Showing papers in "Journal of Primary Care & Community Health in 2013"
TL;DR: Interventions designed to target reasons for no- show are needed to help reduce the no-show rate, improve access and decrease health disparities in underserved patient populations.
Abstract: Background: Missed primary care appointments lead to poor disease control and later presentation to care. No-show rates are higher in clinics caring for underserved populations and may contribute t...
194 citations
TL;DR: Assessment of collaborative care interventions for improving depression and quality of life in primary care patients with varying medical conditions found that intervention recipients achieved greater improvement than controls.
Abstract: Background: Depression concomitant with chronic medical conditions is common and burdensome in primary care. Objective: To assess the effectiveness of practice-based interventions for improving dep...
104 citations
TL;DR: Evidence is provided that interventions using OSNs can successfully promote increases in physical activity and weight loss.
Abstract: Background: Online social networks (OSNs) are a new, promising approach for catalyzing health-related behavior change. To date, the empirical evidence on their impact has been limited. Purpose: Using a randomized trial, we assessed the impact of a health-oriented OSN with accelerometer and scales on participant’s physical activity, weight, and clinical indicators. Methods: A sample of 349 PeaceHealth Oregon employees and family members were randomized to the iWell OSN or a control group and followed for 6 months in 2010-2011. The iWell OSN enabled participants to connect with “friends,” make public postings, view contacts’ postings, set goals, download the number of their steps from an accelerometer and their weight from a scale, view trends in physical activity and weight, and compete against others in physical activity. Both control and intervention participants received traditional education material on diet and physical activity. Laboratory data on weight and clinical indicators (triglycerides, high-d...
48 citations
TL;DR: Rural minorities may face different barriers to colorectal cancer screening than urban minorities or rural non-Hispanic whites and further research to develop interventions to improve screening in these populations is warranted.
Abstract: Background: Despite the existence of effective screening, colorectal cancer remains the second leading cause of cancer death in the United States. Adults living in rural areas and members of minori...
38 citations
TL;DR: Findings imply that physician care for grief may not be effective, and support group referral may be helpful, and Physicians may benefit from training in recognizing and appropriate referring for bereavement-related distress.
Abstract: Bereavement is common among older adults and may result in major depression or complicated grief (CG). Little is known about the effectiveness of physician care for these conditions. We examined whether, among older adults with CG and/or major depression, using physician support was associated with reductions in grief, depression, or anxiety severity. Outcomes were compared to group and religious support. We analyzed data from the Changing Lives of Older Couples (CLOC) Study, a prospective cohort study of married couples in the Detroit area. Spousal death was tracked over 5 years, and follow-up interviews conducted with widowed participants at 6 months (wave 1) and 18 months (wave 2) post loss. Analyses were limited to those with CG or depression with support-seeking data (weighted n = 89). Yes/no items asked whether participants had seen each provider for help with grief up until wave 1. A 19-item grief severity measure was developed by CLOC researchers. The 20-item Center for Epidemiologic Studies Depression scale measured depression severity. The Symptom Checklist 90-Revised assessed anxiety severity. Regressions indicated that seeking support from a family doctor at wave 1 was not associated with changes in anxiety, depression, or grief severity at wave 2 (P > .05). However, support group use was associated with reductions in grief severity (β = -8.46, P < .05), and religious leader support-seeking associated with reductions in depression severity (β = -10.12, P < .01). Findings imply that physician care for grief may not be effective, and support group referral may be helpful. Physicians may benefit from training in recognizing and appropriate referring for bereavement-related distress.
37 citations
TL;DR: In rural areas of developing nations where there are high logistical and economical barriers to accessing health care, this telemedicine system successfully increased the ease and lowered the cost of connecting rural patients with nurses to provide preprimary care.
Abstract: Objective: Access to health care in rural areas of developing nations is hindered by both the lack of physicians and the preference of many physicians to practice in urban settings. As a result, rural patients often choose not to sacrifice wages or time to visit distant health care providers. A telemedicine system, Mashavu: Networked Health Solutions, designed to increase access to preprimary health care in rural areas, was field-tested in rural Kenya. This study aims to examine the reliability of the system compared to the traditional face-to-face method of health care delivery. Method: Reliability of the telemedicine system was tested using a modified intraobserver concordance study. Community health workers operated the system in various remote locations. Patient health information including chief complaint, medical history, and vital statistics were sent via Internet to a consulting nurse. After patients completed the telemedicine consultation, they also met in-person with the same nurse. Subsequently...
35 citations
TL;DR: The study found that the mean monthly health care costs decreased for three consecutive months after initiation of MANNA services, which helps show the significance of medical nutrition therapy and home-delivered meal services on overall health care.
Abstract: Chronically ill populations have a strong need for quality public health nutrition services to aid in disease management and improve health outcomes. Evidence suggests that neglecting the importance of adequate nutrition in chronically ill patients has far-reaching implications on the health status of the individual and the health care costs. Research is currently lacking a focus on this topic. This pilot study done through the nonprofit organization MANNA (Metropolitan Area Neighborhood Nutrition Alliance), which serves the greater Philadelphia area, explored the health care expenditures of 65 MANNA clients over time in comparison with a similar group of Medicaid patients who did not receive MANNA services. Health care expenditures were examined before and after clients began receiving services. The study found that the mean monthly health care costs decreased for three consecutive months after initiation of MANNA services. Other health care cost-related factors, such as inpatient costs, length of stay, and number of hospital admissions also displayed a downward trend. These results help show the significance of medical nutrition therapy and home-delivered meal services on overall health care.
31 citations
TL;DR: The postpartum doula group, compared with the other 2 groups, had a higher proportion of women with a previous history of depression, and similarly, a higherportion of women who were depressed and receiving depression treatment at the 6-month follow-up.
Abstract: Objectives: This research provides the first test of feasibility of recruiting postpartum doulas and depressed mothers for a peer support intervention study and begins to evaluate the benefit of po...
27 citations
TL;DR: Primary care physicians’ approaches to contraception counseling with adolescents are explored, suggesting that when considering IUDs for adolescents some PCPs’ subjective assessment of adolescent sexual behavior, attitudes about STI risk factors and use of overly restrictive IUD eligibility criteria impede adolescent’s IUD access.
Abstract: Purpose: Although the intrauterine device (IUD) may be safely used in adolescents, few US adolescents use IUDs. Increasing IUD use in adolescents can decrease pregnancy rates. Primary care providers’ clinical practices many be one of the many barriers to increasing adolescents access to IUDs. We explored primary care physicians’ (PCPs) approaches to contraception counseling with adolescents, focusing on their views about who would be appropriate IUD candidates. Methods: Phone interviews were conducted with 28 urban family physicians, pediatricians, and obstetrician-gynecologists. Using standard qualitative techniques, we developed coding template and applied codes. Results: Most respondents have a patient-centered general contraceptive counseling approach. However, when considering IUDs many PCPs describe more paternalistic counseling. For example, although many respondents believe adolescents’ primary concern is pregnancy prevention, many PCPs prioritize sexually transmitted infection (STI) prevention an...
26 citations
TL;DR: Women recognized barriers to screening, such as embarrassment, privacy issues, fear, insurance, and cost, and countered perceived barriers through inventive suggestions for education and awareness via social support systems and intergenerational relationships.
Abstract: Objective. Although colorectal cancer (CRC) mortality rates in the US population have shown a decline, American Indian (AI) CRC mortality rates appear to be increasing. CRC screening rates of AIs r...
25 citations
TL;DR: The study findings revealed that the prevalence of low back pain was higher among women than among men, and was observed more frequently among older people and among those who were overweight.
Abstract: Background: Low back pain is one of the most common conditions for which patients seek medical care. Aim: The aim of the study was to study the epidemiology of low back pain in primary care setting...
TL;DR: It was found that patients using CCCs had significantly shorter waiting times from check-in to seeing a clinician than the equivalent waiting times reported by patients at family practice physicians’ offices and that CCC patients had significantly longer consultation times with the clinicians than those reported by family practice patients.
Abstract: This study measures waiting times and consultation times at convenient care clinics (CCCs), and compares them with equivalent times in traditional, family practice, physician offices. The analysis ...
TL;DR: A comprehensive and integrated primary care and public health community effort is needed to support and improve adolescent breastfeeding.
Abstract: Purpose: Breastfeeding is a potential solution to improve health outcomes for adolescent mothers and infants. Adolescence is a risk factor for low breastfeeding rates and is associated with a highe...
TL;DR: About two thirds of the commonly used FIT products performed acceptably on spiked samples of human hemoglobin, however, some had low sensitivity and specificity and probably should not be used for population-based or other screening.
Abstract: Background: Colorectal cancer (CRC) screening reduces the mortality due to CRC. It is important for health care providers to be aware of the variation in the products available for CRC screening. Purpose: The purpose of this study was to summarize the accuracy of results of individual fecal immunochemical test (FIT) products across pathology proficiency testing programs. Methods: Secondary data analysis of proficiency testing programs’ FIT results. Results: Four of 7 proficiency testing program’s FIT evaluations were obtained for a 2-year period. Fourteen unique FIT brands were evaluated by at least 1 of the 4 proficiency testing programs. Five of the products performed similarly with sensitivities ranging from 98.1% to 98.8% and specificities from 98.1% to 99.6%. Ninety-three percent of the FIT tests completed were manual Clinical Laboratory Improvement Amendments–waived FITs. Conclusions: About two thirds of the commonly used FIT products performed acceptably on spiked samples of human hemoglobin. Howev...
TL;DR: Although overall ED utilization did not change significantly between program participants and nonparticipants, TAP patients had a lower rate of ED visits not resulting in inpatient admission relative to the comparison group.
Abstract: Background: The annual number of emergency department (ED) visits in the United States increased 23% between 1997 and 2007. The uninsured and those with chronic medical conditions are high users of...
TL;DR: A mailed low-literacy informational flyer about the PSA test was well received by patients but had no effect on rates of PSA discussions, PSA testing, or patient knowledge of prostate cancer screening.
Abstract: Introduction and aims: Professional societies recommend that the decision to screen for prostate cancer involves a shared discussion between patient and provider. Many men are tested without this d...
TL;DR: This safety program was effective at increasing ATV safety knowledge but demonstrates limited effect on safe riding practices.
Abstract: Background: Although research investigating all-terrain vehicle (ATV) riders and ATV injury patterns has led to support for legislative and educational efforts to decrease injuries in users younger than 16 years, there is little published data regarding the utility of ATV safety education programs. This study investigates the effectiveness of a standardized adolescent ATV safety program in changing the safety knowledge and safe ATV riding practices reported by rural Central Illinois youths. Methods: A convenience sample of 260 rural Central Illinois middle and high school students received an ATV safety presentation with both didactic and interactive features during the 2009-2010 school year. Preintervention and postintervention surveys were distributed and collected by teachers. Survey questions consisted of multiple-choice questions pertaining to demographics, ATV safety knowledge, and ATV riding practices. More than 200 surveys were collected prior to the intervention and 165 surveys were collected 12 to 24 weeks after the intervention. Percentages are reported, with differences in nominal variables tested by χ2 test and interval variables by t test. Results: Following the intervention, there was a significant increase in the correct response rate for ATV safety knowledge questions (45.2% vs 56.2%, P Language: en
TL;DR: Drug reviews intended to reduce the rate of polypharmacy among discharged persons aged ≥65 years can be targeted at patients who have 2 or more high-risk diagnoses and at those discharged to receive personal health services either at home or in a convalescence facility.
Abstract: Background: Polypharmacy has been identified as a quality indicator, but no studies have been reported about the epidemiology of polypharmacy among hospital patients at discharge. Methods: Records ...
TL;DR: Free primary care services and specialty consultation did not reduce use of more costly health care services during its first year, suggesting more prolonged availability of primary care might have greater impact.
Abstract: Background: Access to primary care could reduce use of more costly health care by uninsured individuals through prevention and early treatment. We analyzed data from a program providing free primar...
TL;DR: In “real-life settings,” glucose tolerance status, number of intervention visits, employment status, education, and body mass index explained the success of lifestyle intervention.
Abstract: Aim: The authors assessed the predictors of success of a lifestyle intervention (weight loss ≥ 5% and improved glucose tolerance) in individuals at high risk for type 2 diabetes in a 1-year follow-up in a primary health care setting. Methods: High-risk individuals for type 2 diabetes were identified by opportunistic screening in the implementation of the Finnish National Diabetes Prevention Program (FIN-D2D). All together, 3880 individuals participated in the 1-year follow-up. Sociodemographic characteristics, health status and behavior, family history of diabetes, clinical factors, and health care provider were considered possible predictors of lifestyle intervention success. Results: In sum, 19.3% of individuals lost at least 5% of weight, and 32.6% with abnormal glucose tolerance at baseline showed improvement in glucose tolerance. Abnormal glucose tolerance was the strongest predictor of weight loss and improvement in glucose tolerance. High attendance at lifestyle intervention visits, being outside o...
TL;DR: A positive correlation between per capita costs and program effectiveness, differences in intervention levels, and differences in health status are suggested, which could be helpful to policy makers in making resource allocation decisions.
Abstract: Background: Hypertension and associated chronic diseases impose enormous and growing health and economic burdens worldwide. The objective of this study was to investigate the cost-effectiveness (CE...
TL;DR: In this article, the authors show that non-adherence is associated with higher cost of care and poor outcomes and that medication refill consolidation (synchronization of refill dates for patients on multiple drugs) is an important problem.
Abstract: Background: Medication nonadherence is associated with higher cost of care and poor outcomes. Medication refill consolidation (synchronization of refill dates for patients on multiple drugs) is an ...
TL;DR: Findings from this pilot study suggest that brief PA counseling and a prescription delivered in primary care can be effective for promoting PA among women.
Abstract: Evidence supports the effectiveness of interventions delivered in primary care to promote physical activity (PA). Specifically, approaches where physician counseling is coupled with other strategie...
TL;DR: Many older drivers may be open to discussing their driving plans with physicians and family members, and advance driving directives may facilitate these discussions in the present and help define driving-related wishes in the future.
Abstract: Background: Discussions about driving cessation are difficult. “Advance driving directives” (ADDs), like advance directives for end-of-life care, would allow drivers to designate someone to help ma...
TL;DR: Only a minority of primary health care COPD patients in Mexico are receiving state-of-the-art treatment at the primary care level, despite the existence and availability of evidence-based guidelines.
Abstract: Summary: Despite the popularity of chronic obstructive pulmonary disease (COPD) guidelines, studies have reported important deficits among primary care physicians (PCPs) with respect to diagnosis a...
TL;DR: The colocation model was effective in identifying and treating psychiatric comorbidities and colocation was financially sustainable under certain conditions.
Abstract: Objectives: Comorbid psychiatric illness has been identified as a major driver of health care costs. The colocation of psychiatrists in primary care practices has been proposed as a model to improv...
TL;DR: Comparing continuity of care for family medicine patients using retail medicine clinics to continuity for patients not using retail clinics found that continuity was lower for patients who used retail clinics than for Patients who did not use retail clinics.
Abstract: Purpose: The purpose of this study was to compare continuity of care for family medicine patients using retail medicine clinics to continuity for patients not using retail clinics. Retail medicine ...
TL;DR: The study provides empirical evidence of the utility of practically deployable financial incentives to facilitate high-quality primary care, and finds that financial incentives targeted to care quality or content indicators may facilitate rapid transformation of the health system to a primary care–driven system.
Abstract: Objective: High-quality primary care is envisaged as the centerpiece of the emerging health care delivery system under the Affordable Care Act. Reengineering the US health care system into a primar...
TL;DR: Being female, having family/friends who use sunbeds increased use/intention 2- to 4-fold and users/potential users were less aware of associated risks.
Abstract: Background: Sunbed use in childhood increases risk of melanoma. The under-18s sunbed ban was introduced in England, April 2011. Impact on use has not been investigated since. This cross-sectional study estimates the prevalence of under-18s’ use in Sandwell after the commercial ban and identifies factors associated with use/intention. Methods: Adolescents aged 15 to 17 years in schools were surveyed using self-completed anonymous questionnaires. Data collected include demographics, sunbed use, tanning attitudes, knowledge of risks and ban awareness. All Sandwell schools were approached; adolescents available on the survey days were included. Results: Five out of 22 schools participated, 407 adolescents responded (95.1%). Twenty participants (5.3%; 95% confidence interval [CI] = 3.4-8.0) had used sunbeds, of who 16 reported use in commercial settings. After exclusion of one school cohort with atypical use (possibly associated with beauty vocational course and European migrants), the prevalence of use was 1....
TL;DR: Women who lived within 3 miles of the nearest outlet were more likely to report excessive alcohol consumption than women who lived at least 3 miles from the nearest outlets in adjusted analysis.
Abstract: Background:Breast cancer survivors who consume alcohol excessively are at increased risk of recurrence and have worse prognosis. Because the environments in which people live shape many health beha...