Showing papers in "Journal of Primary Care & Community Health in 2016"
TL;DR: Burnout is highly associated with adverse work conditions and a greater intention to leave the practice, but not with adverse patient outcomes, and care quality appears to be preserved at great personal cost to primary care physicians.
Abstract: Objective: To assess relationships between primary care work conditions, physician burnout, quality of care, and medical errors. Methods: Cross-sectional and longitudinal analyses of data from the MEMO (Minimizing Error, Maximizing Outcome) Study. Two surveys of 422 family physicians and general internists, administered 1 year apart, queried physician job satisfaction, stress and burnout, organizational culture, and intent to leave within 2 years. A chart audit of 1795 of their adult patients with diabetes and/or hypertension assessed care quality and medical errors. Key Results: Women physicians were almost twice as likely as men to report burnout (36% vs 19%, P < .001). Burned out clinicians reported less satisfaction (P < .001), more job stress (P < .001), more time pressure during visits (P < .01), more chaotic work conditions (P < .001), and less work control (P < .001). Their workplaces were less likely to emphasize work-life balance (P < .001) and they noted more intent to leave the practice (56% v...
157 citations
TL;DR: Patients with chronic lung disease frequently meet Fried’s criteria for frailty and gait speed can be used to screen these patients to determine if a more detailed evaluation is needed.
Abstract: Objectives: To determine the prevalence of frailty in patients with chronic lung diseases. Methods: We studied 120 patients with chronic lung disease using Fried’s criteria (gait speed, weight loss...
49 citations
TL;DR: Common characteristics include prioritized vulnerable populations, extensive community collaboration, team approaches that included the patient and family, diversified funding streams, and data-driven approaches and practices.
Abstract: Objective: Despite barriers, organizations with varying characteristics have achieved full integration of primary care services with providers and services that identify, treat, and manage those wi...
39 citations
TL;DR: Routine mental health screening should be a part of the overall comprehensive health assessment provided to refugees nationwide, and considerations should be taken in regards to how refugees from Iraq have even greater risk of mental health disorders compared to other refugee groups.
Abstract: Background and Purpose: Refugees resettling to the United States are at increased risk for mental health disorders, which can lead to difficulty with adaptation and poor health outcomes. Standardized mental health screening of refugees is often neglected at primary care and community health clinics. A pilot project aimed to initiate early mental health screening for newly resettled adult refugees was implemented at a community health center in Fargo, North Dakota. Methods: Current refugee screening processes were evaluated to determine appropriate timing for refugee mental health screening. This took into consideration time, staffing, interpreter availability and the refugee “honeymoon” phase following resettlement. The Refugee Health Screener–15 (RHS-15) was identified as an efficient, valid, and reliable tool for assessing emotional distress in this population and was integrated into refugee health screening practices. Results: The RHS-15 was administered to 178 adult refugees with arrival dates between...
37 citations
TL;DR: Several race/ethnicity categories were significantly associated with missed appointment rates, including Hispanic/Latino patients, American Indian/Alaskan Native patients, and Black/African American patients, as compared with White non-Hispanic patients.
Abstract: Missed appointments have been linked to adverse outcomes known to affect racial/ethnic minorities. However, the association of missed appointments with race/ethnicity has not been determined. We sought to determine the relationships between race/ethnicity and missed appointments by performing a cross-sectional study of 161 350 patients in a safety net health system. Several race/ethnicity categories were significantly associated with missed appointment rates, including Hispanic/Latino patients, American Indian/Alaskan Native patients, and Black/African American patients, as compared with White non-Hispanic patients. Other significant predictors included Mexico as country of origin, medical complexity, and major mental illness. We recommend additional research to determine which interventions best reduce missed appointments for minority populations in order to improve the care of vulnerable patients.
33 citations
TL;DR: DILI was not significantly associated with known risk factors in the authors' settings and Associations of different risk factors were insignificant; including chronic alcohol consumption, hepatitis B infection, hepatitis C infection, HIV infection, and existing chronic TB.
Abstract: Background: Antituberculosis (ATT) drug-induced liver injury (DILI) is a common and serious adverse effect of tuberculosis (TB) treatment. This retrospective study was carried out to study the prevalence of DILI among patients who had received anti-TB medications and to study some of the known risk factors responsible for causing DILI. Materials and Methods: This longitudinal descriptive study was performed to evaluate cases of DILI with predefined criteria. Patients of all ages, diagnosed and treated for smear positive pulmonary TB from January 1, 2008 to December 31, 2012 and those who came for regular follow-up were included in the study. Multiple logistic regression analysis was performed to determine the association of different risk factors and DILI. The confounders considered were age, sex, weight, body mass index, doses of drugs (fixed or per kg), ATT regimens (daily or intermittent), and treatment categories. Results: Of the 253 patients analyzed, 24 (9.48%) developed DILI. Associations of differ...
25 citations
TL;DR: The findings demonstrate the effectiveness of a team-based approach to blood pressure management in a busy, primary care setting and can provide a framework for implementation of team- based care for hypertension in the patient-centered medical home.
Abstract: Objective: Hypertension is the most common condition seen in primary care, occurring in 1 in 3 adults in the United States. The patient-centered medical home provides an opportunity for proactive, ...
24 citations
TL;DR: There is a clear difference between considering the importance of recognizing signs of PPD and acting on it, however screening in pediatric facilities is considered by many to be optimal.
Abstract: Objectives: This study surveyed Israeli primary care physicians’ attitudes and practice regarding postpartum depression (PPD). Methods: Participants included 224 pediatricians and family practition...
24 citations
TL;DR: Investigation of Medicare Part B claims data for a national sample of direct patient care physicians in 2006 and 2011 found trends in physician home visits and domiciliary care visits as well as physician characteristics associated with providing these services are increasing.
Abstract: Objectives: Home visits have been shown to improve quality of care and lower medical costs for complex elderly patients. We investigated trends in physician home visits and domiciliary care visits ...
22 citations
TL;DR: The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable, shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed.
Abstract: Purpose: The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia. Methods: The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared. Results: Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores show...
20 citations
TL;DR: There is a need for LARC counseling and education strategies, particularly for young women from diverse cultural backgrounds and those with less sexual experience, to influence adolescents’ utilization of these methods.
Abstract: Background: A key strategy to reduce unintended adolescent pregnancies is to expand access to long-acting reversible contraceptive (LARC) methods, including intrauterine devices and subdermal contr...
TL;DR: As LARC is highly effective in preventing unplanned pregnancies in adolescents, incomplete or inaccurate information on the Internet present a barrier to promoting its utilization in this at-risk population.
Abstract: Background:Long-acting reversible contraception (LARC) is safe, effective, and recommended as first-line contraception for adolescents. Despite clear medical recommendations, the type and quality o...
TL;DR: There was no statistical difference in improvement of healthy habits, BMI, or physical activity in the intervention group compared with the control group, and the 5-2-1-0 intervention used in this study was feasible.
Abstract: Background: Pediatric obesity is a significant public health problem with a prevalence of 16.9% among US children. School-based obesity interventions show promise for reducing adiposity in elementa...
TL;DR: People who received information about stopping smoking before surgery post-SSBS implementation were more likely than expected to have reduced their smoking and had a significantly higher Awareness of Smoking-Related Perioperative Complications score.
Abstract: Objective: This study aimed to examine the impact of a Stop Smoking Before Surgery (SSBS) program in a health authority where responsibility for surgical services is shared by health professionals ...
TL;DR: HPV knowledge improved over time, but the educational intervention utilized in this study was not successful in improving attitudes and beliefs about co-testing and longer screening intervals, and Beliefs about HPV co- testing and 3-year screening intervals were less favorable.
Abstract: Introduction: Women have been reluctant to adopt longer than annual intervals for cervical cancer screening, despite guidelines recommending screening every 3 to 5 years. Our study assessed patient...
TL;DR: Parents who provide good infant oral health care are more likely to perceive they provide good care and more likelyto have better personal dental health behaviors, which agrees with previous studies concerning older children.
Abstract: Introduction: Parents have an important role ensuring their infants receive oral and medical health care. Their decisions affect the well-being of their children. Methods: This study used data coll...
TL;DR: There is insufficient evidence to determine a pattern of breast density knowledge and awareness in women, and more quality studies are needed that focus on how well women understand the relationship between breast density, breast cancer risk, and breast cancer screening, especially in diverse populations.
Abstract: Objectives: We reviewed the literature on breast density knowledge and breast density awareness to explore what challenges are faced by this area of research. Method: A review of PubMED, PsycINFO, ...
TL;DR: Among homeless-experienced Veterans, permanent supported housing may reduce disparities in the treatment of diagnoses commonly seen in ambulatory care.
Abstract: Purpose: Little is known about how permanent supported housing influences ambulatory care received by homeless persons. To fill this gap, we compared diagnoses treated in VA Greater Los Angeles (VAGLA) ambulatory care between Veterans who are formerly homeless—now housed/case managed through VA Supported Housing (“VASH Veterans”)—and currently homeless. Methods: We performed secondary database analyses of homeless-experienced Veterans (n = 3631) with VAGLA ambulatory care use from October 1, 2010 to September 30, 2011. We compared diagnoses treated—adjusting for demographics and need characteristics in regression analyses—between VASH Veterans (n = 1904) and currently homeless Veterans (n = 1727). Results: On average, considering 26 studied diagnoses, VASH (vs currently homeless) Veterans received care for more (P < .05) diagnoses (mean = 2.9/1.7). Adjusting for demographics and need characteristics, VASH Veterans were more likely (P < .05) than currently homeless Veterans to receive treatment for diagnos...
TL;DR: Overall, the interventions had positive effects and attrition was quite low, and peer-facilitated interventions appear to enhance medication adherence as well as other healthful behaviors, such as exercise.
Abstract: Background: Difficulty taking essential medications as prescribed is a prevalent problem among people living with chronic diseases. Numerous interventions to enhance medication adherence have been developed; the majority facilitated by health care professionals. Objective: This review examined medication adherence interventions delivered by peers (ie, lay individuals living with the same chronic disease) and reports what is known about the impact of peer-facilitated interventions. Data Sources: PubMed, CINAHL, Google Scholar, Google, and PsychInfo, and ancestry searches. Study Selection: Solely peers delivered the intervention and follow-up occurred for at least 24 weeks postintervention. Electronic databases were searched from their start date to December 31, 2014. Results: Eleven studies were located that reported 10 different interventions focused on 6 chronic disease conditions. Most interventions were delivered in clinical settings and grounded in a theoretical framework. Formats were evenly split be...
TL;DR: Patients with co-occurring chronicMedical conditions and mental health disorders have higher rates of acute care utilization compared with patients with chronic medical conditions alone, and Improving access to mental health care at the primary care clinic may have a positive impact on utilization.
Abstract: Objectives: Patients with coexisting mental health disorder and chronic disease are more at risk for poor outcomes, including increased acute care utilization. This study was performed to assess th...
TL;DR: There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan, and knowledge of fasting practices during Ramadan was variable.
Abstract: There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan.
TL;DR: When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care, and opportunities still exist for more aggressive management of depression in patients to help improve remission as well as reduce persistent depressive symptoms.
Abstract: Posttraumatic stress disorder (PTSD) has symptoms that exist along a spectrum that includes depression and the 2 disorders may coexist. Collaborative care management (CCM) has been successfully used in outpatient mental health management (especially depression and anxiety) with favorable outcomes. Despite this, there exist limited data on clinical impact of a diagnosis of PTSD on depression outcomes in CCM. The present study used a retrospective cohort design to examine the association of PTSD with depression outcomes among 2121 adult patients involved in CCM in a primary care setting. Using standardized self-report measures, baseline depression scores and 6-month outcome scores were evaluated. Seventy-six patients had a diagnosis of PTSD documented in their electronic medical record. Patients with PTSD reported more severe depressive symptoms at baseline (Patient Health Questionnaire-9 score of 17.9 vs 15.4, P < .001) than those without PTSD. Controlling for sociodemographic and clinical characteristics, a clinical diagnosis of PTSD was associated with lower odds (AOR = 0.457, CI = 0.274-0.760, P = .003) of remission at 6 months and was also associated with higher odds (AOR = 3.112, CI = 1.921-5.041, P < .001) of persistent depressive symptoms at 6 months after CCM. When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms.
TL;DR: The impact of an 8-week community program implemented by trained volunteers on the hypertension self-management of 185 patients who were batch randomized to intervention or wait-list control groups is described.
Abstract: This article describes the impact of an 8-week community program implemented by trained volunteers on the hypertension self-management of 185 patients who were batch randomized to intervention or wait-list control groups. Compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P < .001), practicing healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, η2 = .036, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005, η(2) = .094. Enduring lifestyle changes necessary for chronic disease self-management require that psychosocial determinants of health behavior are instilled, which is typically beyond standard medical practice. We recommend peer-led, community-based programs as a complement to clinical care and support the increasing health system interest in promoting population health beyond clinical walls.
TL;DR: A modest investment in care coordination and clinical pharmacy review can produce significant reductions in hospitalization and harmful polypharmacy for community dwelling dual eligible patients.
Abstract: Background: Dual eligible persons are those covered by both Medicare and Medicaid. There were 9.6 million dual eligible persons in the United States and 82 000 in West Virginia in 2010. Dual eligib...
TL;DR: A large number of patients in urban primary care settings screened positive for insomnia and screened high risk for sleep apnea and the presence of chronic pain was associated with clinically significant insomnia.
Abstract: Introduction: Sleep disorders affect up to 1 in 4 adults and can adversely affect a variety of health conditions. However, little is known about detection of sleep disorders in ethnically diverse u...
TL;DR: For primary care setting in urban area, the SMBP resulted in lower BP in the older persons with hypertension at 12 months, and among those aged <60 years, SMBP did not perform better than the usual care group.
Abstract: Objective: To examine the effectiveness of self-monitoring blood pressure (SMBP) in a randomized controlled trial with 12 months of follow-up in a community hospital. Methods: A total of 224 eligib...
TL;DR: Targeting theory-based psychosocial changes within a structured after-school care physical activity program was associated with increases in children’s overall time being physically active.
Abstract: Introduction: Volume of moderate-to-vigorous physical activity completed during the elementary school day is insufficient, and associated with health risks. Improvements in theory-based psychosocial factors might facilitate increased out-of-school physical activity. Methods: A behaviorally based after-school care protocol, Youth Fit 4 Life, was tested for its association with increased voluntary, out-of-school physical activity and improvements in its theory-based psychosocial predictors in 9- to 12-year-olds. Results: Increases over 12 weeks in out-of-school physical activity, and improvements in self-regulation for physical activity, exercise self-efficacy, and mood, were significantly greater in the Youth Fit 4 Life group (n = 88) when contrasted with a typical care control group (n = 57). Changes in the 3 psychosocial variables significantly mediated the group–physical activity change relationship (R2 = .31, P < .001). Change in self-regulation was a significant independent mediator, and had a recipro...
TL;DR: Primary care clinics can successfully increase HCV screening in a relatively short time period and age based screening recommendation may provide opportunities to increase communication with others at risk for HCV.
Abstract: Background: In August 2012, the Centers for Disease Control and Prevention released recommendations to screen persons born from 1945 to 1965 for hepatitis C virus (HCV). In September 2012, Warm Spr...
TL;DR: The findings of this study do not support use of eNO as a biomarker of inflammation in diagnosis and management of COPD.
Abstract: Background: Chronic obstructive pulmonary disease (COPD), a progressive and nonreversible disease, is a leading cause of mortality and morbidity throughout the world. Because airway inflammation is...
TL;DR: The use of CHWs through churches as an existing community structure for promoting preventive health behaviors, specifically rotavirus vaccine uptake in Zambia is explored, showing churches can be effective channels for delivering health prevention strategies to often difficult-to-reach rural populations.
Abstract: Introduction: Rural populations, particularly in Africa, suffer worse health outcomes from poor health services access. Community health workers (CHWs) effectively improve health outcomes, but the best means for CHWs reaching rural populations is unknown. Since Zambia is predominantly Christian, this study explored the use of CHWs through churches as an existing community structure for promoting preventive health behaviors, specifically rotavirus vaccine uptake. Methods: A noncontrolled cross-sectional study of 32 churches receiving a packaged intervention of diarrhea prevention and treatment messaging was conducted with repeated time points of data collection over 13 months (2013-2014) in the Kafue District of Zambia. Two churches were selected for each of the 17 catchment areas, and CHWs were identified and trained in the intervention of promoting 4 key messages related to diarrhea prevention and treatment: hand washing with soap, exclusive breast-feeding, rotavirus vaccination, and treating diarrhea wi...