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Showing papers in "Journal of Primary Care & Community Health in 2018"


Journal ArticleDOI
TL;DR: EHR data including patient and scheduling information predicted the missed appointments of underserved populations in urban CHCs, and the application of predictive modeling techniques helped prioritize the design and implementation of interventions that may improve efficiency in community health centers for more timely access to care.
Abstract: Objectives: Using predictive modeling techniques, we developed and compared appointment no-show prediction models to better understand appointment adherence in underserved populations. Methods and ...

51 citations


Journal ArticleDOI
TL;DR: While self-report of hearing loss is an easy and time-efficient screening method to use at primary health care clinics, its accuracy may be limited when used in isolation and it may not be sufficiently sensitive to detect hearing loss.
Abstract: Objective: To evaluate the performance of self-reported hearing loss alone and in combination with pure tone audiometry screening in primary health care clinics in South Africa. Design: Nonprobabil...

30 citations


Journal ArticleDOI
TL;DR: Correct measurement of BP is affected by a wide range of factors and is challenging to accomplish consistently in primary care, and the findings may inform the design of performance improvement programs to maximize the quality of BP measurement in the outpatient setting.
Abstract: Background: Despite the high prevalence of blood pressure (BP) measurement errors in the outpatient setting, little is known about why primary care clinics struggle to achieve consistently accurate...

24 citations


Journal ArticleDOI
TL;DR: Patients’ experience of care in primary care as it pertained to the nursing role was evaluated to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients’Experience of care is better.
Abstract: Purpose: Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients’ experience of care in primary care as it pertai...

17 citations


Journal ArticleDOI
TL;DR: A variety of barriers limited pharmacists’ ability to adequately respond to the magnitude of this disaster, and a paucity of data exists on both the pharmacist and patient factors, which may contribute to an effective immediate response to patient needs at the community pharmacy following a natural disaster.
Abstract: One year ago, Hurricane Maria passed over the archipelago of Puerto Rico, leaving widespread disruption of nearly all human services, including the health care sector. In the aftermath of the hurricane, limited access to medical care and prescription medications presented a serious challenge to maintaining control of preexisting chronic diseases. Many patients did not have access to refrigeration for heat-sensitive medications. Significant dietary changes due to the limited availability of shelf-stable foods further exacerbated chronic conditions such as heart failure and diabetes. The role of community pharmacists following a natural disaster has previously been documented, and may include the triage of evacuees, assessment of immunization needs, and provision of prescription medications under a collaborative practice agreement. However, our experience in Puerto Rico demonstrated a variety of barriers limited pharmacists' ability to adequately respond to the magnitude of this disaster. These included medication shortages, extended loss of power, and limited telecommunications for contacting prescribers, disaster relief agencies, and third-party payers. Ultimately, the lack of preexisting emergency protocols made overcoming such barriers difficult. As the first and sometimes only accessible health care provider to many patients following a natural disaster, we must build a solid evidence base and better understanding of the individual, interpersonal, and environmental factors that contribute to the community pharmacist response. To date, however, a paucity of data exists on both the pharmacist and patient factors, which may contribute to an effective immediate response to patient needs at the community pharmacy following a natural disaster. Future research must focus on these multi-level factors to better inform public policy and effective disaster planning. Ultimately, such research and planning will lead to increased resiliency in our primary health care systems in the face of future disasters.

14 citations


Journal ArticleDOI
TL;DR: Research into neighborhood effects on SMI-T2D comorbidity is still in its infancy and the available evidence inconclusive, which points to an urgent need for attention to the knowledge gap in this important area of public health.
Abstract: Aim of the Study: This review aims to systematically synthesize the body of literature examining the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI)–typ...

10 citations


Journal ArticleDOI
TL;DR: Out of the 3 clusters, the presence of a cluster B PD diagnosis was most significantly associated with poorer depression outcomes at 6-month follow-up, including reduced remission rates and increased risk for PDS.
Abstract: Background: Previous studies have suggested that having a comorbid personality disorder (PD) along with major depression is associated with poorer depression outcomes relative to those without como...

8 citations


Journal ArticleDOI
TL;DR: In this study, giving birth at health facilities did not make immediate newborn care practices universal, but unhealthy practices were more common among home births, and more efforts to promote community-based immediately newborn care are needed with great emphasis to proper thermal care.
Abstract: BACKGROUND Globally, there has been progress in reducing maternal and under-5 child deaths in the past 2 decades; however, the progress in reducing newborn mortality has been slower with estimated 3 million neonatal deaths per year. In Ethiopia, unhealthy newborn care is common at home deliveries compared with institutional births that might be associated with neonatal deaths. The purpose of the current study was to assess the practices of immediate newborn care at home and institutional deliveries in rural Sidama Zone, 2017. METHODS A population-based cross-sectional survey was used. The study was conducted in 5 districts of Sidama Zone, from January 21 to February 4, 2017. A total of 2300 mothers who gave live births in the past 6 months were selected using a 2-stage cluster sampling methods. Data were entered, cleaned, and recoded using Epi Data and SPSS for analysis. Accordingly, descriptive and bivariate analyses were done, and the results are presented using P values. RESULTS The response rate was 99% (2279/2300). About one-third of the mothers are in the age group of 20 to 24 years, and 94.6% of them had at least 1 antenatal care follow-up. Most (72%) mothers delivered at health facilities. The practices of skin to skin care of the babies was 52% (61% at health facilities, 28% at home; P < .002). Baby bathing delay for at least 24 hours was 78% and clean cord care was 73% overall (home 21% vs health institution 93.6%). The cord was not tied in 11.6% of cases all of whom were home births ( P < .001). As to immediate breastfeeding of the child, most (78%) of the babies were put to the breast within an hour of birth with no significant difference between the 2 places of births ( P = .75). CONCLUSION In this study, giving birth at health facilities did not make immediate newborn care practices universal, but unhealthy practices were more common among home births. Therefore, more efforts to promote community-based immediate newborn care are needed with great emphasis to proper thermal care.

8 citations


Journal ArticleDOI
TL;DR: The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations.
Abstract: Objective: We set out to investigate the behaviors of low-income African American women who successfully lost weight. Methods: From an urban, academic, family medicine practice, we used a mixed met...

7 citations


Journal ArticleDOI
TL;DR: Centralized waiting lists seem to be used by early career physicians to build up their patient panels, however, because of the large number of them participating in the centralized waiting lists, physicians with more experience and those practicing in traditional models of primary care might be of interest for future measures to decrease the number of patients waiting for attachment in centralized waiting list.
Abstract: Purpose: In response to more than 15% of Canadians not having a family physician, 7 provinces have implemented centralized waiting lists for unattached patients. The aim of this study is to analyze...

7 citations


Journal ArticleDOI
TL;DR: The study demonstrates that the health education by the pharmacists produce significant outcomes of the ASCVD risk, smoking status, and QoL of physical and social function particularly in the younger group.
Abstract: Background: Evidence from previous studies demonstrates that lifestyle modification reduces the incidence and complications of atherosclerotic cardiovascular disease. The study aimed to investigate...

Journal ArticleDOI
TL;DR: It is suggested that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to theprimary care provider.
Abstract: Objectives: The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry re...

Journal ArticleDOI
TL;DR: Federal health care facilities in an administrative area of the Indian Health Service conducted a review to identify and address gaps in HCV treatment, indicating that rural clinics can be successful providing HCV diagnosis and treatment.
Abstract: Background: American Indian/Alaska Natives (AI/ANs) are disproportionately affected by hepatitis C virus (HCV), with more than double the national rate of HCV-related mortality as well as the highe...

Journal ArticleDOI
TL;DR: In patients with comorbid MDD and PD, clinical outcomes at 6 months were significantly improved when treated with CCM compared with UC, which supports the idea that CCM is an effective model for caring for patients with behavioral concerns, and it may be of even greater benefit for those patients being treated forComorbid behavioral health conditions.
Abstract: Background: The use of a collaborative care management (CCM) model can dramatically improve short- and long-term treatment outcomes for patients with major depressive disorder (MDD). Patients with ...

Journal ArticleDOI
TL;DR: For occupational therapy to reach its potential in Norwegian community-based health care, the profession needs to establish itself more firmly and increase its influence within the health care services.
Abstract: Aim: This study aimed to assess the perceived influence that community-working occupational therapists in Norway have on the service goals of their respective organizations. In addition, we aimed t...

Journal ArticleDOI
TL;DR: Patients and physicians in a linguistically and culturally diverse urban safety-net primary care clinic were highly satisfied with the use of telephone visits, though completion of the visits was low.
Abstract: BACKGROUND Telephone consultation is widely used in primary care and can provide an effective and efficient alternative for the in-person visit. Gouverneur Health, a safety-net primary care practice in New York City serving a predominately immigrant population, evaluated the feasibility and physician and patient acceptability of a telephone visit initiative in 2015. MEASURES Patient and physician surveys, and physician focus groups. RESULTS Though only 85 of 270 scheduled telephone visits (31%) were completed, 84% of patients reported being highly satisfied with their telephone visit. Half of physicians opted to participate in the pilot. Among participating physicians, all reported they were able to communicate adequately and safely care for patients over the telephone. CONCLUSIONS Participating patients and physicians in a linguistically and culturally diverse urban safety-net primary care clinic were highly satisfied with the use of telephone visits, though completion of the visits was low. Lessons learned from this implementation can be used to expand access and provision of high-quality primary care to other vulnerable populations.

Journal ArticleDOI
TL;DR: It is important for clinicians to discuss with their patients the pharmacologic options available for VTE prophylaxis, how organizations differ in their recommendations, and the limitations of these pharmacologic agents.
Abstract: A 62-year-old Caucasian man with past medical history significant for coronary artery disease, status post drug eluting stent to the left anterior descending artery 10 years prior, was admitted for elective total right knee arthroplasty. His intraoperative course was uneventful, and he was discharged on hospital day 2 on aspirin 325 mg twice daily for 6 weeks for venous thromboembolism (VTE) prophylaxis. Three weeks later the patient developed chest pain shortly after an approximately 1-hour flight and presented to a local emergency department where computed tomography angiogram showed pulmonary emboli involving segmental and subsegmental pulmonary arteries bilaterally. He was transitioned from aspirin 325 mg twice a day to rivaroxaban 15 mg twice daily for 21 days, with a plan to transition to 20 mg daily to complete a 3-month course. He returned to his primary care physician 6 days after discharge with questions about his current anticoagulation therapy as well as the regimen he was on prior to the pulmonary embolism. Two major organizations, The American Academy of Orthopedic Surgeons and The American College of Chest Physicians, provide recommendations for VTE prophylaxis, but they differ regarding the preferred pharmacologic modality and duration. Although the goal is to provide optimal patient care, lack of guideline consensus may lead to different postoperative recommendations. It is important for clinicians to discuss with their patients the pharmacologic options available for VTE prophylaxis, how organizations differ in their recommendations, and the limitations of these pharmacologic agents.

Journal ArticleDOI
TL;DR: A team-based care training program based on the AHRQ TeamSTEPPS framework is implemented in 6 primary care practices affiliated with a Primary Care Practice Based Research Network to increase communication and performance of the care teams.
Abstract: Background: One of the key factors of the patient-centered medical home (PCMH) transformation require shifting mental models at the individual level and culture change at the practice level on how ...

Journal ArticleDOI
TL;DR: It is proposed that implementing ASCVD risk tools in decision aids could contribute to referring those most in need of cardiology care, as there is no evidence to indicate excessive referral to cardiology in patients with chest pain.
Abstract: Background: The atherosclerotic cardiovascular disease (ASCVD) 10-year risk estimate is recommended by cardiologists for determining risk of a cardiac event. However, the majority of patients prese...

Journal ArticleDOI
TL;DR: The course of a patient with advanced RCC is presented, from initial presentation through workup and to eventual diagnosis, which features late-onset symptoms, extensive paraneoplastic phenomena, and significant physical examination findings.
Abstract: Renal cell carcinoma (RCC) accounts for approximately 80% of all primary renal neoplasms in United States causing approximately 65 000 new cases of RCC and 14 000 deaths each year Symptoms of RCC typically include weight loss and night sweats but may also feature paraneoplastic phenomena in advanced stages as well as flank pain, gross hematuria, scrotal varicocele, inferior vena cava pathology, and a palpable abdominal mass In this article, we present the course of a patient with advanced RCC, from initial presentation through workup and to eventual diagnosis The case features late-onset symptoms, extensive paraneoplastic phenomena, and significant physical examination findings We also review the literature available on RCC and critically analyze inefficiencies of the workup retrospectively

Journal ArticleDOI
TL;DR: Predictors of difficulty accessing care in the event that the VA facility that homeless VA patients routinely use is forced to close because of a natural disaster are examined to suggest that Medicaid coverage has the potential to facilitate access to care for homeless veterans during disasters.
Abstract: Introduction: Since 1970, natural disasters have led to both temporary and permanent closures of multiple medical centers and outpatient clinics at the US Department of Veterans Affairs (VA) nation...