Journal of Primary Care and Community Health最新文献

Introduction: Colorectal cancer (CRC) screening rates remain low in the US. Previous research has indicated that primary care providers are trusted sources for healthcare recommendations, including cancer screening.

Methods: CRC module questions within the 2022 BRFSS were reviewed and multivariable logistic regression was used to explore the relationship between healthcare engagement and likelihood of CRC screening.

Results: Results showed that those with the highest level of healthcare seeking behavior were almost 10 times as likely to receive appropriate CRC screening compared to the lowest engagement group. In a multivariable logistic regression, this relationship remained with higher healthcare engagement having an odds ratio of 5.951 compared to low engagement.

Discussion: This study indicates seeing a regular healthcare provider in the past year is associated with increased CRC screening. These results confirmed he role that marriage/partnership plays in cancer screening in the US which should be an intervention area considered. This study re-emphasized that there remain racial/ethnic disparities in CRC screening with almost all groups receiving less CRC screening compared to White, non-Hispanic respondents.

Conclusion: This research re-emphasizes the critical role that primary care providers play in the landscape of patient care and specifically identifies these settings as key for intervening to increase uptake of CRC screening recommendations.

Purpose: Hypertension (HTN) disproportionately affects marginalized communities due to persistent healthcare disparities and socioeconomic barriers. Less than half of patients with HTN achieve blood pressure (BP) control, with Black Americans on antihypertensive medication experiencing lower rates of BP control (34.9%) compared to non-Hispanic Whites (45.0%). This pilot study evaluates the effectiveness of a telephone outreach intervention designed to improve BP control through self-management in a historically underserved population.

Major findings: This single-cohort, pre-post intervention study was conducted at a Federally Qualified Health Center (FQHC). Patients with severe hypertension were identified and contacted by trained student ambassadors (SAs). These SAs provided hypertension-specific health education, health goal-setting, guidance for self-monitoring blood pressure, and referrals to address health-related social needs (HRSN). During in-person classes, patients were educated on BP self-monitoring and goal setting regarding healthy lifestyle practices. Results from this study showed a reduction in SBP and DBP among engaged patients and improved hypertension knowledge.

Conclusion: These findings suggest that telephone outreach, when combined with skill-based in-person education, can improve hypertension control in Black American populations.

Background: Loneliness is increasingly recognized as a major determinant of health rather than a transient emotional experience. Extensive evidence links chronic loneliness to adverse physical and mental health outcomes and increased healthcare utilization. Despite growing policy attention, loneliness remains inconsistently identified and addressed in healthcare systems, particularly in primary care, where other social determinants of health are increasingly screened.

Objective: This narrative synthesis aims to advance a biopsychosocial reframing of loneliness as a "vital sign" to reflect a clinically relevant, measurable, and actionable health metric that can be feasibly integrated into primary care workflows to inform whole-person care, risk stratification, and referral pathways.

Methods: A literature search of interdisciplinary peer-reviewed manuscripts published between 2010 and 2025 across public health, psychology, gerontology, and translational health sciences. Included sources encompassed epidemiological studies, mechanistic research, and implementation science literature examining loneliness screening and integration within real-world clinical workflows.

Results: Results are presented thematically to reflect the manuscript's objective of reframing loneliness as a clinically actionable vital sign. Findings are organized to reflect evidence supporting loneliness as a biopsychosocial health risk; feasibility and validity of brief loneliness screening tools in primary care; and implementation determinants influencing adoption, sustainability, and equity, aligning empirical evidence. Synthesized evidence demonstrates that loneliness influences health through interconnected biopsychosocial pathways shaped by structural inequities and marginalization across the life course. Brief, validated screening tools are feasible for use in time-constrained primary care settings, particularly when embedded into existing workflows. Implementation evidence indicates that electronic health record prompts, brief clinician training, and clear referral pathways enhance feasibility and acceptability, while clinician emotional labor, time pressures, and organizational readiness are key determinants of sustainability.

Conclusions: Conceptualizing loneliness as a vital sign offers a translational pathway to normalize assessment, reduce stigma, and integrate social connection into biopsychosocial models of care. Theory-informed implementation strategies are essential to support adoption, equity, and long-term maintenance. This reframing positions primary care as a critical site for early identification and intervention and underscores the central role of health, clinical, and community psychology in advancing whole-person, socially responsive healthcare.

Purpose: To evaluate the impact of clinical pharmacist interventions on HbA1c and adherence to diabetes preventative screenings among Spanish-speaking adults with uncontrolled type 2 diabetes.

Methods: This retrospective evaluation of a quality improvement initiative included Spanish-speaking adults with baseline HbA1c of 8% or greater who received at least 1 clinical pharmacist visit at a Federally Qualified Health Center. Outcomes included changes in glycemic control and timely preventive care screenings (diabetic eye exam, diabetic foot exam, urine albumin-to-creatinine ratio [UACR] test, and statin use), analyzed using logistical regression and McNemar's test.

Results: Among 70 included patients, the mean age was 55.6 years, with 65.7% of patients identifying as female and 62.9% having Medicaid insurance. The baseline mean HbA1c was 11.0%. Within 12 months, 40 patients achieved HbA1c <8% (Cochran's Q₅ = 142.88, P < .0001). Gender and insurance status were significant predictors of success. The odds of a timely diabetic eye exams (odds ratio [OR]: 8.67, 95% confidence interval [CI]: 2.66-44.74, P < .0001), foot exams (P < .0001), and UACR tests (OR: 4.80, 95% CI: 1.80-16.11, P = .0008) increased.

Conclusion: Spanish-speaking patients exposed to clinical pharmacist care observed significant improvements in glycemic control and timely preventative care screening.

Financial incentives are a promising strategy to promote physical activity. While randomized trials in Western countries have demonstrated short-term effectiveness, evidence from non-Western settings remains limited. This rapid review synthesized evidence from Japan on financial incentive-based interventions considering both individual-level behavioral responses and their use as policy tools implemented by administrative organizations. A systematic search of 4 databases (CiNii Articles, PubMed, Google Scholar, and Ichushi Web) was conducted between May and June 2025, covering English and Japanese studies. Intervention characteristics were described using the TIDieR checklist and step count changes were extracted. Where necessary, healthcare cost savings and return on investment (ROI) were also estimated. Fourteen studies (11 peer-reviewed and 3 gray literature) were included. Most interventions used redeemable points or gift certificates as incentives, with daily values ranging from ¥11 to ¥100. On average, interventions increased daily step counts by 997 steps and reduced annual medical expenditures by ¥28 425, yielding an average ROI of 5.67. Effects were consistent across population subgroups and incentive types. Only 1 study reported post-intervention sustainability, which concluded that step increases were not maintained after receiving the incentive. Low-cost financial incentives have the potential to increase physical activity and reduce healthcare costs in Japan. Further long-term and cost-effectiveness studies are warranted to support sustainable health policy design.

Introduction: Carcinoembryonic antigen (CEA) is a blood biomarker with significance in cancer monitoring and prognosis prediction. Despite not being a primary diagnostic tumor marker, it is frequently measured in clinical practice and health check-ups in primary care services, often prompting extensive investigations due to its non-specific nature. This study investigated the integration of CEA levels with a clinical risk scoring system to enhance cancer prediction in individuals with elevated CEA.

Methods: We retrospectively reviewed records, focusing on people who participated in general health check-up programs. Participants with elevated CEA levels (≥5 ng/mL) and no previous cancer diagnosis were selected. A multivariable logistic regression model was employed to establish the risk scoring system, which was then evaluated using Receiver Operating Characteristic (ROC) analysis.

Results: Among 17 859 participants, 310 had elevated CEA levels, with 7.40% subsequently diagnosed with cancer, primarily colorectal cancer. Combining the clinical risk scoring system with CEA levels significantly improved cancer prediction, with an Area under the ROC curve of 0.918, compared to 0.825 for CEA levels alone.

Conclusion: CEA, alongside clinical risk prediction, shows promise in predicting cancer among individuals with high CEA levels. This integrated approach can optimize early cancer detection strategies and improve patient outcomes.

Introduction: E-cigarette use has become increasingly prevalent among adolescents and young adults.

Objective: This study aimed to identify determinants associated with successful e-cigarette cessation among secondary school students.

Setting: Study was conducted at the secondary schools in northern Thailand.

Methods: A cross-sectional study was conducted among 277 secondary school students in Thailand, aged 12 to 25 years. Participants completed a self-administered electronic questionnaire assessing sociodemographic characteristics, academic performance, age of initiation, exposure to e-cigarette use in the environment (defined as having 1 or more e-cigarette users among family, relatives, or friends), perceived risks, and attitudes toward e-cigarettes (the higher score indicates risky attitudes toward e-cigarettes). The outcome was successful cessation, defined as being a former e-cigarette user (no use in the past 12 months among ever-users). Multiple logistic regression analyses were used to explore the factors associated with successful e-cigarette quitting. The gender subgroup analysis was performed.

Results: Of 277 participants, 114 (41.2%) were former users and 163 (58.8%) were current users. The absence of e-cigarette users in the environment (aOR 0.38, 95% CI 0.22-0.67, P = .001) and risky attitudes toward e-cigarettes (aOR 0.79, 95% CI 0.72-0.88, P < .001) were independently associated with cessation. Subgroup analysis confirmed the importance of attitudes for both males and females, while environmental exposure was significant among females.

Conclusion: Successful cessation among secondary school students was strongly associated with less risky attitudes toward e-cigarettes and the absence of e-cigarette users in the peer and family environment. Interventions should target both individual attitude and environmental factors to improve quit rates. Therefore, interventions should focus on correcting attitudes regarding the social image, stress relief, and socialization aspects of e-cigarettes, while simultaneously engaging families and peers to create a vape-free environment.

Background: A healthy lifestyle can slow the progression of chronic conditions and improve quality of life. Lifestyle counseling in Dutch general practices can be further optimized, among other factors by improving collaboration with social work services. To achieve this, it is important to map out the system of lifestyle counseling within and between general practices and social work services, as well as to identify opportunities for improvement.

Methods: Semi-structured individual interviews were conducted with 3 general practitioners (GPs) and 6 practice nurses (PNs), as well as 5 group interviews with in total 15 professionals from social work services. Participants were based in the city of Nijmegen, the Netherlands. The interviews were conducted between March and August 2024. A thematic analysis was performed which resulted in themes and subthemes. Hereafter, the interviews were re-read to examine relationships between subthemes. The themes, subthemes, and relationships formed the basis for developing a causal loop diagram (CLD) and identifying areas for improvement. The CLD was subsequently reviewed through a member check with the same professions.

Results: The system of lifestyle counseling within and between general practices and social work services consists of the following main themes; addressing lifestyle within general practices, referral to social work services from general practices, GP/PNs' overview and knowledge about social work services, contact between GP/PNs and social work services, and patient status exchange between GP/PNs and social work services. These main themes include interrelated variables which facilitate or impede referrals from general practices to social work services, which is illustrated by the CLD. For example, the more patient status information is shared, the better the GP/PNs' understanding of the available social work services.

Conclusion: The CLD illustrates multiple factors that influence the system of lifestyle counseling in and between general practices and social work services. The CLD, together with the improvement points identified in the interviews, leads to actionable strategies to enhance collaboration between general practices and social work services. These strategies include increasing GP/PNs' understanding of the role and activities of social work services, exchange information, as well as strengthening mutual familiarity and facilitating personal contact between professionals in both domains.

Introduction: To combat persistent health and social disparities, the VA Greater Los Angeles and its community partners piloted a novel vocational rehabilitation program that employed persons who have experienced homelessness (PEHs) as app-based food deliverers. The program focused on removing barriers to employment, providing subsidized electronic bicycles for deliveries and personal use; "priority status" as deliverers; and access to financial literacy coaching. We aimed to characterize program experiences, with a lens toward program scale-up.

Methods: We conducted semi-structured interviews with a convenience sample of 6 participants and 5 vocational rehabilitation staff. Interviews explored motivations to participate (among participants), and program strengths/challenges. Data were analyzed using rapid qualitative methods.

Results: PEHs reported high motivation to participate due to the e-bike and flexible scheduling of work duties. Interviewees reported positive program impacts including: financial relief; reduced transportation barriers; and improved mental health. Suggesting for improvement included enhanced technical support (with the app and e-bike); improved communication among program partners; and more individualized employment opportunities.

Conclusions: These data suggest the value of this novel vocational rehabilitation model for PEHs. Specific recommendations for program scale-up include a centralized platform for participant technical support requests; and regular communication and data sharing agreements between implementation partners.

Background: Global Initiative for Asthma (GINA) has recommended inhaled corticosteroid (ICS)-Formoterol as Track-1 treatment for patients. Using ICS and SABA (Short-Acting Beta-Agonist) as a reliever is an alternative Track-2 option. Both modalities are tied to type of inhaler use, dry powder inhalers (DPI) and propellent-containing metered-dose inhalers (pMDI). Compared to propellent-free DPI, pMDI have much higher carbon footprint (CF) detrimental to the environment. Leveraging on dispensed inhaler data from the electronic medical records of patients managed in primary care, the study aimed to quantify their CF using Budesonide-Formoterol (BUD-FOR) DPI alone, compared to those who were treated with BUD-FOR DPI + pMDI as a reliever.

Methods: Electronic medical records from 8 public primary care clinics were analysed, covering adult asthma patients (aged ≥21) between 2018 and 2023. Data on inhaler dispensing, asthma control test (ACT) scores and rescue therapy (RT) needs were assessed. CF was computed based on inhaler canisters dispensed. Associations between treatment modality, asthma control, RT and CF were analysed using Generalized Estimating Equations.

Results: A total of 5634 patients using BUD-FOR DPI were included. Over the study period, Track-1 usage increased substantially from 466 to 2317 patients, while Track-2 rose modestly from 628 to 758. In 2023, 78.5% of patients achieved good asthma control compared to 68.7% in Track-2. The total CF per patient was substantially lower in Track-1 compared to Track-2 (3.3 vs 62.4 kgCO₂e). Patients in Track-1 had a significantly lower CF by 60 kgCO₂e (P < .001), had 1.5 times higher odds to achieve good asthma control based on ACT scores (P < .001) and had approximately 30% lower odds of receiving RT (P < .001). The average number of SABA-pMDI canisters dispensed per patient declined from 2.8 to 2.1 over the study period. BUD/FOR inhalers use per patient per year was consistently higher in Track 2 compared to Track 1, with an average difference of 1.2 canisters (5.3 vs 4.1).

Conclusion: Patients managed under Track-1 treatment approach demonstrated significantly better asthma outcomes and lower CF. These findings highlight potential of Track-1 treatment as the preferred strategy, enabling better clinical outcomes and reduced environmental impact.