The Permanente journal最新文献

Background: Food insecurity (FI) is the most common health-related social need (HRSN) and is frequently identified in primary care through screening and referral. However, health care workers often do not have the knowledge, motivation, capability, or opportunity necessary to discuss FI with patients in patient-centered ways.

Methods: An educational module for health care workers on FI was created using user-centered design and tested with health care workers, using the COM-B model as an evaluation framework.

Results: Watching the module's video increased participant knowledge, capability, and motivation to address FI with patients.

Discussion: This preliminary pilot study suggests that simple training modules could help with the effectiveness of efforts to address HRSNs, such as FI, by increasing health care workers' capacity to discuss, screen, and refer patients. Findings warrant expanded studies to assess the effectiveness of such modules on patient-level outcomes.

Conclusion: This type of educational module on FI or other HRSNs holds promise as a time- and cost-efficient strategy for improving screening and referral processes, ultimately alleviating FI for more patients and improving health outcomes.

Background: Screening for adverse childhood experiences (ACEs) and resilience in pregnancy is a promising practice for mitigating ACEs-related health complications. Yet, the best follow-up for pregnant patients with high ACEs and/or low resilience has not been established.

Objective: This study evaluates referrals to and participation in an embedded health psychologist (EHP) intervention for pregnant patients with ACEs and/or low resilience.

Materials and methods: Patients in 3 Kaiser Permanente Northern California medical centers with ACEs who had also received resilience screening during standard prenatal care and who were participating in an EHP intervention were included (N = 910). The authors used multivariable logistic regression to examine whether ACEs (0, 1-2, 3+) and resilience (high vs low) were associated with referrals to and participation in EHP intervention. They also evaluated the impact of EHP intervention through clinician (N = 53) and patient (N = 51) surveys.

Results: Patients with 3+ vs 0 ACEs were more likely to receive an EHP referral (adjusted odds ratio [aOR] = 2.89, 95% confidence interval [CI]: 1.93-4.33) and were more likely to participate in EHP intervention (aOR = 2.85, 95% CI: 1.87-4.36). Those with low vs high resilience were also more likely to receive an EHP referral (aOR = 1.86, 95% CI: 1.32-2.62) and participate in EHP (aOR = 1.71, 95% CI: 1.19-2.44). When ACEs and resilience were combined, those with high ACEs and low resilience had the greatest odds of referrals and participation. Patients and clinicians reported positive experiences with EHP intervention.

Conclusion: Patients with higher ACEs and lower resilience scores were more likely to be referred to and participate in EHP intervention, suggesting that at-risk patients can be successfully linked with a health psychologist when accessible within obstetric care.

Introduction: Rapid identification of individuals developing a psychotic spectrum disorder (PSD) is crucial because untreated psychosis is associated with poor outcomes and decreased treatment response. Lack of recognition of early psychotic symptoms often delays diagnosis, further worsening these outcomes.

Methods: The proposed study is a cross-sectional, retrospective analysis of electronic health record data including clinician documentation and patient-clinician secure messages for patients aged 15-29 years with ≥ 1 primary care encounter between 2017 and 2019 within 2 Kaiser Permanente regions. Patients with new-onset PSD will be distinguished from those without a diagnosis if they have ≥ 1 PSD diagnosis within 12 months following the primary care encounter. The prediction model will be trained using a trisourced natural language processing feature extraction design and validated both within each region separately and in a modified combined sample.

Discussion: This proposed model leverages the strengths of the large volume of patient-specific data from an integrated electronic health record with natural language processing to identify patients at elevated chance of developing a PSD. This project carries the potential to reduce the duration of untreated psychosis and thereby improve long-term patient outcomes.

Background: There has been substantial development of shared decision-making (SDM) methods and approaches in the past few decades, but despite this, building capability and scaling application of SDM in clinical practice remains a challenge. Here the authors describe the development and initial experience with a new virtual Practical Approach continuing education program for busy practicing clinicians who care for people with complex, chronic, and costly conditions who are frequently faced with preference-sensitive decisions. This program was designed to provide plain language training in SDM for real-world clinical practice using an easy 4-step approach that does not require prior training or formal education in SDM theory or methods.

Methods: The authors describe the development of the Practical Approach program using established evidence-based principles. The program was piloted in 4 different settings across 2 chronic conditions. Qualitative interviews of program participants were conducted to observe SDM attitudes and observed performance in repeated case-based simulation role-play exercises to assess knowledge and skills performance.

Results: The authors observed improved and more realistic SDM attitudes in qualitative interviews with program participants after exposure to the program compared to baseline, and they similarly observed improved knowledge and skills demonstrated in sequential simulations conducted as participants were exposed to the program. Post-program focus groups revealed that participants perceived the program to be feasible, acceptable, and useful.

Conclusions: Initial experience with the Practical Approach program suggests that it may beneficially affect basic SDM knowledge, skills, and attitudes in busy practicing clinicians who are novices in SDM. It also has demonstrated initial feasibility, utility, and acceptability.

Digital health tools can improve health care access and outcomes for individuals with limited access to health care, particularly those residing in rural areas. This scoping review examines the existing literature on using digital tools in patients with limited access to health care in rural areas. It assesses their effectiveness in improving health outcomes. The review adopts a comprehensive search strategy to identify relevant studies from electronic databases, and the selected studies are analyzed descriptively. The findings highlight the advantages and barriers of digital health interventions in rural populations. The advantages include increased access to health care practitioners through teleconsultations, improved health care outcomes through remote monitoring, better disease management through mobile health applications and wearable devices, and enhanced access to specialized care and preventive programs. However, limited internet connectivity and a lack of familiarity with digital tools are barriers that must be addressed to ensure equitable access to digital health interventions in rural areas. Overall, digital tools improve health outcomes for individuals with limited health care access in rural areas.