thrive in even the most isolated and economically depressed rural communities.
Collapse
Affiliation(s)
- Sarah Treat
- Author Affiliations:School of Nursing, University of Tennessee, Chattanooga
- College of Nursing, East Tennessee State University
- Health Education Learning Program for Sexual Assault in Rural Appalachia (HELP SARA)
| | - Patricia Vanhook
- College of Nursing, East Tennessee State University
- Health Education Learning Program for Sexual Assault in Rural Appalachia (HELP SARA)
| | - Lenee’ Hendrix
- College of Nursing, East Tennessee State University
- Sullivan County Family Justice Center
| | | | - Judy G. McCook
- College of Nursing, East Tennessee State University
- Health Education Learning Program for Sexual Assault in Rural Appalachia (HELP SARA)
| |
Collapse
|
37
|
Fleary SA, Gonçalves C, Joseph PL, Baker DM. Census Tract Demographics Associated with Libraries' Social, Economic, and Health-Related Programming. Int J Environ Res Public Health 2022; 19:6598. [PMID: 35682183 PMCID: PMC9180538 DOI: 10.3390/ijerph19116598] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
Background: Public libraries can contribute to reducing economic, social, and health inequities through their programming and practices. However, the extent to which libraries regularly provide programming that improve the social determinants of health (SDH) in underserved communities is unclear. Objective: This study explored the relationship between census tract demographic characteristics and library programming implicated in the SDH for underserved groups at risk for health disparities. Method: A stratified random sample of libraries (n = 235) who completed the 2017 Public Libraries Survey were recruited. Librarians completed surveys about their libraries' economic, social, and health-related programming. Libraries' census tract demographic characteristics were taken from the 2013-2017 American Community Survey. Linear regressions were estimated to determine the relationship between relevant census tract demographic characteristics and programming offered at libraries in the census tracts. Results: Higher proportions of racial and ethnic minorities were associated with more frequent economic and social programs, but results were mixed for health-related programs. Lower proportions of populations with no more than a high school diploma or GED were related to more frequent economic, social, and health-related programs. Conclusions: The inequitable distribution of SDH-related library programming highlights gaps in libraries' responsiveness to community needs. Libraries' programming likely perpetuate systemic inequities.
Collapse
Affiliation(s)
- Sasha A. Fleary
- Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY 10027, USA
| | - Carolina Gonçalves
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, MA 02155, USA;
| | - Patrece L. Joseph
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA;
| | - Dwayne M. Baker
- Urban Studies Department, CUNY Queens College, Queens, NY 11367, USA;
| |
Collapse
|
38
|
Bradshaw JT, Peterson T, Parker LM, Richards Z, Skidmore CJ, Brighton K, Muir MW, Moody A, Collyer A, Zapata I, Brooks AE, Reyes M. A Prospective Analysis of the Simplified Student Sight Savers Program on Open-Angle Glaucoma Cost Burden in Underserved Communities. J Clin Med 2022; 11. [PMID: 35629028 DOI: 10.3390/jcm11102903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Glaucoma is a leading cause of irreversible blindness worldwide. Unfortunately, no noticeable symptoms exist until mid- to late-stage glaucoma, leading to substantial costs to the patient and the healthcare system. (2) Methods: The Student Sight Savers Program, an initiative started at Johns Hopkins University, was designed to meet the needs of community screening for glaucoma. Several medical students at the Rocky Vista University in Saint George, Utah, were trained, and screened patients at local fairs and gathering places using a modified version of this program. Patients found to have elevated pressure (>21 mmHg) or other ocular abnormalities were referred for an ophthalmological examination. (3) Results: Individuals from medically underserved areas/populations (MUA/Ps) were nearly three times as likely to have elevated intraocular pressure as individuals not in underserved areas (p = 0.0141). A further analysis demonstrates that medical students can help reduce medical costs for patients and the healthcare system by providing referrals to ophthalmologists and reaching populations that are not usually screened for glaucoma. (4) Conclusions: Allowing medical students to perform community-based glaucoma screening events in MUA/Ps using handheld tonometers may decrease the cost burden associated with late diagnosis, and raise awareness about glaucoma, especially in underserved populations.
Collapse
|
39
|
Silverman ME, Sami TJ, Kangwa TS, Burgos L, Stern TA. Socioeconomic Disparity in Birth Rates During the COVID-19 Pandemic in New York City. J Womens Health (Larchmt) 2022; 31:1113-1119. [PMID: 35404128 DOI: 10.1089/jwh.2021.0571] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: The differential impact of the coronavirus disease 2019 (COVID-19) pandemic across race, ethnicity, and socioeconomic status remains poorly understood. While recent explorations into birthrates during the pandemic have revealed significant declines, how birthrates may have differed between racial and socioeconomic subgroups during the pandemic remains to be detailed. Methods: Using electronic health records from a large hospital network in New York serving a racially and socioeconomically diverse population, we explored birthrates associated with conceptions that occurred during the COVID-19 pandemic lockdown for demographic and obstetric differences. Results: Two thousand five hundred twenty-three unique patient deliveries corresponded with conceptions that occurred during the COVID-19 pandemic lockdown in New York. Compared to the same period the previous year, there was a 22.85% decrease in births. Explorations into differences in birthrates by socioeconomic status revealed that much of the decline could be explained by fewer births among individuals living in higher socioeconomic status as opposed to individuals living in urban economic poverty [χ2(n = 5588) = 18.35, p < 0.01]. Conclusion: On March 22, 2020, New York instituted a prohibition of all nonessential social gatherings and the closure of all nonessential businesses. Although the full impact of the COVID-19 pandemic on reproductive health and outcomes remains largely unknown, the decreased birthrate associated with the initial COVID-19 wave in New York was not entirely unexpected. While the mechanisms that drive health disparities are complex and multifactorial, most of the decrease occurred among those living in higher socioeconomic status. This finding has important implications for understanding health behaviors and disparities among minorities living in low socioeconomic status.
Collapse
Affiliation(s)
- Michael E Silverman
- Department of Psychiatry and Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Tanya J Sami
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Thandiwe S Kangwa
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Laudy Burgos
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| | - Toni A Stern
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
40
|
Lin SC, Gathua N, Thompson C, Sripipatana A, Makaroff L. Disparities in smoking prevalence and associations with mental health and substance use disorders in underserved communities across the United States. Cancer 2022; 128:1826-1831. [PMID: 35253202 DOI: 10.1002/cncr.34132] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Smoking contributes to the top 3 deadliest cancers, cancers of the lung, colon, and pancreas, which account for nearly 40% of all cancer-related deaths in the United States. Despite historicly low smoking rates, substantial disparities remain among people with mental health conditions and substance use disorders (SUDs). METHODS The study examined the prevalence of smoking among adults from underserved communities who are served at federally qualified health centers through an analysis of the 2014 Health Center Patient Survey. Furthermore, the study assessed associations of smoking with co-occurring mental health conditions and SUDs among adult smokers (n = 1735). RESULTS The prevalence of smoking among health center patients was 28.1%. Among current smokers, 59.1% had depression and 45.4% had generalized anxiety. Non-Hispanic Black smokers had more than 2 times the odds of reporting SUDs (adjusted odds ratio [aOR], 2.13; 95% confidence interval [CI], 1.06-4.30). Individuals at or below 100% of the federal poverty level had more than 2 times the odds of having mental health conditions (aOR, 2.55; 95% CI, 1.58-4.11), and those who were unemployed had more than 3 times the odds for SUDs (aOR, 3.21; 95% CI, 1.27-8.10). CONCLUSIONS The prevalence of smoking in underserved communities is nearly double the national prevalence. In addition, the study underscores important socioeconomic determinants of health in smoking cessation behavior and the marked disparities among individuals with mental health conditions and SUDs. Finally, the findings illuminate the unique need for tailored treatments supporting cancer prevention care to address challenges confronted by vulnerable populations.
Collapse
Affiliation(s)
- Sue C Lin
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Naomie Gathua
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Cheryl Thompson
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | | |
Collapse
|
41
|
Huguet N, Hodes T, Bailey SR, Marino M, Hartung DM, Voss R, O'Malley J, Chamine I, Muench J. Characterizations of Opioid Prescribing in Community Health Centers in 2018. J Prim Care Community Health 2022; 13:21501319221074115. [PMID: 35098789 PMCID: PMC8808028 DOI: 10.1177/21501319221074115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To identify the patient- and clinic-level correlates of any prescription opioid use, chronic use, and high-dose opioid use in a multi-state network of Community Health Centers (CHCs). Methods: We used electronic health record data from 337 primary care clinics serving 610 983 patients across 15 states in 2018. The primary outcomes were prescription of any opioid, chronic opioid, and high-dose opioid. Results: Overall, 6.5% of patients were prescribed an opioid; of these, 31% were chronic users and 5% were high-dose users. Males had 5% lower odds (Odds Ratio [OR] = 0.95; 95% Confidence Interval = 0.93-0.97) of being prescribed an opioid but 16% higher odds (OR = 1.16; 95% CI = 1.10-1.21) of being chronic users and 48% (OR = 1.48; 95% CI = 1.36-1.64) higher odds of being high-dose users than females. Rural clinics had higher rates of chronic opioid (rate ratio = 1.86; 95% CI = 1.20, 2.88) and high-dose users (rate ratio = 2.95; 95% CI = 1.81-4.81). Conclusions: Our study highlights variations in opioid prescribing with regard to patient-level and clinic-level factors. Targeted efforts and resources may be required to support rural CHCs who seek to reduce high-risk opioid prescribing.
Collapse
Affiliation(s)
| | - Tahlia Hodes
- Oregon Health & Science University, Portland, OR, USA
| | | | - Miguel Marino
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Irina Chamine
- Oregon Health & Science University, Portland, OR, USA
| | - John Muench
- Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
42
|
Jacobs ZM, Reddy AT, Weinreich HM, Nazinyan M, Pila JM, Gabrielian S. Improving Consumer Experiences in Permanent Supportive Housing Co-Located With Health Centers: A Case Study From the Department of Veterans Affairs. J Prim Care Community Health 2022; 13:21501319221098530. [PMID: 35578766 PMCID: PMC9118417 DOI: 10.1177/21501319221098530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Permanent Supportive Housing (PSH), which provides subsidies for independent housing and supportive services, is an evidence-based practice that improves health and housing for homeless experienced persons. Though most PSH is scattered-site, that is, housing dispersed throughout the mainstream rental market, project-based PSH offers housing and supportive services in dedicated facilities with on-site services. In 2013, the Veterans Health Administration (VA) at Greater Los Angeles opened a novel project-based PSH program located on a VA campus. To inform plans to expand project-based PSH at this VA, we examined participants’ experiences in this program. We aimed to identify participant characteristics that suggested they were well suited for the planned PSH expansion; to characterize services that participants found valuable in this setting; and to highlight gaps between participants’ needs and PSH services provided. Methods: We performed semi-structured interviews with a convenience sample (n = 24) of participants who had engaged in this project-based PSH program. Interviews asked why participants selected housing on a VA campus and explored valued program characteristics, designs, and services. Using rapid analysis methods, we generated templated summaries of each participant’s responses across the domains of our interview guide, then used matrix analyses to identify salient themes across the interviews. Key Findings: Participants appreciated the ease of access to medical and mental health services; however, as services were assumed to be optimized by virtue of co-location with VA healthcare, their PSH providers often did not link them with non-VA social services as assertively as desired. Many participants raised concerns about building safety and on-site substance use. A lack of participant engagement in program oversight, often leading to conflicts with staff and building management, was also highlighted in our interviews. Discussion: Given the value placed on ease of access to healthcare, these data suggest the value of this PSH model for persons with healthcare vulnerabilities. Specific recommendations for the planned PSH expansion include: (1) continuation of proximate, open-access healthcare; (2) clear tenant policies; (3) tenant councils for each development; (4) staff knowledgeable of non-VA resources and social services; (5) Veteran-preferred hiring practices by Property/Service management; (6) gender-specific accommodations; and (7) robust 24/7 security on-site.
Collapse
Affiliation(s)
- Zachary M Jacobs
- UCLA David Geffen School of Medicine-Psychiatry, Los Angeles, CA, USA
| | - Anjani T Reddy
- UCLA David Geffen School of Medicine-Psychiatry, Los Angeles, CA, USA.,VA Greater Los Angeles, Los Angeles, CA, USA
| | | | - Mariam Nazinyan
- UCLA David Geffen School of Medicine-Psychiatry, Los Angeles, CA, USA.,VA Greater Los Angeles, Los Angeles, CA, USA
| | - Jose M Pila
- VA Greater Los Angeles, Los Angeles, CA, USA
| | - Sonya Gabrielian
- UCLA David Geffen School of Medicine-Psychiatry, Los Angeles, CA, USA.,VA Greater Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
43
|
O'Brien M, Daws R, Amin P, Lee K. Utilizing Telemedicine and Modified Fibrosis Staging Protocols to Maintain Treatment Initiation and Adherence Among Hepatitis C Patients During the COVID-19 Pandemic. J Prim Care Community Health 2022; 13:21501319221108000. [PMID: 35748428 PMCID: PMC9234933 DOI: 10.1177/21501319221108000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The COVID-19 pandemic exacerbated the decline in Hepatitis C Virus (HCV)
screening and treatment globally in part due to lockdowns and restrictions at
healthcare centers. The goal of this retrospective cohort study was to assess
the effectiveness of an updated workflow implemented at Boston Medical Center
(BMC) HCV clinics. Revised workflow incorporated appointments via telemedicine,
transitioning to blood test-based fibrosis scoring, and delivering medication by
mail to mitigate the lack of in-person services. We compared 2 cohorts of
patients who attended at least the initial intake appointment at BMCHCV clinics:
170 before the pandemic and 133 after the pandemic. Outcome variables included
treatment starts, fibrosis lab tests completed, appointment attendance, and SVR
achievement. Proportions for outcome variables were compared between groups by
use of χ2 and 2-sample t-tests where appropriate.
Our results showed a 14.43% decrease in completing fibrosis scoring tests
(P-value: <.001) and a 15.21% decrease in medication
initiation (P-value: <.001) among the patients who initiated
care during the pandemic (modified workflow group). Furthermore, we found a
18.56% decrease in sustained virologic response (SVR) among the modified
workflow group when compared to the controls. Overall, these results align with
current trends of patients’ decreasing engagement in HCV care but show higher
retention than other published data. Furthermore, these figures support how
appointments via telemedicine, transitioning to blood test-based fibrosis
scoring, and medication delivery by mail can serve as tools to increase access
to HCV care and successful HCV treatment completion even after COVID
restrictions are lifted.
Collapse
|
44
|
Hart AM, Seagriff N, Flinter M. Sustained Impact of a Postgraduate Residency Training Program on Nurse Practitioners' Careers. J Prim Care Community Health 2022; 13:21501319221136938. [PMID: 36373693 PMCID: PMC9663609 DOI: 10.1177/21501319221136938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/25/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION In 2007, the first formal postgraduate nurse practitioner (NP) residency program was launched at Community Health Center, Inc., a large Federally Qualified Health Center in Connecticut, and focused on primary care and community health. There are numerous post-graduate nurse practitioner training programs across the nation, and many more are under development. Although the literature describes the impact of postgraduate residency training programs on new NPs' early practice transition, to date, no studies have examined the long-term impact of postgraduate NP training programs on alumni's career choices, practice, and satisfaction. This study sought to understand the impact over time of Community Health Center Inc.'s postgraduate NP residency program on the subsequent career paths of alumni who completed the program between 2008 and 2019. Additionally, it explored alumni's current reflections on the impact of their postgraduate residency training on their transition to the post-residency year and beyond, as well as their professional development and career choices. Moreover, it sought to identify any previously undocumented elements of impact for further exploration in subsequent studies. METHODS This was a retrospective cohort study that used an electronic survey and interviews. All 90 of the alumni who had completed Community Health Center Inc.'s residency between 2008 and 2019 were invited to participate. RESULTS The survey's response rate was 72%. Most (74%) of the participating alumni indicated they were still practicing as primary care providers. Of these, 57% were practicing at FQHCs. Nine subthemes were identified from the interviews, with an overarching theme that the program was foundational to a successful career in community-based primary care and that the impact of the program continues to evolve. CONCLUSION Community Health Center Inc.'s postgraduate NP residency program had a long-standing impact on alumni's commitment to continuing in primary care practice, as well as their engagement in leadership activities to ensure quality care.
Collapse
|
45
|
D'Souza MS, O'Mahony J, Achoba A. Exploring Foot Care Conditions for People Experiencing Homelessness: A Community Participatory Approach. J Prim Care Community Health 2022; 13:21501319211065247. [PMID: 35090358 PMCID: PMC8801709 DOI: 10.1177/21501319211065247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: People experiencing homelessness are faced with complex challenges and are at high risk of illness due to inequities and disparities in access to health care services. Objective: To explore the health and foot care problems related to people experiencing homelessness in British Columbia. Methods: A community participatory research approach was used with a sample of 65 people experiencing homelessness. Data were collected using a survey questionnaire and face-to-face semistructured interviews. Results: Thematic findings shows risk of foot injuries, lack of foot care resources, and absence of family support. Barriers to equitable access to services for most participants experiencing homelessness were lack of housing (76.92%), inability to work (72.31%), and inability to afford the cost of living on their own (63.08%). Conclusions: There is a pressing need for early screening and detection by health care professionals and enhanced foot care services to reduce foot problems and improve foot care wellness of homeless people. Addressing foot-related care are necessary steps in promoting health, preventing illness, and improving access to health services among people experiencing homelessness.
Collapse
Affiliation(s)
| | | | - Alfred Achoba
- Executive Director, Canadian Mental Health Association, Kamloops
| |
Collapse
|
46
|
David P, Fracci S, Wojtowicz J, McCune E, Sullivan K, Sigman G, O'Keefe J, Qureshi NK. Ethnicity, Social Determinants of Health, and Pediatric Primary Care During the COVID-19 Pandemic. J Prim Care Community Health 2022; 13:21501319221112248. [PMID: 35822762 PMCID: PMC9284195 DOI: 10.1177/21501319221112248] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study assessed the relationship between ethnicity, social determinants of
health (SDH), and measures of health outcomes for children during the COVID-19
pandemic. This retrospective study reviewed electronic medical records of 1234
in-person well child visits (WCVs for age <18 years) at a single academic
primary care clinic in a Chicago suburb for the results of SDH screening in the
domains of food, financial, and transportation insecurity. The association
between ethnicity, unmet SDH domains, routine medical care delay, vaccine
delays, and utilization of acute and emergency department (ED) visits were
evaluated. Patients with unmet SDH were more likely to be non-White
(P < .001), ≥3 years of age
(P < .001) and have Medicaid coverage
(P < .001). Unmet social needs were also associated with
more acute visits (P < .001), ED visits
(P < .001), and WCV delays (P < .001).
The results suggest that the COVID-19 pandemic has disproportionately affected
patients with unmet SDH in obtaining routine pediatric well child care.
Collapse
Affiliation(s)
- Pyone David
- Loyola University Medical Center, Maywood, IL, USA
| | | | | | - Erin McCune
- Stritch School of Medicine, Maywood, IL, USA
| | | | - Garry Sigman
- Loyola University Medical Center, Maywood, IL, USA
| | | | | |
Collapse
|
47
|
West RL, Margo J, Brown J, Dowley A, Haas S. Convergence of Service Providers and Managers' Perspectives on Strengths, Gaps, and Priorities for Rural Health System Redesign: A Whole-Systems Qualitative Study in Washington County, Maine. J Prim Care Community Health 2022; 13:21501319221102041. [PMID: 35603501 PMCID: PMC9130803 DOI: 10.1177/21501319221102041] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Both rural residents and state government leaders describe a need to redesign
rural health care systems. Community members should be at the center of this
effort. Methods: We conducted 46 in-depth interviews of direct service providers between
September and November 2020 in Washington County, Maine. Data were analyzed
using a thematic analysis approach. Results: Existing strengths included collaboration between government and health
systems, and community-based services. Gaps included insufficient workforce,
restricted scope of licensing and poor reimbursement, lack of coordination
between health systems, and limited paramedicine capacity. Strategies for
health system redesign included addressing maldistribution of services and
resource optimization, changing federal and state legislation around
insurance and scope of practice, and moving toward value-based purchasing
models. Conclusions: Participants provided pragmatic recommendations based on their deep
understanding of the community context. Lessons learned are likely to be
salient in areas with similar profiles regarding rurality and poverty.
Collapse
Affiliation(s)
- Rebecca L West
- Ariadne Labs, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | | | | | | | | |
Collapse
|
48
|
Bliss JW, Yau A, Beideck E, Novak JSS, d'Andrea FB, Blobel NJ, Batavia AS, Charney P. A Medical Student-Run Telehealth Primary Care Clinic During the COVID-19 Pandemic: Maintaining Care for the Underserved. J Prim Care Community Health 2022; 13:21501319221114831. [PMID: 35920022 PMCID: PMC9358338 DOI: 10.1177/21501319221114831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In this report, we outline our approach to implementing a hybrid in-person and virtual clinic model at a student-run free clinic (SRFC) during the COVID-19 pandemic. Individuals of low socioeconomic status (SES) are at an increased risk for COVID-19 infection and severe clinical outcomes. It is unclear if telehealth is a viable continuity of care enabler for the underserved. METHODS The Weill Cornell Community Clinic (WCCC) implemented a novel telehealth clinic model to serve uninsured patients in May 2020. A phone survey of was conducted to assess WCCC patients access to technology needed for telehealth visits (eg, personal computers, smartphones). Patient no-show rates were retrospectively assessed for both in-person (pre-pandemic) and hybrid continuity of care models. RESULTS The phone survey found that 90% of WCCC patients had access to technology needed for telehealth visits. In the 8 months following implementation of the hybrid model, telehealth and in-person no-show rates were 11% (14/128) and 15% (10/67) respectively; the combined hybrid no-show rate was 12% (24/195). For comparison, the in-person 2019 no-show rate was 23% (84/367). This study aligns with previous reports that telehealth improves patient attendance. CONCLUSION Literature on the transition of SRFCs from in-person to telehealth care delivery models is limited. At the WCCC, the reduction in no-show rates supports the feasibility and benefits of adopting telehealth for the delivery of care to underserved patient populations. We believe the hybrid telehealth model described here is a viable model for other student run free clinics to increase access to care in low SES communities.
Collapse
Affiliation(s)
- Joshua W Bliss
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Annie Yau
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Elena Beideck
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jesse S S Novak
- Weill Cornell Medicine/Sloan-Kettering/Rockefeller Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Felipe B d'Andrea
- Weill Cornell Medicine/Sloan-Kettering/Rockefeller Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Nicolas J Blobel
- Weill Cornell Medicine/Sloan-Kettering/Rockefeller Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Ashita S Batavia
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pamela Charney
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
49
|
Bolduc P, Day PG, Behl-Chadha B, Karapanos M, Carson-Sasso V, Simpson EH, Hebert S. Community-Based HIV and Viral Hepatitis Fellowship Evaluation: Results from a Qualitative Study. J Prim Care Community Health 2022; 13:21501319221138193. [PMID: 36377210 PMCID: PMC9666842 DOI: 10.1177/21501319221138193] [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: 11/17/2022] Open
Abstract
PURPOSE The UMass Chan Medical School/New England AIDS Education and Training Center Community-Based HIV and Viral Hepatitis Fellowship was launched in 2014 to train physicians and nurse practitioners to become experts in outpatient management of HIV, hepatitis B and C, and latent tuberculosis. The purpose of this study was to identify areas of strength and improvement and understand fellows' perceptions of the program and its impact on their current positions and career trajectories. METHODS Qualitative study utilizing a semi-structured interview guide with (11) fellowship graduates (8 MDs; 3 NPs). 45 to 60 min interviews were conducted in April and May 2021, recorded and transcribed. Transcripts were analyzed for representative themes and general patterns in the data. RESULTS Results indicate high satisfaction with the fellowship, which left a positive and indelible impact on their careers and patient care. Fellows highlighted the program's commitment to health equity, its role in transforming them into leaders and advocates for HIV in primary care, and their ability to balance their work and training demands with their personal lives and needs. The fellowship motivated them to become more involved in public health initiatives, serve marginalized communities and reduce their health disparities. They expressed confidence in their ability to independently manage outpatient HIV, viral hepatitis B and C, and latent tuberculosis, and found areas of overlap with their work in primary care. CONCLUSION As the care of people with HIV becomes more commonplace in primary care clinics, it is imperative that primary care providers receive the necessary training and education to meet this need. Our study of 11 former fellows shows that the Community-Based HIV and Viral Hepatitis Fellowship offers such training, spreads it to other institutions, and can be a model for other programs nationwide.
Collapse
Affiliation(s)
- Philip Bolduc
- New England AIDS Education and Training Center and Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Family Health Center of Worcester, Worcester, MA, USA
| | - Philip G Day
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bittie Behl-Chadha
- Office of Survey Research, Commonwealth Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Melissa Karapanos
- Office of Survey Research, Commonwealth Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Vanessa Carson-Sasso
- New England AIDS Education and Training Center and Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - E Hatheway Simpson
- New England AIDS Education and Training Center and Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Scott Hebert
- New England AIDS Education and Training Center and Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| |
Collapse
|
50
|
Henry O, Brito A, Lloyd MC, Miller R, Weaver E, Upender R. A Model for Sleep Apnea Management in Underserved Patient Populations. J Prim Care Community Health 2022; 13:21501319211068969. [PMID: 35040343 PMCID: PMC8771751 DOI: 10.1177/21501319211068969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a common condition in the United States that is strongly linked to metabolic disease, cardiovascular disease, and increased mortality. Uninsured populations experience sleep health disparities, including delayed recognition, diagnosis, and treatment of OSA due to barriers accessing and affording care. Partnerships between primary care clinics and sleep medicine specialists for sleep apnea management have the potential to increase screening, testing, and treatment among underserved populations. Here, we present an integrated and cost-effective model that is easier to navigate for patients while maintaining high quality care. METHODS We designed and implemented a specialty sleep clinic at Shade Tree Clinic, Vanderbilt's student-run, free primary care clinic. Patients with signs and symptoms of OSA were identified at primary care appointments and screened using the STOP-BANG questionnaire. Clinic visits took place over telehealth with a medical student and sleep specialist. Patients were diagnosed using a home sleep test, and if indicated, were prescribed and given a CPAP device for treatment. CPAP adherence was monitored using a cloud-based remote monitoring system. RESULTS From December 2020 through August 2021, we hosted 6 telehealth Sleep Clinics, seeing a total of 28 patients across these visits. We have received a total of 37 referrals and have coordinated sleep evaluations and diagnostic testing for 18 of these patients so far. Prior to initiation of the sleep clinic, there were 17 patients on our primary care panel at Shade Tree with a diagnosis of OSA. These patients were using donated equipment and many had been lost to follow-up or had broken parts. We were able to replace 10 of these patient's CPAP devices and plan to replace the remaining seven. CONCLUSIONS We have created a model of integrated specialty care that is efficient and cost-effective. This paradigm can be replicated for the many specialties that are typically overlooked and undertreated when working with uninsured patients. As awareness of this sleep medicine program becomes more widespread at Shade Tree Clinic, we anticipate reaching more primary care patients with signs and symptoms of sleep apnea through student education, cost-effective diagnostics, and partnership with sleep specialists.
Collapse
Affiliation(s)
- Olivia Henry
- Vanderbilt University Medical School, Nashville, TN, USA
| | | | | | - Robert Miller
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eleanor Weaver
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raghu Upender
- Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|