Journal of Primary Care and Community Health最新文献

Introduction: As males are less engaged with healthcare than females, they often present when a condition is more advanced, reducing the potential for early intervention. Little is known about why men are less engaged and what influences them to be more proactive. This study sought to explore men's experiences of engagement with general practice.

Methods: A qualitative descriptive study was nested within a sequential mixed-methods project. Semi-structured interviews were undertaken with 17 male staff and volunteers of the New South Wales Rural Fire Service about their experiences, attitudes, and preferences for general practice engagement. Thematic analysis was used to analyze data.

Results: Five sub-themes emerged about men's engagement with general practice. "Reasons for engagement" revealed motivations for seeking healthcare. "Seeking validation" explained how social influences impacted engagement. The "importance of relationships" highlighted the value men place on trust with the healthcare provider/team, and how this impacts engagement. "Interpersonal communication" addressed preferences for direct and authentic communication. Finally, "barriers to engagement" revealed the challenges in accessing care.

Conclusions: Awareness of the barriers and facilitators to men's engagement with general practice can inform strategies to improve care. This study suggests that health professionals play a crucial role in building therapeutic relationships with men and partnering with them in their healthcare journey to improve engagement and health outcomes.

Background: Cesarean delivery surgical quality indicators and outcomes support the surgical skills of family medicine physicians. These data have educational and clinical implications yet are largely unexplored. Our study updated cesarean surgical times, incision-to-delivery time, and neonatal Apgar scores from a midwestern family medicine residency program.

Methods: All cesarean deliveries performed by family medicine faculty from January 2012 to March 2021 were reviewed. Total surgical time, incision-to-delivery time, Apgar scores at 1 and 5 min, and maternal demographic information were recorded.

Results: 320 cesarean deliveries were reviewed. The average total surgical procedure time was 64.3 min (SD = 17.9) and incision-to-delivery time was 9.5 min (SD = 4.9). The average 1-min Apgar score was 7.5 (SD = 1.8) and the average 5-min Apgar score was 8.7 (SD = 1.0). There were no significant correlations between 1- and 5-min Apgar scores and procedure times.

Conclusion: Cesarean delivery quality indicators from family medicine faculty are updated and appear similar to those reported previously in studies that did not include the presence of learners. This EMR-based study provides baseline information for future surgical cesarean delivery quality improvement and outcomes research.

Introduction/objectives: As healthcare embraces telehealth, a need exists to understand factors that promote older adults' telehealth usage, including the influence of age-related sensory impairments. The objective of this study was to describe older adults' perceptions of telehealth and factors they considered before using telehealth within the framework of The Unified Theory of Acceptance and Use of Technology (UTAUT).

Methods: This descriptive qualitative study collected data through semi-structured interviews. Twenty-four older adults were randomly selected from a pool of 103 participants who completed the initial UTAUT survey study. Individual interviews were conducted by telephone. Reflective thematic analysis was used to identify themes within the UTAUT construct that influence older adults' use of telehealth.

Results: Older adults identified preparedness, receptiveness, and willingness to use telehealth as important overarching factors to consider when using telehealth. These are connected to the UTAUT constructs: facilitating conditions, social influence, effort expectancy, and performance expectancy.

Conclusions: This study supports UTAUT as an appropriate framework for assessing telehealth readiness and predicting behavioral intention to use telehealth. Our findings provide limited evidence that sensory impairments do not impact telehealth readiness unless the individual lacks appropriate adaptations.

Introduction: Parent training (PT) programs are recognized as effective interventions that enhance parenting techniques and improve the parent-child relationship. In Japan, these programs are increasingly implemented to help parents manage behavioral issues in children. This study evaluated the effectiveness of PT pamphlets designed and distributed in Shioya Town, Japan, by comparing outcomes between the intervention and control groups and within subgroups of parents, categorized based on their children's need for follow-up health checkups.

Methods: The study included an intervention group that received PT pamphlets during their 1.5-year health checkups and a control group that did not. Data were collected through self-administered questionnaires at the 3.5-year health checkups, assessing adherence to 3 recommended parenting techniques. The analysis focused on comparing intervention and control groups, evaluating adherence to 2 recommended parenting techniques versus one or none. The study also analyzed adherence to each recommended parenting technique within subgroups of parents whose children needed follow-up health checkups and those whose children did not.

Results: The study included 114 participants, with 55 in the intervention group and 59 in the control group. Analysis revealed that 29.1% of the intervention group adhered to 2 recommended parenting techniques, compared with 24.6% in the control group. However, no significant differences were observed between the intervention and control groups in adherence to 2 recommended techniques versus one or none, or to any single technique among the 3. Subgroup analyses revealed significant differences in adherence among parents whose children were identified to have developmental concerns at the 1.5-year health checkup and were required to have follow-up checkups, specifically in the "avoid immediate reactions" approach between intervention and control groups.

Conclusions: The PT pamphlets effectively increased adherence to recommended parenting techniques in the intervention group among children requiring follow-ups. This underscores the importance of culturally adapted PT programs and demonstrates the potential of simple educational interventions in improving parenting styles.

Introduction: Home care workers (HCWs) are paid caregivers who provide support to patients with chronic conditions and functional limitations. Additionally, they provide emotional support to patients and familial support. Although several qualitative studies have been conducted on HCWs, they focused more on studying prevalently the lived experiences about the workplace violence, the end of life, stressor and resilience, during the COVID-19 pandemic or focused more in dementia and heart failure, but not on feelings and working conditions.

Methods: The study was carried out using Cohen's phenomenological methodology. The subjects were enrolled in several cities of Central Italy and interviewed with open questions to allow them full freedom of expression and asked to describe their lived experience of HCWs who helped people with chronic diseases. Each interview was recorded audio and lasted between 20 and 60 min. Researchers involved in the analysis were independently immersed in the data by reading and rereading the transcripts to gain a sense of the entire data set. The extrapolation of the themes followed. The individual researchers compared the various extrapolated themes.

Results: Seventeen HCWs, all women, with a mean age of 54 years were enrolled in this study. All had more than a year (from 4 to 26 years) of experience in Italy, and almost the whole sample lived with the person they were assisting. Three themes were identified in the interviews: (1) feeling inadequate as a nurse, (2) feeling valued in this role, and (3) uncertain future. Feeling inadequate due to lack of training, difficulties related to the Italian language, or uncertainty about their future were topics identified by the HCWs.

Conclusions: Since HCWs represent an important resource which, if properly trained, could positively influence the quality of life of the elderly population and a valid support for their families, understanding the lived experience can suggest interventions that could be implemented by a health care professional and provide evidence to inform political decision makers to increase the support for HCWs.

Dermatofibrosarcoma protuberans (DFSP) is a rare slow-growing skin cancer with a great capacity for local destruction. DFSP can manifest in a myriad of ways. This case report aims to contribute to the literature by increasing awareness of this condition, along with common diagnostic practices and treatment regimens. We present a 52-year-old Filipino woman who was evaluated for dyspnea with an incidental finding of an indeterminate nodule on imaging. A comprehensive diagnostic workup confirmed dermatofibrosarcoma protuberans (DFSP), which was ultimately treated with surgical resection. Clinically, about 52% of patients are misdiagnosed, leading to poor outcomes. Therefore, awareness, early detection, multidisciplinary treatment, and lifelong screening are essential for optimal outcomes.

Objective: This study explores the associations between various sleep durations and metabolic health indices, including systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol levels, high-density lipoprotein (HDL) cholesterol, and waist circumference.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2021 to 2023, were analyzed. MANOVA and Bonferroni-adjusted ANOVAs were conducted to examine the relationships between sleep duration (sleep deprivation (≤5 h), short sleep (5-7 h), recommended sleep (7-9 h), and long sleep (>9 h)) and metabolic health indices.

Results: MANOVA revealed significant group differences between sleep duration and metabolic health indices, with Wilks' Lambda (Λ) = .98, F (3, 5095) = 4.26, P < .001. Compared to recommended sleep duration, both sleep deprivation and short sleep were associated with higher DBP (Ps < .01) and waist circumference (Ps < .001), and lower HDL levels (Ps < .05) Long sleep was associated with lower HDL levels (P < .01) and lower total cholesterol (P < .01).

Conclusion: The study highlights the detrimental associations of both sleep deprivation and short sleep with metabolic health, such as elevated blood pressure and waist circumference, and lowered HDL cholesterol. Long sleep may also negatively impact metabolic health by reducing HDL.

Objective: To estimate associations between transportation barriers and diabetes outcomes.

Methods: Longitudinal cohort study; 86 977 adults with type 2 diabetes mellitus in community-based health centers were assessed for transportation barriers, with up to 36 months of follow-up after initial assessment. We compared scenarios in which individuals did not experience transportation barriers to scenarios in which they did, to estimate differences in mean hemoglobin a1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and LDL cholesterol. For analysis, we used targeted minimum loss estimation at the following timepoints after initial transportation barrier assessment: 12 (primary), 6, 18, 24, 30, and 36 months. The study period was June 24, 2016 to April 30, 2023.

Results: We estimated that if participants did not experience transportation barriers, mean HbA1c would have been 0.09% lower (95% CI = -0.14% to -0.04%, P = .0002) at 12 months, compared to a scenario in which they did experience transportation barriers. These results were similar at other time points. We also estimated that absence of transportation barriers was associated with, at 12 months, lower SBP (-0.6mm Hg, 95% CI = -1.0mm Hg to -0.2mm Hg, P = .004) and DBP (-0.3mm Hg, 95% CI = -0.5mm Hg to -0.1mm Hg, P = .02), but not LDL (-1.1mg/dL, 95% CI = -2.6 mg/dL to 0.5 mg/dL, P = .19). Results at other time points for SBP, DBP, and LDL outcomes were similar.

Conclusions: Absence of transportation barriers was associated with slightly lower hemoglobin A1c and blood pressure, but the small magnitude of the differences suggests that also addressing other factors may be needed to improve diabetes outcomes more meaningfully.

Objective: This study evaluates whether gaining Medicaid following the Affordable Care Act (ACA) expansion led to changes in the rate of acute diabetes complications diagnosed in primary care settings, relative to in inpatient, emergency department (ED), or urgent care (UC) settings.

Methods: This retrospective cohort study used Medicaid administrative claims data linked to electronic health records for 3767 patients, aged 19 to 64 years, who experienced acute preventable complications of diabetes between 2014 and 2019 diagnosed in inpatient, ED, UC, or primary care settings in the state of Oregon. These patients were classified as either continuously Medicaid-insured or having gained Medicaid.

Results: Annual rates of acute complications diagnosed in primary care and inpatient/ED/UC settings increased for both continuously [Adjusted Rate Ratio (aRR) = 2.20, 95% CI = 1.65-2.91] and newly Medicaid-insured patients (aRR = 2.67, 95% CI = 2.05-3.47) after the ACA. Among newly Medicaid-insured, annual rates of abnormal blood glucose diagnosed in primary care settings significantly increased with time while those diagnosed in inpatient/ED/UC decreased (2014 vs 2016 aRR = 3.36, 95% CI = 1.60-7.09).

Conclusion: We found a significantly greater rate of abnormal blood glucose diagnosed in primary care clinics among patients who gained Medicaid post-ACA and a corresponding decline in diagnosis in inpatient/ED/UC settings.

Introduction: Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.

Methods: The Medical Expenditure Panel Survey data (2010-2021) were used to examine trends in the total number and share of ambulatory, preventive, acute, and chronic care visits and investigate sociodemographic factors associated with a given clinician visit. The outcome variable was the clinician type: Primary Care Physicians (PCPs), Internal Medicine (IM) subspecialists, and Nurse Practitioners or Physician Assistants or Registered Nurses (NP/PA/RNs). Explanatory variables included gender, age, race/ethnicity, education, region of respondent's residence, income-to-poverty ratio, insurance coverage, number of chronic conditions, and survey year. Univariate, bivariate, and multinomial logistic regression analyses were performed.

Results: The visits led by PCPs and IM subspecialists declined by 43% and 23% between 2010 and 2021, respectively. However, visits led by NP/PA/RNs increased by 98%. From 2010 to 2021, the proportion of preventive care visits provided by PCPs, IMs, and NP/PA/RNs increased by 25%, 7%, and 4%, respectively. PCPs provided fewer acute and chronic care visits in 2021 than in 2010. Regression analyses illustrated that relative to Non-Hispanic White patients, non-White patients had a higher likelihood of seeing PCPs. Patients reporting 1 chronic condition were more likely to obtain care from an IM or NP/PA/RN than a PCP. In contrast, those with 2 or more chronic conditions had a greater propensity to see PCP than NP/PA/RN.

Conclusion: Despite a growing need for primary care services, the decrease in visits to PCPs is concerning and requires further examination. The declining trends in acute and chronic care visits raise questions as to whether primary care, in its current form, can continue to provide its essential attributes and services.