Journal of Primary Care and Community Health最新文献

Background: In the state of Maharashtra in India, a pilgrimage called "Pandharpur Wari" attracts half a million pilgrims annually. Orthodox Hindu culture is generally resistant to allowing women to participate in religious functions during their menstruation. With a significant female presence, ensuring adequate Water Sanitation and Hygiene (WASH) facilities and Menstrual Health and Hygiene (MHH) is crucial. Due to scant reliable quantitative data, a qualitative study was conducted to investigate first-hand accounts of experiences of WASH facilities and MHH practices of women pilgrims during 2023 pilgrimage.

Methods: This study employed a qualitative design with convenience sampling, selecting 100 women pilgrims (aged 18-45 years) from the pilgrimage across 3 sites. Data were collected through semi-structured interviews. Descriptive and thematic analyses were conducted to examine experiences, challenges, and suggestions.

Results: Over half (53%) were aged 32 to 41 years while (18%) were between 22 and 31 years. Most had studied up to secondary level (77%) and were married (95%). Thirty-four percent were farmers and a few had some other day job (7%). A large majority (97%) faced difficulties accessing toilets and bathing facilities, with some resorting to open defecation (36%). About (2%) used oral contraceptive to delay periods and (7%) experienced menstruation during pilgrimage. Lack of facilities for bathing and toilets along the pilgrimage route was one prominent challenge. Other challenges were, needing to bathe in the open, lack of gender-segregated facilities, and scanty sanitary facilities along the route. Women were found to be resilient in managing menstruation amidst systemic gaps. It was also found that cultural beliefs shaped pilgrimage participation while in menses and how it was hard to manage menstruation during pilgrimage without adequate infrastructure.

Conclusion: The pilgrimage poses logistical, sanitation challenges for the pilgrims. Strategic planning, including mobile toilets, private bathing, menstrual hygiene support can improve the experience.

In this Commentary, we provide an in-depth look at the National Academies of Sciences, Engineering, and Medicine (NASEM) report, "Making Eye Health a Population Health Imperative Vision for Tomorrow (2016)," which emphasizes the need for the integration of vision and eye care into more holistic healthcare delivery approaches, since many individuals who are visually impaired have disproportionately high rates of chronic co-morbidities. We have highlighted current barriers as well as a coordinated approach and methodology to improve team-based care in the United States to reduce eye and vision health disparities, particularly through the delivery model of community health centers; however, the model might be applied in other countries.

Acquired angioedema due to C1-inhibitor deficiency (AAE-C1INH) is a rare condition characterized by the localized swelling of the deeper skin layers and mucous membranes, especially the face, lips, tongue, throat, and gastrointestinal tract. AAE-C1INH is strongly associated with lymphoproliferative disorders, although it can also be linked to autoimmune conditions, solid tumors, infections, or even occur without an identifiable cause. We present the case of a 45-year-old female patient with complaints of recurrent abdominal pain, bloating, and joint swelling. Laboratory testing showed decreased C1q and C4 complement levels, and C1 esterase inhibitor levels, indicative of AAE-C1INH. Further work up confirmed a diagnosis of extranodal marginal zone lymphoma with involvement of the bone marrow and spleen. Treatment with rituximab led to resolution of angioedema symptoms and almost complete remission of underlying lymphoma. This case underscores the importance of evaluating an underlying lymphoproliferative disorder in AAE-C1INH. Therefore, the early participation of a multidisciplinary team including specialists in immunology, hematology, and oncology is necessary for appropriate management.

Objective: Evaluate healthcare providers' and staffs' knowledge, self-reported abilities, activities, and barriers to providing preventive oral health services (POHS) at primary care medical visits before and after participation in the Rocky Mountain Network of Oral Health (RoMoNOH) project.

Methods: The RoMoNOH project integrated POHS into primary care medical visits of young children at 22 community health centers (CHCs) in Arizona, Colorado, Montana, and Wyoming by medical team members and/or by embedded dental hygienists (DHs). Twelve CHCs embedded DHs onto their teams. In an observational pre/post evaluation, a convenience sample of healthcare providers' characteristics were surveyed at baseline and 3 years across 4 oral health domains: knowledge, self-reported abilities, behaviors, and barriers. Each domain was scored from 0% to 100%, with 100% being optimal. Differences between pre- and post-project domain scores were assessed using chi-square, t-tests, and linear and logistic regression adjusting for providers' age.

Results: Embedding DHs into CHCs and staff turnover impacted pre/post survey participants. The final analytic cohort included 213 (pre-survey response rate: 71%) and 165 (post-survey response rate: 52%) healthcare providers who worked with children < age 3. Participants were female (pre: 81%, post: 81%) and aged >35 years (pre: 39%, post: 41%). Unadjusted mean differences across surveys improved across all oral health domains (pre/post): knowledge: 65%/81%, P < .001; self-reported ability: 52%/71%, P < .001; activities: 32%/57%, P < .001; barriers: 27%/21%, P = .011. After adjustment for age, these improvements remained significant (all P ≤ .011).

Conclusions: Healthcare providers' oral health practices improved over a multi-year oral health integration project aimed at increasing delivery of POHS at medical visits.

Objective: The objective of our retrospective study was to evaluate differences between screening methods (oral administration versus written self-report) for adolescent depression in an outpatient settingStudy Design:We analyzed data from 4075 well-child check (WCC) visits from adolescents (ages 12-18 years) at an academic medical center from January 2022 through December 2023. We evaluated the outcomes of depression screening questions from both those asked by staff (oral administration) and those filled out on paper by the patient (written self-report). A composite score of 3 or greater (out of 6) indicates a positive screen for depression. Logistic regression was used to assess for the likelihood of discrepancy between scores.

Results: Of the 4518 WCC visits analyzed, 3380 (75%) had completed data for both the orally administered and the written screenings. The scores were equal in 2563 (76%) visits; the written score was greater in 766 (22.6%) visits and the oral score was greater in 51 (1.5%) visits. The screen was positive for depression in 232 (6.8%) visits for the written self-report compared with 66 (2.0%) from the oral administration. Logistic regression analyses showed likelihood of score differences were higher in older age, female gender, Hispanic race/ethnicity, and those with public insurance.

Conclusion: This preliminary pilot study shows that there are score differences in depression screening when administered orally by staff versus self-reported in writing, and scores may be higher on the written self-report screening. Limitations of this study include slight differences in the wording of the questions and lack of rigorous protocol guidelines.

Introduction/objective: We qualitatively assessed current practices and perceived barriers surrounding the integration of tobacco dependence treatment (TDT) into lung cancer screening (LCS).

Methods: Informed by the Practical, Robust Implementation and Sustainability Model, we conducted semi-structured interviews with clinicians (n = 18) at 6 Veterans Affairs medical centers in the Midwest.

Results: TDT was usually addressed at an initial shared decision-making visit but often not with subsequent rounds of screening or nodule follow-up. No site was aware that any TDT-related outcomes were tracked within their program. While the LCS clinical reminders included some aspects of tobacco use (eg, tobacco pack-years), they did not support clinicians in offering TDT or capture outcomes and were perceived as "checkboxes to nowhere." This was contrasted with other clinical reminders linked to dashboards that provide rolling feedback for important clinical outcomes (eg, diabetes care). Interviewees reported competing demands and limited expertise in motivational interventions as additional barriers. A dedicated team for TDT and a "one-click referral" were perceived as key success factors.

Conclusions: TDT remains poorly integrated into LCS. Addressing identified barriers will require considerable investment in TDT resources and improvements to LCS tools to support the provision of cessation support.

Introduction: The COVID-19 pandemic accelerated telehealth adoption, but disparities in its utilization persist. This study examines primary care patient sociodemographic characteristics, telehealth utilization patterns, and provider adoptions before and during the pandemic.

Methods: A retrospective cohort study analyzed data from Mississippi Medicare beneficiaries continuously enrolled in Parts A, B, and D who accessed primary care services from 2019 to 2021.

Results: Among 201 677 Medicare beneficiaries accessing primary care, 1364 used telehealth before the pandemic, compared to 73 994 during the pandemic. Telehealth utilization shifted during the pandemic to younger, female, White beneficiaries, and those enrolled in Medicare due to disability or End Stage Renal Disease. During the pandemic, telehealth users exhibited higher Charlson Comorbidity Index and Social Vulnerability Index but lower Digital Divide Index scores compared to non-telehealth users. Telehealth was associated with more primary care visits, broader access, and higher continuity of care. Primary care physicians increased their share of telehealth services to 39%, while specialties such as neuropsychiatry and psychiatry showed the highest adoption rates, reaching 55% and 38%, respectively.

Conclusions: Telehealth demonstrated a growing role in primary care during the pandemic. Future efforts must address digital divides and advance health equity when integrating telehealth into primary care services.

Introduction: The Primary Health Care approach emphasizes service integration and interprofessional (IP) collaboration, recognizing teamwork as an essential component. Despite the evidence being in favor of the application of teamwork, its adoption in primary care (PC) systems remains difficult. In Italy, a recent national policy supports the strengthening of IP teamwork in the "House of Community"-HoC (a model of Community Health Centers), but its implementation needs further evaluation. This study examines how IP teamwork has developed within a HoC in an Italian neighborhood, focusing on its transition toward a more structured collaborative practice and examining the perceptions and experiences of PC professionals.

Methods: Nine semi-structured interviews and 2 focus-groups were conducted with PC professionals from different PC services. Then, an analytical model was proposed. Data were analyzed using both deductive and inductive approaches.

Results: Four main themes emerged: rethinking of traditional roles and scopes of practices, leadership/management skills and time/space, IP initiatives, and early perceptions. Based on these findings, an analytical model of teamwork evolution identified 3 interconnected key areas: resource, process, and context.

Conclusion: The integration of an IP teamwork into the broader healthcare structure can enhance the promotion of a cohesive and collaborative organization, while also recognizing and dealing with its challenges.

Background: Previous publications have demonstrated the benefits of pharmacist involvement in hypertension management, including in rural health care settings. Unlike many of the previous studies that evaluated pharmacist interventions occurring in collaboration with physicians, this study uniquely assessed the impact of pharmacist-led interventions under a collaborative practice agreement (CPA) on hypertension outcomes in a rural, medically underserved federally qualified health center (FQHC) in the southeastern U.S.

Objectives: To evaluate the effectiveness of direct pharmacist intervention under a CPA compared to physician-only standard care in achieving blood pressure (BP) control. Secondary outcomes included all-cause hospitalization rates and adherence to antihypertensive medications.

Methods: This retrospective, single-center observational study included adult patients with hypertension seen by either a clinical pharmacist or a primary care provider over a 3-month period. Primary outcomes were the proportion of patients reaching target systolic and/or diastolic BP and the median time in days to control. Secondary outcomes included all-cause hospitalizations and changes in antihypertensive medication adherence, measured by proportion of days covered (PDC).

Results: Among 159 patients, those managed by pharmacists achieved significantly faster BP control (SBP: 49 days vs 182 days, P < .0001; DBP: 146 days vs 160 days, P = .0061). Combined SBP/DBP control was also achieved more quickly (160 days, P < .0001), despite higher initial BP levels. Notably, 0% of patients in the pharmacist group were hospitalized, compared to 10% in the physician-only group (P = .0065). Medication adherence improved, with average PDC rising from 72.5% to 80.2%, and 70.4% of patients reaching ≥80% adherence by study end.

Conclusions: Pharmacist-led hypertension management under a CPA significantly improves BP control, time to goal, medication adherence, and reduces hospitalizations compared to physician-only care in a rural, underserved FQHC setting.

Introduction: Early recognition of ischemic heart disease (IHD) is important, yet, delays still occur due to low symptom recognition. Accessible information may improve symptom recognition, however, it is unclear how information should be provided to reach different populations. Hence, we studied health information seeking behavior (HISB) and preferences, in ethnically-diverse women and men in the Netherlands.

Methods: We conducted 31 patients interviews, seven key figure interviews and one focus group with key figures (community leaders and physicians), and eight focus groups with non-patients (N = 44) about HISB and health information preferences. We thematically analyzed the data using inductive coding.

Results: We found minimal variation in HISB, as most patients did not seek information about symptoms. Participants required information about cardiac symptoms, risk factors, when to seek care, prevention, and navigating the Dutch healthcare system. Several information provision strategies emerged, with preferences varying somewhat across ethnic groups and age groups. Ethnic minority participants described a preference for culturally-sensitive community-based live information provision. Other strategies included media, social media, and native Dutch participants mentioned public spaces and healthcare settings.

Conclusion: HISB was limited in this ethnically-diverse population. Different strategies may be employed to promote symptom recognition, particularly co-created culturally-sensitive interventions.