Showing papers in "Journal of Primary Care & Community Health in 2014"
TL;DR: A pharmacist-driven intervention focused on patient education and medication reconciliation after discharge improved medication use and reduced health care resource utilization in this pilot study.
Abstract: Purpose: Medication errors related to hospital discharge result in rehospitalization and emergency department (ED) visits, yet no systematic approach has been implemented nationally to decrease the...
90 citations
TL;DR: It is documented that exercise is a valuable primary care and community health strategy for healthy adults to improve insulin sensitivity and lower the risk for diabetes conferred by insulin resistance.
Abstract: Objective: Although exercise can improve insulin sensitivity, no adequate synthesis exists of exercise intervention studies with regard to their effect on insulin sensitivity. This comprehensive me...
68 citations
TL;DR: The robust capability of SAS to calculate MCC prevalence and adjusted associations with risk factors provides the fundamentals for developing and evaluating primary care services and community health programs.
Abstract: Background: Multiple chronic conditions (MCCs) are significant public health problems receiving much attention, and rightly so, because of the substantial morbidity, mortality, and cost burden. Obj...
44 citations
TL;DR: The prevalence of IP among elderly home care patients is high, with risk factors that include not only polypharmacy but also several specific underlying medical conditions.
Abstract: Background: Although several previous studies have examined the prevalence and risk factors associated with inappropriate prescribing (IP) among elderly patients, as identified by the Screening Too...
34 citations
TL;DR: CHWs can be successfully integrated into the PCMH care team and may also impact the identification of high-risk populations for care coordination and delivery of comprehensive care.
Abstract: Objectives: Establishing patient-centered medical homes (PCMHs) that deliver comprehensive care can be challenging for practices serving diverse populations. Integrating community health workers (CHWs) as members of the care team is one approach to deliver such care; however, little is known about this process. We study an approach of integrating CHWs into PCMHs with predominantly Latino, pediatric asthma patients and examine the impact on care delivery. Methods: A case study was conducted to examine the integration of 8 CHWs into 5 PCMHs in an academic medical center located in a large, urban setting. Data associated with referrals to CHW practice-based education and support and to a care coordination program, as well as survey results from providers on the impact of CHWs in PCMHs were collected and analyzed over the study period. Results: More than 750 families of children with asthma received education and support from CHWs from February 2011 through December 2013. The number of referrals to the care c...
30 citations
TL;DR: Differences between participant- and provider-based prevalence of chronic conditions demonstrate why health care administrators and policy makers should not rely exclusively on medical record–based administrative data for a comprehensive evaluation of population health.
Abstract: The gold standard for health information is the health record. Hospitalization and outpatient diagnoses provide health systems with data on which to project health costs and plan programmatic changes. Although health record information may be reliable and perceived as accurate, it may not include population-specific information and may exclude care provided outside a specific health care facility. Sole reliance on medical record information may lead to underutilization of health care services and inadequate assessment of population health status. In this study, we analyzed agreement, without assuming a gold standard, between self-reported and recorded chronic conditions in an American Indian/Alaska Native cohort. Self-reported health history was collected from 3821 adult participants of the Alaska EARTH study during 2004-2006. Participant medical records were electronically accessed and reviewed. Self-reported chronic conditions were underreported in relation to the medical record and both information sou...
26 citations
TL;DR: In this article, the authors examined the impact of integrating mental health into primary health care for patients and staff and found that patients receiving mental health care experienced an improved relationship with caregivers and improved overall functioning in their lives.
Abstract: This article examines the impact of integrating mental health into primary health care. Mental Health Integration (MHI) within Intermountain Healthcare has changed the culture of primary health care by standardizing a team-based care process that includes mental health as a normal part of the routine medical encounter. Using a quantitative statistical analysis of qualitative reports (mixed methods study), the study reports on health outcomes associated with MHI for patients and staff. Researchers interviewed 59 patients and 50 staff to evaluate the impact of MHI on depression care. Patients receiving MHI reported an improved relationship with caregivers (P < .001) and improved overall functioning in their lives (P < .01). Staff providing care in MHI reported that patients experienced improved access to mental health care, improved overall patient productivity in daily functions (P < .01), and access to team care (P < .001). As MHI became routine, patients discussed complementary team interventions more frequently (P < .0001). Mental health problems rank second in chronic disease today. MHI offers promising results for improving the quality and cost of effective treatment for chronic disease. This research provides guidelines for organizing mental health care, staff productivity, and patient satisfaction, using a team approach to improve outcomes.
25 citations
TL;DR: An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.
Abstract: Introduction: Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. Methods: A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. Results: A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily v...
24 citations
TL;DR: In the primary care setting, assessing and addressing knowledge and distress barriers after feedback of an abnormal cervical cytology result may improve adherence to follow-up recommendations and thereby reduce disparities in cervical cancer.
Abstract: Objectives: Low-income, inner-city women bear a disproportionate burden of cervical cancer in both incidence and mortality rates in the United States, largely because of low adherence to follow-up ...
24 citations
TL;DR: The barriers to the adoption of depression and primary care models in the United States are examined to present information for future implementation of services.
Abstract: Objective: Despite the prevailing consensus as to its value, the adoption of integrated care models is not widespread. Thus, the objective of this article it to examine the barriers to the adoption...
23 citations
TL;DR: Though family physicians feel tremendous satisfaction from care of underserved patients, they are frustrated with the overwhelming workload they experience and report poor administrative management while working in CHCs.
Abstract: Background: More than 1100 community health centers (CHCs) in the United States provide primary care to 20 million underserved patients annually. CHCs have struggled to recruit and retain qualified...
TL;DR: CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.
Abstract: Background: Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery. Objective: To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years. Methods: Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions. Results: The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of t...
TL;DR: Simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years).
Abstract: Objectives:Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes.Methods:The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight.Results:The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 yea...
TL;DR: In this large academic primary care clinic setting, interdisciplinary team training in QI, support for data collection, and dedicated coaching resources produced few sustainable continuous QI initiatives.
Abstract: Background: Continuous quality improvement (QI) is important to primary care in general, and is emphasized as a key tenet of the primary care patient-centered medical home (PCMH) model. While team-...
TL;DR: Severe obesity is associated with substantially increased frequency of high blood pressure measurements in children, and should be investigated further as a potential marker for hypertension in children.
Abstract: Background: Child obesity is a major health problem particularly affecting disadvantaged population groups. Severe obesity carries additional health risks for children. In the context of the childhood obesity epidemic, high blood pressure among children is of increasing concern. Methods: Chart reviews were carried out to examine the prevalence of severe obesity and its association with high blood pressure measurements among randomly selected patients aged 3 to 17 years who had well-child care visits at 8 public community health centers during 2010. Results: A majority of the 691 patients reviewed were African American (58%); an additional 16% were Hispanic. The prevalence of severe obesity was 7.7% (95% confidence interval = 5.8% to 9.9%) and the prevalence of high blood pressure measurements was 17.5% (95% confidence interval = 14.8% to 20.6%). Patients who were severely obese were more than twice as likely as other children to have high blood pressure values. Conclusions: Severe obesity is associated wi...
TL;DR: Health services evolve as new medical technology emerges, so established indicators may need to be tested for their responsiveness to variations in the care process and sometimes new quality indicators may be necessary.
Abstract: Quality improvement (QI) in medical care and health services has a long history. Practitioners and scholars have debated whether we should focus on whether the services delivered meet professional standards (process measures) or on end results. Ultimately, a valid measure of the quality of the process will be related to good outcomes. And a valid patient outcome measure will be related to guideline adherence. After all, if providers cannot improve a particular outcome then they should not be held accountable for it. In primary care and community health, quality indicators can be classified as biomarkers, health behaviors, or measures of service use. Commonly examined biomarkers include the following: blood glucose, HbA1c, blood pressures, cholesterol levels, body mass index, depression, anxiety, and similar measures relating to common medical conditions. Examples of health behaviors that, in theory, should be influenced by medical and health programs include tobacco use, physical activity, diet, alcohol consumption, and use of illicit drugs. Use of health services also can relate to the quality of services. Service use measures can include screenings, hospital admissions for sentinel events, hospital readmissions, emergency department visits, return visits to ambulatory care providers, referrals to specialists, polypharmacy, and adherence to protocols. Patient satisfaction with care and provider perceptions of quality are relevant but are not direct measures of the quality of care. The above list covers a lot of ground and raises questions about whether the field needs any more quality indicators. Don’t we have enough to work with already? However, health services evolve as new medical technology emerges, so established indicators may need to be tested for their responsiveness to variations in the care process and sometimes new quality indicators may be necessary. Also, our persistent concern with the cost of collecting data pushes us toward measures that can be obtained from medical records, hopefully via automated extraction. If we must survey patients, we try to do so with brief scales, so as to reduce the burden on both patients and analysts and also boost response rates. So, these new, less expensively obtained indicators must be validated.
TL;DR: There were significant racial/ethnic disparities among CSHCN with mental disorders, indicating several sizeable effects of each of the 5 components on Hispanic, black, and other children compared with white children.
Abstract: Background: A health care reform has been taking place to provide cost-effective and coordinated care. One method of achieving these goals is a patient-centered medical home (PCMH) model, which is ...
TL;DR: Clinical reminders have been a key part of a multistep process to improve screening for depression, tobacco cessation, intimate partner violence, alcohol use, and cardiovascular disease in Kodiak, Alaska.
Abstract: Purpose: The Kodiak Area Native Association (KANA) provides primary health care in Kodiak, Alaska and 6 outlying villages. KANA sought to actively improve key preventive screening rates for its patients. Methods: KANA adopted an electronic health record in 2008 and deployed national clinical reminders from the Indian Health Service for 5 key preventive screenings: tobacco use, alcohol use, depression, intimate partner violence, and a comprehensive cardiovascular exam. Clinical reminders were deployed in a 5-step process: (a) establish clinical demand, (b) pilot test reminder, (c) expand reminder to all providers, (d) measure outcomes and share results, and (e) delegate clinical reminder follow-up (primarily to nurses). Results: Data from 2007-2011 show screening rates for all 5 measures improved considerably, to levels significantly above the national average for Indian Health Service facilities. Conclusions: Clinical reminders have been a key part of a multistep process to improve screening for depressio...
TL;DR: Whether panel management could improve blood pressure control in patients with previously uncontrolled hypertension and how panel management can be integrated in an urban, low-income, primary care setting is explored.
Abstract: Objective: Panel management is a system of care that targets groups of patients with similar needs to improve their quality of care. The purpose of this pilot was to determine whether panel managem...
TL;DR: There has been steady improvement in the rates of obesity diagnosis andesity-related counseling by primary care providers, however, continued efforts to increase awareness of these issues are needed as nearly half of obese children remained undiagnosed and recommended laboratory screening for obesity-related comorbidities was performed in only a third of obeseChildren.
Abstract: Objective: To determine the temporal trends in diagnosis and management of pediatric overweight/obesity by primary care providers at a single medical center. Patients: Children 2 to 18 years old un...
TL;DR: It is suggested that postpartum women are receptive to nutrition education and that nutrition education can influence vegetable intake and the effectiveness of a 4-month clinic-based dietary intervention emphasizing the intake of deep yellow and dark green vegetables versus usual care is examined.
Abstract: This pilot study examined the effectiveness of a 4-month clinic-based dietary intervention emphasizing the intake of deep yellow and dark green vegetables versus usual care on improving diet quality in postpartum women. The intervention group (n = 31) received 1 face-to-face nutrition education session with a registered dietitian, 2 follow-up phone calls, and 3 pamphlets distributed by mail. The usual care group (n = 25) received handouts with guidelines on healthy eating. Dietary outcomes were assessed from 3-day food recalls and evaluated using paired and independent t tests. Intervention women exhibited a significant increase in total vegetable intake (P < .001) and in dark green and deep yellow vegetables (P < .001). In comparison, the control group increased the intake of total vegetables (P < .001), but did not increase the consumption of dark green and deep yellow vegetables. When comparing the change in intake between study groups for both types of vegetables, the difference was not significant. Furthermore, 61% of the intervention women met the goals for total vegetable intake compared with 12% for the usual care group (P < .001). The intervention group also had a greater percentage of women (25.8%) that met the goal for deep yellow and dark green vegetable intake when compared with the usual care group (8%; P < .08). These results suggest that postpartum women are receptive to nutrition education and that nutrition education can influence vegetable intake.
TL;DR: This study implicates diet, in addition to advanced age, as a possible risk factor in the development of reduced testosterone levels.
Abstract: Purpose: Hypogonadism is highly prevalent in men older than 45 years and is associated with an increased risk of chronic diseases, including obesity, metabolic syndrome, diabetes, and cardiovascula...
TL;DR: The difference between symptoms in the acutely infected patients and those experiencing persistent symptoms is not as large as initially thought, and the symptoms experienced by the group of patients with persistent symptoms had unexpectedly strong overlap with those experienced by acute infected patients.
Abstract: Background: Western Connecticut Health Network created the Lyme Disease Registry in response to the community’s request and clinical need for more Lyme disease research. The registry includes acute, recovered, and persistently symptomatic patients to better define the different stages of the disease. The design of the registry was guided by community and clinician input through a community-based participatory research process. Methods: Registry participants are asked questions regarding their diagnosis, symptoms, treatments, recovery, and satisfaction with the Registry. A blood specimen is also collected and stored at the initial appointment. Results: The Lyme Disease Registry has enrolled 256 participants, 24% are acute cases, 45% are persistently symptomatic cases, and 31% are recovered cases. The symptoms experienced by the group of patients with persistent symptoms had unexpectedly strong overlap with those experienced by acutely infected patients. Conclusion: The difference between symptoms in the ac...
TL;DR: Using a pilot study as an example, this commentary reviews the ways in which physicians can effectively harness the power of social networking to meaningfully engage their patients in primary prevention.
Abstract: The advent of social networking as a major platform for human interaction has introduced a new dimension into the physician–patient relationship, known as Health 2.0. The concept of Health 2.0 is y...
TL;DR: The results challenge the prevalent expectation that requiring mental health screening will reduce unmet need for MH treatment and suggestidated MH screening tools, primary care provider training, and access to MH services may also be needed but further study is required.
Abstract: Objective: To determine if the Guidelines for Adolescent Preventive Services (GAPS) increases detection or shortens time to diagnosis of mental health (MH) disorders, particularly adolescent depres...
TL;DR: It is confirmed that rosuvastatin therapy in commonly prescribed doses is the most effective statin for low-density lipoprotein cholesterol goal achievement and for improving the lipid profile in hypercholesterolemic diabetic patients with and without metabolic syndrome.
Abstract: Aim: The aim of the current study was to determine the efficacy of the 4 most commonly prescribed statins (rosuvastatin, atorvastatin, pravastatin, and simvastatin) for managing dyslipidemia among ...
TL;DR: Although 30% of participants improved or maintained glycemic control over 2 years, more were uncontrolled at the end than at study start, suggesting that Multidisciplinary care may improve diabetes control in low-income patients.
Abstract: Background: Uninsured patients with diabetes are at increased risk for poor outcomes and often have limited access to health and prescription services necessary to manage diabetes. Hamilton Health ...
TL;DR: It is demonstrated that not all PCMH clinics are alike and that these differences can possibly affect patient perceptions of their care.
Abstract: Background: There is growing and sustained recognition that Patient-Centered Medical Homes (PCMHs) represent a viable approach to dealing with the fragmentation of care faced by many individuals, i...
TL;DR: The results indicate that mental health screening can be effectively managed in primary care practice by a registered nurse using a follow-up protocol and Mailing the ASQ:SE is likely not an effective way to comprehensively screen most primary care populations.
Abstract: Background: Early recognition and treatment of social and emotional disorders in children is significant for school preparation. These disorders are frequently underdetected without the use of stan...
TL;DR: The average consumption of sugar in the Malaysian population has reached an alarming rate, exceeding the benchmark recommended by experts, and the need of a paradigm shift is argued.
Abstract: Objectives:The average consumption of sugar in the Malaysian population has reached an alarming rate, exceeding the benchmark recommended by experts. This article argues the need of a paradigm shift in the management of sugar consumption in the country through evidence derived from addiction research.Methods:“Food addiction” could lead to high levels of sugar consumption. This probable link could accelerate the development of diabetes and obesity in the community. A total of 94 reports and studies that describe the importance of addiction theory–based interventions were found through a search on PubMed, Google Scholar, and Academic Search Complete.Results:Research in the field of addiction medicine has revealed the addictive potential of high levels of sugar intake. Preexisting health promotion strategies could benefit from the integration of the concept of sugar addiction. A targeted intervention could yield more positive results in health outcomes within the country.Conclusion:Current literature seems t...