Showing papers in "Journal of Primary Care & Community Health in 2015"
TL;DR: Evidence is provided that health policy initiatives, patient-centered care, and targeted interventions can assist with improving primary care access among the homeless.
Abstract: Objective: To identify barriers and facilitators to primary care access among the homeless using the Equity of Access to Medical Care Framework and to provide recommendations for medical and public health practitioners to improve health among this underserved population. Methods: A quasi-systematic review of the literature was conducted using the PubMed, CINAHL, and PsycINFO databases. Study elements from articles in the final analysis were extracted and categorized into dimensions of access from the Framework. Results: The review identified multiple barriers to primary care access for the homeless. This included lack of insurance coverage and competing priorities. Facilitators to access included tailored health care delivery systems and having a regular source of care. Conclusion: This review provides evidence that health policy initiatives, patient-centered care, and targeted interventions can assist with improving primary care access among the homeless.
78 citations
TL;DR: Homeless and vulnerably housed individuals face significant barriers to medication adherence and health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.
Abstract: Objectives: Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barr...
54 citations
TL;DR: Providers and staff with greater cultural competence and preparedness have more positive expectations of CHW interventions to reduce healthcare disparities, and cultural competency training may complement the use of CHWs and support their effective integration into primary care clinics that are seeking to reduce disparities.
Abstract: Introduction: Community health worker (CHW) interventions improve health outcomes of patients from underserved communities, but health professionals’ perceptions of their effectiveness may impede i...
36 citations
TL;DR: Children with multiple chronic conditions accounted for a large proportion of health care expenditures and were more likely to persist in the top 10th percentile spender group in year-to-year spending.
Abstract: Objectives: To examine multiple chronic conditions and related health care expenditures in children. Methods: Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan ...
26 citations
TL;DR: It was found that Somali women generally preferred a female provider for conducting the physical examination, particularly for the pelvic, breast, and abdominal examinations, and there was no stated preference for patient–provider racial concordance.
Abstract: Objectives: Somali people are among the largest refugee populations to resettle in North America and Europe over the past 2 decades, and health disparities are well documented, including barriers t...
24 citations
TL;DR: Most patients with COPD who had participated in pulmonary rehabilitation had good balance confidence scores and their gait and balance were qualitatively normal using the Tinetti tools for assessment, therefore, their risk for falls seems low.
Abstract: Background: Patients with chronic obstructive pulmonary disease (COPD) have reduced gait speeds and more frequent falls. We analyzed gait characteristics and fall risk in these patients using video...
22 citations
TL;DR: The number and geographic distribution of medical providers who actively prescribed direct acting antiviral drugs for hepatitis C in Wisconsin during 2012 were investigated and it was found that there was 1 treatment provider for every 340 residents known to be living with HCV.
Abstract: New recommendations for birth cohort screening for hepatitis C virus (HCV) infection and the development of new, highly effective antiviral medications are expected to increase the demand for HCV treatment. In the past, antiviral therapy for HCV was almost exclusively prescribed by specialists in the field of gastroenterology and infectious diseases, meaning that people living in rural areas that are underserved by specialists may have poor access to treatment. We investigated the number and geographic distribution of medical providers who actively prescribed direct acting antiviral drugs for hepatitis C in Wisconsin during 2012. Using public health surveillance data and a state-wide prescription drug database, we found that there was 1 treatment provider for every 340 residents known to be living with HCV. However, 51 of 72 Wisconsin counties had no providers who provided HCV treatment in 2012.Scaling up antiviral treatment to address the epidemic of hepatitis C efficiently and equitably will require strategies to increase the number of treatment providers in rural communities. Providing education, training, and support to the primary care workforce serving rural communities should be considered a potentially effective and efficient approach to preventing future HCV-related illness.
22 citations
TL;DR: People living with HIV who experience food insecurity are significantly more likely to be prescribed ART regimens that require food and experience poorer treatment outcomes.
Abstract: Background: Food insecurity is a known barrier to medication adherence among people living with HIV. Antiretroviral therapies (ART) that require food likely pose added challenges to patients who do...
21 citations
TL;DR: In the primary health care setting, the concept of enablement is well defined as an outcome measure of quality and the association between enablement and patients’ expectations and satisfaction is less clear.
Abstract: Objectives: To review how enablement is conceptualized and practiced in primary health care and to explore the factors that influence patient enablement in this setting. Method: A narrative integrative literature review was undertaken. Results: Twenty-four articles specifically relating to enablement in primary health care were identified. Three literature reviews, 4 qualitative studies, and 17 quantitative studies were included in the analysis. Conclusions: In the primary health care setting, the concept of enablement is well defined as an outcome measure of quality. The literature exploring the practice of enablement is sparse, but 2 randomized controlled trials suggest enablement is linked to better outcomes for patients with asthma and diabetes. Primary factors influencing enablement included the practitioners’ open communication style, the degree to which the practitioner is patient centered, and longer consultations. Other factors found to be associated with enablement were the presenting health iss...
20 citations
TL;DR: Embedding a psychologist in a primary care clinic leads to increased access to behavioral health services, especially among patients who may not seek out these services themselves or follow through with a physician’s referral to an outside behavioral health clinic.
Abstract: Background: Patients commonly report psychological issues during primary care visits; however, few patients will follow through with a referral for behavioral health services at an outside facility...
19 citations
TL;DR: Large-scale awareness campaigns are needed to address the ill effects of this seemingly innocuous cultural practice of consanguineous marriages.
Abstract: Objectives: This community-based study was done to assess the awareness of people regarding the ill effects of consanguinity and to observe its association with various sociodemographic variables a...
TL;DR: CDS assistance significantly reduced the time spent by physicians for deciding on preventive services and chronic disease management, and the result needs to be confirmed by performing similar studies at other institutions.
Abstract: Background: Clinical decision support (CDS) for primary care has been shown to improve delivery of preventive services. However, there is little evidence for efficiency of physicians due to CDS assistance. In this article, we report a pilot study for measuring the impact of CDS on the time spent by physicians for deciding on preventive services and chronic disease management. Methods: We randomly selected 30 patients from a primary care practice, and assigned them to 10 physicians. The physicians were requested to perform chart review to decide on preventive services and chronic disease management for the assigned patients. The patients assignment was done in a randomized crossover design, such that each patient received 2 sets of recommendations—one from a physician with CDS assistance and the other from a different physician without CDS assistance. We compared the physician recommendations made using CDS assistance, with the recommendations made without CDS assistance. Results: The physicians required an average of 1 minute 44 seconds, when they were they had access to the decision support system and 5 minutes when they were unassisted. Hence the CDS assistance resulted in an estimated saving of 3 minutes 16 seconds (65%) of the physicians’ time, which was statistically significant (P < .0001). There was no statistically significant difference in the number of recommendations. Conclusion: Our findings suggest that CDS assistance significantly reduced the time spent by physicians for deciding on preventive services and chronic disease management. The result needs to be confirmed by performing similar studies at other institutions.
TL;DR: Patients with cellulitis weighing >120kg or with a BMI ≥50 kg/m2 were at greatest risk for treatment failure in the outpatient setting, even when controlling for comorbid diabetes and tobacco use.
Abstract: Purpose: Cellulitis in obese patients is associated with increased rates of treatment failure compared to those with normal body mass index (BMI); however, patients have not been extensively studie...
TL;DR: This article presents how the Affordable Care Act is an appropriate framework for COPC to succeed and the way forward to develop COPC through practical alternatives for the delivery of primary care within a population context.
Abstract: Community-oriented primary care (COPC) is a model of health care delivery that tightly integrates primary care and public health. This model of care, applied around the globe, could be more widely adopted in the United States as clinical delivery systems respond to the growing demand for population health management, which has been driven largely by various provisions of the Affordable Care Act (ACA). For that purpose, there is need for changes in capacitating health professionals and changes in organizational structures that will address the needs and health priorities of the population, considering individual care management in the context of population health for a defined population. This article presents how the Affordable Care Act is an appropriate framework for COPC to succeed and the way forward to develop COPC through practical alternatives for the delivery of primary care within a population context.
TL;DR: The improvements between 2009 and 2013 demonstrate the measurable impact on maternal health outcomes of the program through local communities and primary health care services and show the importance of an integrated approach blending supply- and demand-side interventions.
Abstract: Background: Maternal health outcomes in Nigeria, the most populous African nation, are among the worst in the world, and urgent efforts to improve the situation are critical as the deadline (2015) ...
TL;DR: This study raises awareness of the low incidence of homeless adults receiving the influenza vaccination in Toronto and the data are concerning given the high risk of morbidity from communicable respiratory illnesses in this group.
Abstract: Objective: To determine the incidence of influenza vaccination among homeless individuals with mental illness in Toronto. Methods: A retrospective chart review was carried out using a random sample...
TL;DR: Encouraging patients’ involvement in religion and certain coping strategies, especially among those families coping with children with special health care needs, may improve life satisfaction.
Abstract: Background: Urban families face many challenges that affect life satisfaction, including low income, limited access to resources, and unstable neighborhoods. Purpose: To investigate life satisfaction and identify potential mediators: neighborhood stability, emotional coping strategies, religion, and spirituality. Methods: A convenience sample of families presenting to an urban primary care clinic for routine care filled out an anonymous, voluntary survey that included demographic data, the Satisfaction with Life Scale (SWLS), the Spiritual Inventory and Beliefs Scale, and an emotional coping inventory. Results: 127 individuals filled out the survey. Life satisfaction was high (21.3 ± 9). Families in the lowest quartile of the SWLS were 4.5 times as likely to have a child with a chronic medical illness. SWLS correlated with strategy planning (r = 0.24, P < .01), external practices of religion (r = 0.23, P < .01), and humility (r = 0.18, P < .05). Conclusions: Encouraging patients’ involvement in religion a...
TL;DR: The findings of this study can be used to inform future CHW program policy both in Mozambique and in other countries, as well as provide a set of incremental cost per output measures to be used in benchmarking to other CHW costing analyses.
Abstract: Introduction: Community health worker (CHW) programs are a key strategy for reducing mortality and morbidity. Despite this, there is a gap in the literature on the cost and cost-effectiveness of CH...
TL;DR: The collaboration between a clinical pharmacist and family physicians to develop aclinical pharmacist managed medication refill clinic decreased physician workload and improved patient care.
Abstract: Objective: To evaluate the impact of a clinical pharmacist managed medication refill clinic on physician workload. Methods: A retrospective case study was conducted for patients receiving refill au...
TL;DR: Interventions to increase IUD counseling should focus on improving PCPs’ competency around counseling and side effect management as well as increasing access to IUD inserters.
Abstract: Background: The intrauterine device (IUD) is a highly effective contraceptive, yet not all primary care providers (PCPs) counsel adolescents about IUDs. We sought to describe PCPs’ frequency of counseling adolescents about IUDs and identify whether different factors are associated with frequent counseling by pediatricians compared with family physicians and gynecologists. Methods: Surveyed PCPs affiliated with a Bronx, New York academic institution. Main Outcome: Frequent counseling of female adolescents about IUDs. Results: Frequent counseling was lower in pediatricians compared with family physicians and gynecologists (35.8% and 81.6%, respectively, P < .001). Among all PCP types, frequent counseling was associated with feeling more competent counseling and managing expected IUD side effects (P < .001). Other significant variables included inserting IUDs themselves (P < .001, family physicians and gynecologists) or having access to an inserter in their office (P = .04, pediatricians). Conclusions: Corre...
TL;DR: RHCs have limited capacity to respond to the opportunities and challenges of the ACA, and need additional resources and incentives to thrive in a reformed health care delivery system.
Abstract: Objective: To evaluate the capacity of rural health clinics (RHCs) in Iowa as the Affordable Care Act (ACA) is implemented. Methods: We developed and fielded an online survey among the 142 RHCs in ...
TL;DR: Findings suggest that participation in the HC course is an effective means for providers and staff to increase preparedness, self-efficacy, and actual use of health coaching skills.
Abstract: Background:The purpose of this study was to determine whether a health coaching (HC) course for providers and staff in Veterans Health Affairs medical facilities resulted in increased attitudes tow...
TL;DR: It is demonstrated that simply implementing BH screening in primary care may not result in improved outcomes for these children and simply accessing PSC data resulted in a trivial difference in BH concerns identified by physicians and did not affect physician responses.
Abstract: This pilot study investigated the effect of the Pediatric Symptom Checklist (PSC) on identification of and physician response to behavioral health (BH) concerns. Researchers reviewed 1211 charts of youth aged 4 to 16 years. Records were compared during baseline and an intervention consisting of implementation of the PSC to determine the rate of BH identification and pediatrician response. Access to PSC data resulted in a trivial difference in BH concerns identified by physicians and did not affect physician responses. This case study demonstrates that simply implementing BH screening in primary care may not result in improved outcomes for these children.
TL;DR: Most PCPs recommended healthy behaviors to their adult patients to prevent hypertension, and PCPs’ own healthy behaviors were associated with their recommendations.
Abstract: Background: Healthy behaviors, including maintaining an ideal body weight, eating a healthy diet, being physically active, limiting alcohol intake, and not smoking, can help prevent hypertension. T...
TL;DR: Missed opportunities abound during the entire influenza season, especially after December, and strategies targeting patients most likely to have MOs and encouraging the use standing orders, reminders, and monitoring in order to reduce them need to be sustained.
Abstract: Objective: Annual influenza vaccination rates remain well below health objectives. Most primary care clinic visits present opportunities for vaccination. The purpose of this study was to quantify missed opportunities (MOs) during the entire influenza season. Patients and clinic characteristics associated with vaccination and MOs are identified. Methods: Influenza vaccinations recorded in random chart reviews of children 6 months to 5 years and of adults 50 years and older at 6 pediatric and 7 adult primary care clinics were assessed during the 2010-2011 influenza season. Patient-specific MOs accounted for variable timing and number of visits throughout the vaccination season. Data were assessed using descriptive, graphical, proportional hazards regression methods. Results: Data for 1136 children and 1329 adults were analyzed. By the end of the season, influenza vaccination coverage recorded in medical records reached 56% and 26% for children and adults, respectively. MOs are common throughout the season a...
TL;DR: Implementing strategies to address the patient-identified system barriers (eg, time, transportation, and copays) may increase participation in diabetes group visits.
Abstract: Purpose: Through this exploratory study, we sought to understand why group visit participation is low among adult patients with type 2 diabetes. Methods: Eligible study participants included adult patients with type 2 diabetes. After a pilot survey was sent to a random sample of 48 patients, the remaining 187 eligible patients were invited to complete a revised version of the survey. Results: Most frequently cited reasons for not attending group visits included diabetes under control, work and/or other responsibilities, and time barriers. There was variability in the desired time for the visits, though the majority of patients preferred evening visits. While some patients reported copays as a challenge, the likelihood of attending did not decrease for this subgroup. Most patients surveyed (54%) indicated interest in diabetes group visits. Conclusion: Implementing strategies to address the patient-identified system barriers (eg, time, transportation, and copays) may increase participation in diabetes group...
TL;DR: In this paper, the authors presented a large-scale epidemiological study in developing regions of the world like rural Guatemala, using a sample size of 1104 subjects (552 females, all 18 years or old).
Abstract: Background: Hypertension (HT) epidemiological studies in developing regions of the world like rural Guatemala are lacking. Methods: A sample size of 1104 subjects (552 females, all 18 years or olde...
TL;DR: Overall, a majority of family physicians are using hospitalist services, and family physicians seem more likely to use hospitalists services when they are available which may lead to fragmentation of care.
Abstract: Background:The hospitalist movement in the United States has risen in prominence over the past 2 decades with more physicians practicing as hospitalists. Our objective was to examine different strategies used by family physicians when their patients require inpatient care. Methods: Secondary analysis of a cross-sectional survey of physicians accessing the American Board of Family Medicine Web site in 2011 and the 2011 Area Resource File. Logistic regression assessed for associations between using hospitalists, managing inpatients personally, or with a group partner, and then comparing and contrasting these physicians with health care market characteristics. Results: A total of 3857 physicians had data on practice characteristics and could be geocoded to their county of residence. Compared with other physicians meeting inclusion criteria in the American Board of Family Medicine database, our sample was slightly older and more likely to be female. In all, 54% of respondents reported using hospitalist servic...
TL;DR: Concern about common EMF sources is highly prevalent among German GPs, and CAM-GPs perceive stronger associations between EMF and health problems than COM-Gps.
Abstract: Objective: General practitioners (GPs) play a key role in consulting patients worried about health effects of electromagnetic fields (EMF). We compared GPs using conventional medicine (COM) with GP...
TL;DR: It is demonstrated that young Hispanic men develop diverticulitis and that this diagnosis needs to be considered when they present to emergency rooms with abdominal symptoms.
Abstract: Background: Colonic diverticulitis is relatively uncommon in young patients, especially those younger than 40 years. We compared demographic data, clinical presentation, management, and clinical co...